Cannabis Legalization Linked to More Binge Drinking During Pregnancy
States with legal recreational cannabis retail sales saw a 5 percentage point increase in binge drinking during pregnancy, and pregnant women in those states were twice as likely to binge drink.
Quick Facts
What This Study Found
Prevalence of binge drinking during pregnancy was 2.13 times higher in states with legal recreational cannabis retail sales. Difference-in-difference analysis showed implementation was associated with a 4.96 percentage point increase in binge drinking during pregnancy (95% CI: 1.22-8.70). Current drinking showed a non-significant increase.
Key Numbers
Current drinking: 1.43x higher in legal states (95% CI: 1.18-1.73). Binge drinking: 2.13x higher (95% CI: 1.47-3.09). DID estimate: +4.96 percentage points for binge drinking (p<.05). Data span: 2011-2023 BRFSS.
How They Did This
Analysis of 2011-2023 Behavioral Risk Factor Surveillance System data. Adjusted prevalence ratios and difference-in-difference analyses compared drinking during pregnancy in states before/after implementing legal nonmedical cannabis retail sales versus states without implementation, controlling for demographics and policy variables.
Why This Research Matters
This unexpected association suggests cannabis legalization may have unintended effects on other substance use during pregnancy. If the relationship is causal, it would mean cannabis policy changes are increasing risk of fetal alcohol spectrum disorders.
The Bigger Picture
The mechanism is unclear — it could be normalization of substance use generally, lifestyle clustering effects, or confounding factors. Regardless, this finding suggests public health messaging about alcohol during pregnancy may need intensifying in states legalizing cannabis.
What This Study Doesn't Tell Us
Observational — cannot prove cannabis legalization causes increased drinking. Self-reported data likely underestimates both cannabis and alcohol use during pregnancy. Confounders may exist. Ecological fallacy risk (state-level associations don't prove individual behavior).
Questions This Raises
- ?What mechanism links cannabis legalization to alcohol use during pregnancy?
- ?Are women substituting or adding?
- ?Would enhanced prenatal screening in legal states help?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large national dataset with rigorous difference-in-difference design, but observational nature limits causal claims.
- Study Age:
- Published in 2026, analyzing 2011-2023 data capturing the key period of U.S. cannabis legalization rollout.
- Original Title:
- Alcohol Consumption During Pregnancy and State Implementation of Legal Nonmedical Cannabis Retail Sales in the U.S., 2011-2023.
- Published In:
- American journal of preventive medicine, 70(2), 108105 (2026)
- Authors:
- Denny, Clark H(3), Deputy, Nicholas P, Abouk, Rahi, Dunkley, Janae D, Drake, Coleman, Kim, Shin Y, Pella, Michael, Roehler, Douglas R, Rose, Charles E
- Database ID:
- RTHC-08221
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Does cannabis legalization increase drinking during pregnancy?
This study found a significant association — binge drinking during pregnancy was twice as common in states with legal cannabis sales. However, the study can't prove legalization caused the increase; other factors may explain the relationship.
Why would cannabis legalization affect alcohol use?
The mechanism is unknown. Possibilities include general normalization of substance use, lifestyle factors that cluster in early-adopter states, or changes in risk perception. Whatever the cause, the finding suggests heightened alcohol screening may be needed.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08221APA
Denny, Clark H; Deputy, Nicholas P; Abouk, Rahi; Dunkley, Janae D; Drake, Coleman; Kim, Shin Y; Pella, Michael; Roehler, Douglas R; Rose, Charles E. (2026). Alcohol Consumption During Pregnancy and State Implementation of Legal Nonmedical Cannabis Retail Sales in the U.S., 2011-2023.. American journal of preventive medicine, 70(2), 108105. https://doi.org/10.1016/j.amepre.2025.108105
MLA
Denny, Clark H, et al. "Alcohol Consumption During Pregnancy and State Implementation of Legal Nonmedical Cannabis Retail Sales in the U.S., 2011-2023.." American journal of preventive medicine, 2026. https://doi.org/10.1016/j.amepre.2025.108105
RethinkTHC
RethinkTHC Research Database. "Alcohol Consumption During Pregnancy and State Implementatio..." RTHC-08221. Retrieved from https://rethinkthc.com/research/denny-2026-alcohol-consumption-during-pregnancy
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.