Abstract
Objective: To conduct a detailed epidemiological exploration of the relative contributions of cannabis and ethnicity to US atrial septal defect (ASD) rates (ASDR). Study design: State-based ASDR data from the US National Births Defects Prevention Network, substance use, income and ethnicity data analyzed in RStudio. Results: Ethnic effects were significant with relative risks amongst African Americans and American Indians and Alaskan Natives of 2·40 (95%C.I. 2·27, 2·54) and 2·31 (2·19, 21·43), Cohen’s D of 1·44 and 1·46 and P values of 2·94 × 10−168 and 3·01 × 10−172 compared to others, respectively. In general, additive models inclusion of ethnicity:cannabinoid and ethnicity:tobacco interactions were significant down to P=zero for cannabis, Δ9THC and cannabidiol. Sequentially doubly robust targeted multiple likelihood estimations confirmed epidemiologically causal relationships under standard assumptions. ASDR amongst Asians and Pacific Islanders in Nevada showed an exponential doubling time of 2.83 years. Conclusions: Cannabinoid and cannabinoid:ethnicity interactions drive ASDR and meet epidemiological causal criteria.
Keywords
cannabis, cannabinoids, atrial septal defect, congenital heart defects, ethnicity, epidemiology
Document Type
Journal Article
Date of Publication
1-1-2026
ISSN
07438346
Publication Title
Journal of Perinatology
Publisher
Nature
School
School of Medical and Health Sciences
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Reece, A. S., & Hulse, G. K. (2026). Cannabinoid impacts on ethnic modulation of atrial septal defect prevalence USA. Journal of Perinatology. Advance online publication. https://doi.org/10.1038/s41372-026-02717-7