A statewide population-based study found 16.8% of pregnant women in Michigan used cannabis, with depression, adverse childhood experiences, and lower education strongly associated with use.
Pregnant individuals, OB-GYNs, public health officials, and maternal health researchers
What the researchers found
Weighted prevalence of prenatal cannabis use was 16.8% combining self-report and urinalysis; self-report alone captured 12.3% while urinalysis caught 13.3%, indicating neither method alone captures the full picture.
Why it matters
One in six pregnancies involving cannabis is a public health figure that demands attention — and the finding that self-report underestimates use means the true number may be even higher.
The numbers in context
16.8% overall prevalence; 12.3% by self-report; 13.3% by urinalysis; depression aPRR=1.72; ACEs ≥3 aPRR=2.04; single status aPRR=2.08; some college vs. undergrad+ aPRR=3.76.
How the study worked
Prospective statewide pregnancy cohort (MARCH/ECHO) using three-stage stratified cluster sampling across Michigan's lower peninsula, with 1,092 participants providing self-reports and/or urine toxicology during pregnancy.
What this study cannot tell us
Michigan-specific results may not generalize to all states; recruitment at prenatal clinics misses those without prenatal care; urine captures recent use but may miss intermittent users.
How to read the evidence
Large population-based cohort with dual verification methods (self-report and urinalysis), complex survey design, and multivariate analysis from NIH ECHO program.
When this study was published
Published in 2026 with data from 2017-2023, capturing the transition period around recreational cannabis legalization.
The bigger picture
This is among the most methodologically rigorous estimates of prenatal cannabis use in the US, and the strong links to depression and childhood trauma suggest cannabis use in pregnancy is often self-medication for unmet mental health needs.
Questions still open
- How has prenatal cannabis prevalence changed since Michigan's recreational legalization in 2018? Would integrated mental health support during pregnancy reduce cannabis use?
Common questions
How common is cannabis use during pregnancy?
Who is most likely to use cannabis during pregnancy?
Read the original research
Prevalence and characteristics of prenatal cannabis use in Michigan, USA: A statewide population-based pregnancy cohort.
Addiction (Abingdon, England), 121(1), 126-137
Citation
Al-Sahab, Ban; Kerver, Jean M; Alshaarawy, Omayma; Bohnert, Kipling M; Elliott, Michael R; Qiu, Hongxiang; Jaber, Audriyana; Neelam, Harish; Paneth, Nigel. (2026). Prevalence and characteristics of prenatal cannabis use in Michigan, USA: A statewide population-based pregnancy cohort.. Addiction (Abingdon, England), 121(1), 126-137. https://doi.org/10.1111/add.70188
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