While we have seen decreasing rates of alcohol and tobacco use during pregnancy over the last few decades, the use of cannabis during pregnancy is on the rise.  Qualitative studies indicate that pregnant women report using cannabis to manage a range of psychological symptoms, including anxiety and depression.  Given that the COVID-19 pandemic has led to increased levels of stress, anxiety and depression among pregnant women, we have been concerned about the impact of these symptoms on pregnancy outcomes.  We must also consider the possibility that the pandemic may contribute to increased use of cannabis and other substances during pregnancy.

In a recent study, data from the Kaiser Permanente Northern California (KPNC) health care system was used to examine the prevalence of cannabis use during pregnancy before and during the pandemic.  Urine toxicology tests were performed at about 8 weeks’ of gestation as part of a universal prenatal screening for prenatal cannabis use in the context of routine obstetric care.     

Of the 100,005 pregnancies (in 95,?412 women) included in this analysis, 26% were Asian or Pacific Islander, 7% Black, 28% Hispanic, 34% non-Hispanic White, and 5% other, unknown, or multiracial. The mean age was 31 years (median, 31 years).

Prior to the pandemic (January 2019 to March 2020), 6.75% of the urine screens were positive.  Between April 2020 and December 2020, positive tests increased to 8.14%.  This represents a 25% increase in the number of women using cannabis during pregnancy.

Although many consider cannabis to be relatively benign, a growing body of medical research indicates that prenatal cannabis use has been associated with an array of adverse outcomes, including small for gestational age, preterm birth, low birth weight, and death during the first year of life.  Other studies have demonstrated worse neurodevelopmental outcomes in cannabis-exposed children.  

Many women who are pregnant or planning to conceive are unaware of these risks. Thus, it is essential that clinicians, as well as those working in dispensaries, must educate women about the risks associated with cannabis use during pregnancy.  


Ruta Nonacs, MD PhD


Young-Wolff KC, Ray GT, Alexeeff SE, Adams SR, Does MB, Ansley D, Avalos LA.  Rates of Prenatal Cannabis Use Among Pregnant Women Before and During the COVID-19 Pandemic.  JAMA. 2021 Sep 27. 


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