Pregnant people who used cannabis made conscious decisions to reduce harm by changing amounts, products, and sources

Three themes emerged for how pregnant cannabis users modified their behavior: (1) changing the amount of cannabis used (reducing frequency or quantity), (2) changing types of products (switching from smoking to edibles, topicals, or lower-THC products), and (3) changing procurement sources (seeking regulated dispensaries over illicit sources). Participants were actively seeking evidence-based harm reduction information but could not find trustworthy guidance.

Qualitative constructivist grounded theory. 19 semi-structured interviews (December 2022-March 2023) with BIPOC individuals over 21 who used cannabis during pregnancy within the past 0-2 years in California.

Rather than choosing between "use" and "don't use," pregnant cannabis users are already practicing harm reduction. Understanding their decision-making can inform clinical approaches that meet patients where they are rather than simply advising abstinence.

The gap between patients' desire for evidence-based harm reduction guidance and the absence of such information from healthcare providers represents a missed opportunity. A harm reduction framework for prenatal cannabis use could improve outcomes even when abstinence is unrealistic.

Small qualitative sample from California. BIPOC participants only; findings may not generalize across demographics. Self-reported behaviors. Retrospective recall of pregnancy decisions (0-2 years post). No health outcome data for mothers or infants.