Australian doctors frequently ask pregnant women about cigarettes but rarely about cannabis, e-cigarettes, or secondhand smoke | Research

The takeaway

While 95% of surveyed Australian GPs and obstetricians asked pregnant women about cigarette smoking, only 58% asked about cannabis and just 13-14% asked about e-cigarettes, potentially missing important exposures.

Read this if you're interested in how prenatal care screens for cannabis and other non-tobacco exposures.

95% asked about cigarettes vs 58% about cannabis during prenatal visits

What the researchers found

Among 378 Australian GPs and obstetricians, 95% asked pregnant patients about cigarette smoking at most visits. However, other exposures were assessed far less frequently: cannabis (58%), cannabis mixed with tobacco (38%), secondhand smoke (27%), e-cigarettes (13-14%), and chewing tobacco (10%).

Aboriginal health GPs were more likely to ask about cannabis compared to general obstetricians and GPs. The disparity suggests that healthcare providers focus heavily on cigarettes while underassessing other smoke and nicotine exposures that may also affect maternal and fetal health.

Why it matters

If clinicians rarely ask about cannabis, e-cigarettes, and secondhand smoke during pregnancy, they cannot counsel patients about these exposures or track their prevalence. This assessment gap represents a missed opportunity for preventive health, particularly as cannabis and e-cigarette use are increasing.

The numbers in context

378 GPs and OBS surveyed. Asking rates: cigarettes 95%, cannabis 58%, cannabis+tobacco 38%, secondhand smoke 27%, e-cigarettes 13-14%, chewing tobacco 10%. Aboriginal health GPs asked about cannabis more often.

How the study worked

Two cross-sectional surveys: one targeting GPs in Aboriginal and Torres Strait Islander health (NFATSIH) and another targeting GPs and obstetricians through RANZCOG. Surveys assessed frequency of asking about various smoke and nicotine exposures using Likert scales.

What this study cannot tell us

Low response rate (6.2%). Australian healthcare context may not generalize to other countries. Self-reported screening practices may overestimate actual asking rates. The survey did not assess whether asking about cannabis changed clinical management.

How to read the evidence

Cross-sectional survey with low response rate. Identifies important practice gaps but may not represent all Australian clinicians.

When this study was published

Published in 2017. Prenatal screening for cannabis and e-cigarettes has received increasing attention since.

The bigger picture

The dramatic difference between cigarette screening (95%) and cannabis screening (58%) likely reflects clinical training that has historically focused on tobacco. As cannabis becomes more normalized and e-cigarettes more prevalent, prenatal screening needs to expand to capture the full spectrum of exposures that could affect the developing fetus.

Questions still open

Would systematic screening for cannabis during pregnancy improve outcomes? Are there validated prenatal cannabis screening tools? How should clinicians counsel pregnant patients who disclose cannabis use?

Common questions

Should doctors ask pregnant women about cannabis?

Yes. Cannabis is the most commonly used illicit drug during pregnancy, and evidence links prenatal exposure to adverse outcomes. Only 58% of Australian clinicians in this survey routinely asked about it, meaning many opportunities for counseling are being missed.

Why do doctors ask about cigarettes but not cannabis?

Clinical training has historically focused on tobacco screening during pregnancy. Cannabis screening may be less routine due to its stigma, legal status, lack of standardized screening tools, and clinician uncertainty about how to respond to a positive disclosure.

Read the original research

Do Clinicians Ask Pregnant Women about Exposures to Tobacco and Cannabis Smoking, Second-Hand-Smoke and E-Cigarettes? An Australian National Cross-Sectional Survey.

International journal of environmental research and public health, 14(12)

View on PubMed ↗Publisher’s paper ↗

Citation

Gould, Gillian S; Zeev, Yael Bar; Tywman, Laura; Oldmeadow, Christopher; Chiu, Simon; Clarke, Marilyn; Bonevski, Billie. (2017). Do Clinicians Ask Pregnant Women about Exposures to Tobacco and Cannabis Smoking, Second-Hand-Smoke and E-Cigarettes? An Australian National Cross-Sectional Survey.. International journal of environmental research and public health, 14(12). https://doi.org/10.3390/ijerph14121585