Prenatal cannabis screening and counseling practices by state recreational legalization status: A multi-state examination of PRAMS data (2017–2020)

Objective

Despite increased recreational cannabis legalization (RCL) in the US in recent years, little is known about cannabis advice received at prenatal care visits. We aimed to examine cannabis screening and counseling occurring at prenatal care visits, including adherence of advice to current clinical guidelines and variations by RCL status.

Methods

In this repeated cross-sectional study, we used 2017–2020 Pregnancy Risk Assessment Monitoring System data for 9 states to calculate weighted prevalence estimates of cannabis screening and advice received during prenatal care. We also examined adherence to the American College of Obstetricians and Gynecology’s clinical guidelines for cannabis use during pregnancy, including variations across RCL and self-reported prenatal cannabis use via chi-squared tests.

Results

In the sample (weighted N = 742,491), 20.53 % received cannabis advice that was adherent to clinical guidelines. Women in states with RCL more frequently reported being asked about cannabis use (78.66 % vs. 62.30 %; P < 0.001), and reported being advised against cannabis use during pregnancy (44.29 % vs. 37.06 %; P < 0.001) and lactation (31.03 % vs. 25.50 %; P < 0.001) at a prenatal care visit than women residing in states without RCL. Similarly, women in states with RCL more frequently reported being advised to use cannabis prenatally (2.96 % vs 1.45 %, P < 0.001). Women who reported any prenatal cannabis use were more likely to report being advised to use cannabis at a prenatal care visit in comparison to those who did not report prenatal cannabis use (10.10 % vs 1.16 %, P < 0.001).

Conclusions

Given the variations in cannabis screening and advice occurring at prenatal care visits, findings underscore the importance of clinical practice that is consistent with current guidelines.