Only 21% of Pregnant Women Received Guideline-Adherent Cannabis Counseling at Prenatal Visits

Only 20.53% received guideline-adherent cannabis advice. Women in recreational legalization states were more often asked about cannabis (78.66% vs. 62.30%, p<0.001) and advised against use during pregnancy (44.29% vs. 37.06%, p<0.001) and lactation (31.03% vs. 25.50%, p<0.001). Notably, women who used cannabis prenatally were more likely to report being advised to use it (10.10% vs. 1.16%, p<0.001).

Repeated cross-sectional study using 2017-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 9 US states (weighted N=742,491). Examined cannabis screening and advice at prenatal visits, adherence to ACOG guidelines, and variation by recreational legalization status.

With prenatal cannabis use rising alongside legalization, consistent clinical guidance is critical. This study reveals that the majority of pregnant women do not receive guideline-adherent cannabis counseling, regardless of state legalization status.

The finding that some women are being advised to use cannabis during pregnancy, and that this is more common among those already using it, suggests a troubling gap between clinical guidelines and practice. This is especially concerning given limited safety data for prenatal cannabis exposure.

Self-reported screening and advice may be subject to recall bias. Only 9 states included, limiting generalizability. Cannot determine quality or depth of counseling conversations. State-level legalization status may not capture local availability.