Cannabis Legalization Linked to Higher Use Before and During Pregnancy | Research

The takeaway

Among 36,391 women surveyed, living in a state with recreational cannabis legalization was associated with 2.37 times higher odds of preconception use and 1.51 times higher odds of prenatal use.

Obstetricians, maternal health researchers, cannabis policy professionals

Recreational legalization was associated with 2.37x higher preconception cannabis use

What the researchers found

Recreational cannabis legalization was associated with higher cannabis use across preconception (OR=2.37), prenatal (OR=1.51), and postpartum periods. Medical legalization was associated with higher preconception use (OR=3.32) but not prenatal use. Tobacco, e-cigarette, and moderate alcohol use were also associated with cannabis use.

Why it matters

As more states legalize cannabis, understanding how legalization affects use during pregnancy is critical for developing updated prenatal counseling and public health messaging.

The numbers in context

36,391 women surveyed; recreational legalization: OR 2.37 for preconception, 1.51 for prenatal use; medical legalization: OR 3.32 for preconception use, not significant for prenatal; tobacco and e-cigarette use also associated with cannabis use.

How the study worked

Cross-sectional analysis of combined 2016-2018 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 36,391 women, using logistic regression to estimate effects of state legalization status on cannabis use across reproductive periods.

What this study cannot tell us

Self-reported data may underestimate actual use; cross-sectional design limits causal inference; state-level legalization status does not capture individual access; potential confounders related to state culture.

How to read the evidence

Large nationally representative dataset with robust statistical methods, limited by self-report and cross-sectional design.

When this study was published

Data from 2016-2018 PRAMS surveys.

The bigger picture

The association between legalization and increased preconception and prenatal cannabis use suggests that legalization policies should be accompanied by strengthened prenatal substance use prevention programs and provider education.

Questions still open

Are women in legal states receiving adequate counseling about cannabis risks during pregnancy? Does the type of cannabis product used during pregnancy affect fetal outcomes?

Common questions

Does legalization increase cannabis use during pregnancy?

This study found that women in states with recreational cannabis legalization were 1.51 times more likely to use cannabis during pregnancy compared to women in non-legal states, suggesting legalization is associated with increased prenatal use.

What about medical cannabis states?

Medical legalization was associated with higher preconception use (3.32x) but was not significantly associated with prenatal use, suggesting different patterns between medical and recreational legalization.

Read the original research

Factors Associated With Cannabis Use During the Reproductive Cycle: A Retrospective Cross-Sectional Study of Women in States With Recreational and Medical Cannabis Legalization.

Maternal and child health journal, 25(9), 1491-1500

View on PubMed ↗Publisher’s paper ↗

Citation

Taylor, Danica Loralyn; Bell, Janice F; Adams, Susan L; Drake, Christiana. (2021). Factors Associated With Cannabis Use During the Reproductive Cycle: A Retrospective Cross-Sectional Study of Women in States With Recreational and Medical Cannabis Legalization.. Maternal and child health journal, 25(9), 1491-1500. https://doi.org/10.1007/s10995-021-03197-1