Alcohol Consumption During Pregnancy and State Implementation of Legal Nonmedical Cannabis Retail Sales in the United States, 2011 to 2023.

Introduction: Alcohol consumption during pregnancy causes fetal alcohol spectrum disorders and may increase the risk of adverse pregnancy outcomes, such as miscarriage and stillbirth. It is unknown whether legalization of cannabis influences alcohol consumption during pregnancy. This analysis estimated the association between state implementation of legal nonmedical cannabis retail sales (NCRS) and alcohol consumption during pregnancy.

Methods: Data from the 2011 to 2023 Behavioral Risk Factor Surveillance System were analyzed in 2023-2024. Adjusted prevalence ratios comparing current and binge drinking during pregnancy in states after implementation of legal NCRS to states before or without implementation were estimated, adjusting for demographic factors. Difference-in-difference analyses, that adjusted for state and time variability, estimated the association between the implementation of legal NCRS and the change in current and binge drinking during pregnancy, controlling for selected demographic and policy variables.

Results: Prevalence of current and binge drinking during pregnancy were 1.43 (95% CI=1.18, 1.73) and 2.13 (95% CI=1.47, 3.09) times higher, respectively, among respondents in states with implementation of legal NCRS compared to respondents in states before or without implementation. Implementation of legal NCRS was significantly associated with a 4.96 (95% CI=1.22, 8.70) percentage point increase in binge drinking and a nonsignificant change in current drinking 3.18 (95% CI=-1.03, 7.39).

Conclusions: Alcohol consumption among pregnant women may be higher where legal NCRS has been implemented, and implementation may be associated with an increase in binge drinking among pregnant women. Improving alcohol screening and counseling during pregnancy, and patient education, may be considered.