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Cannabis advice occurring at prenatal care visits in the United States, 2017–2021

Journal of Perinatology volume 45, pages 1302–1304 (2025)Cite this article

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With the proliferation of state-level cannabis legalization for adult use, increasing prevalence of cannabis use before, during, and after pregnancy is a growing perinatal issue of concern [1]. Conflicting federal and state cannabis policies may complicate interpretation of clinical guidelines about cannabis use during pregnancy and lactation. Current American College of Obstetricians and Gynecologists (ACOG) recommendations include the following: pregnant women be asked about cannabis use, encouraged to discontinue recreational and medicinal use, counseled about potential adverse health outcomes of continued use, and advised against cannabis use while breastfeeding [2]. Further, guidance states that obstetrician-gynecologists should be discouraged from prescribing or recommending cannabis use during pregnancy and lactation [2]. There is, however, there is little evidence about cannabis communication received at prenatal care visits in the U.S. [3] and fidelity to current guidelines is unknown. Recent evidence has found prenatal healthcare providers are unfamiliar with contemporary evidence of adverse health effects of cannabis use during pregnancy [4], often leading to limited communication about cannabis use during pregnancy. Importantly, patients interpret a lack of healthcare provider counseling about cannabis use as perceived safety of the drug and likely, leads to increased rates of cannabis use during pregnancy [4, 5]. Changing cannabis policies, in combination with contemporary evidence on adverse health outcomes of in utero cannabis exposure, including preterm birth, small for gestational age infants, and increased NICU admission [6], underscore the need to examine cannabis screening and advice occurring during prenatal care visits. Therefore, we examined the cannabis advice, recommendations, and extent to which communication received at prenatal care visits adhered to current ACOG guidelines for cannabis use during pregnancy and variations in advice and adherence over time.

This repeated, cross-sectional study used surveillance system data from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) and Marijuana Supplement [7]. Survey respondents are asked whether a health care provider, nurse, or clinician at any prenatal care visit asked them about cannabis use, advised them not to use cannabis while pregnant, recommended they use cannabis, or advised them not to use cannabis while breastfeeding (Supplement). The Towson University IRB determined this study exempt.

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References

  1. Skelton KR, Hecht AA, Benjamin-Neelon SE. Association of recreational cannabis legalization with maternal cannabis use in the preconception, prenatal, and postpartum periods. JAMA Netw Open. 2021;4:e210138.

    Article  PubMed  PubMed Central  Google Scholar 

  2. American College of Obstetricians and Gynecologists Comittee on Obstetric Practice. Committee opinion no. 722: marijuana use during pregnancy and lactation. Obstet Gynecol. 2017;130:e205.

    Article  Google Scholar 

  3. Skelton KR, Nyarko S, Benjamin-Neelon SE. Maternal report of cannabis screening and recommendations during prenatal care visits in the United States. Am J Obstet Gynecol. 2023;229:464–6.e2.

    Article  PubMed  Google Scholar 

  4. Kitsantas P, Pursell SR. Are health care providers caring for pregnant and postpartum women ready to confront the perinatal cannabis use challenge? Am J Perinatol. 2024;41:e3249–54.

    Article  PubMed  Google Scholar 

  5. Bayrampour H, Zahradnik M, Lisonkova S, Janssen P. Women’s perspectives about cannabis use during pregnancy and the postpartum period: an integrative review. Prev Med. 2019;119:17–23.

    Article  PubMed  Google Scholar 

  6. Marchand G, Masoud A, Govindan M, Ware K, King A, Ruther S, et al. Birth outcomes of neonates exposed to marijuana in utero: a systematic review and meta-analysis. JAMA Netw Open. 2022;5:e2145653-e2145653.

  7. Shulman HB, D’Angelo DV, Harrison L, Smith RA, Warner L. The pregnancy risk assessment monitoring system (PRAMS): overview of design and methodology. Am J Public Health. 2018;108:1305–13.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Holland CL, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM, et al. Obstetric health care providers’ counseling responses to pregnant patient disclosures of marijuana use. Obstet Gynecol. 2016;127:681.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jarlenski M, Tarr JA, Holland CL, Farrell D, Chang JC. Pregnant women’s access to information about perinatal marijuana use: a qualitative study. Womens Health Issues. 2016;26:452–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Young-Wolff KC, Sarovar V, Tucker L-Y, Avalos LA, Alexeeff S, Conway A, et al. Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009–2016. Drug Alcohol Depend. 2019;196:66–70.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank the PRAMS Working Group, which includes the PRAMS Team, Division of Reproductive Health, CDC and the following PRAMS sites for their role in conducting PRAMS surveillance and allowing the use of their data: PRAMS Alaska, PRAMS Illinois, PRAMS Maine, PRAMS North Dakota, PRAMS New Jersey, PRAMS New Mexico, PRAMS New York, PRAMS Pennsylvania, PRAMS Virginia, PRAMS West Virginia.

Funding

The Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) provided financial support for this study. The award provided 100% of total costs and totaled $118,943.00. The contents are those of the author. They may not reflect the policies of HRSA, HHS, or the U.S. Government.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Kara R. Skelton & Sara E. Benjamin-Neelon

  2. Department of Nursing, Towson University, Towson, MD, USA

    Stacey Iobst

Authors
  1. Kara R. Skelton
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  2. Stacey Iobst
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  3. Sara E. Benjamin-Neelon
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Contributions

Kara Skelton: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration and writing—original draft; Stacey Iobst: project administration, writing – review and editing; Sara Benjamin-Neelon: conceptualization, funding acquisition, writing—review and editing.

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Correspondence to Kara R. Skelton.

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Skelton, K.R., Iobst, S. & Benjamin-Neelon, S.E. Cannabis advice occurring at prenatal care visits in the United States, 2017–2021. J Perinatol 45, 1302–1304 (2025). https://doi.org/10.1038/s41372-025-02331-z

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