Mandatory Warning Signs for Cannabis: Perspectives and Preferences of Pregnant and Recently Pregnant People Who Use Cannabis.

Background: Five U.S. states where recreational cannabis is legal require Mandatory Warning Signs for cannabis use during pregnancy (MWS-cannabis) to be posted in cannabis dispensaries. Previous research has found adverse health consequences associated with MWS-cannabis and that people lack trust in information on signs. This qualitative study explores people's perspectives and preferences regarding MWS-cannabis.

Methods: We conducted in-depth interviews with 34 pregnant or recently pregnant individuals from multiple states with varying policy climates in the U.S. who used cannabis before and/or during pregnancy. We asked participants about their perspectives on MWS-cannabis and reactions to specific messages. We reviewed transcripts using thematic analysis.

Results: Participants reported mostly negative views on MWS-cannabis, suggesting they may have stigmatizing and negative impacts on pregnant people who use cannabis, discouraging them from seeking care. Many said that the scientific evidence is not strong enough to justify MWS-cannabis, and that they are unlikely to deter pregnant people from using cannabis. Participants asserted that vague or fear-based messages, distrust of government, and the location and timing of the signs undermine the goals of MWS-cannabis. When reacting to specific messages, participants preferred messages that are evidence-based, clear, specific, and aligned with autonomous decision-making.

Conclusions: Pregnant and recently pregnant people who use cannabis have mostly negative perceptions of MWS-cannabis and believe they have negative consequences. More work is needed to develop health information resources that meet the needs of people who use cannabis in pregnancy without increasing stigma.