Across 9 US states, only about 21% of pregnant women received cannabis advice consistent with clinical guidelines, though screening was more common in states with recreational legalization.
obstetricians, midwives, prenatal care providers, maternal health policymakers
What the researchers found
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).
Why it matters
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 numbers in context
Weighted N=742,491 across 9 states. 20.53% received guideline-adherent advice. RCL states: 78.66% asked about cannabis vs. 62.30% without RCL. 2.96% in RCL states advised to use cannabis vs. 1.45% without. 10.10% of prenatal cannabis users were advised to use vs. 1.16% of non-users.
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Large population-based dataset with validated methodology, but self-reported outcomes and limited state coverage place evidence at moderate.
When this study was published
PRAMS data from 2017-2020.
The bigger picture
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.
Questions still open
- Why are some prenatal providers advising cannabis use contrary to guidelines?
- Would provider education improve guideline adherence?
Common questions
Are pregnant women being told it's okay to use cannabis?
Does legalization improve prenatal cannabis screening?
Read the original research
Prenatal cannabis screening and counseling practices by state recreational legalization status: A multi-state examination of PRAMS data (2017-2020).
Drug and alcohol dependence reports, 17, 100385
Citation
Skelton, Kara R; Iobst, Stacey E; Benjamin-Neelon, Sara E. (2025). Prenatal cannabis screening and counseling practices by state recreational legalization status: A multi-state examination of PRAMS data (2017-2020).. Drug and alcohol dependence reports, 17, 100385. https://doi.org/10.1016/j.dadr.2025.100385
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