In This article

• Cannabis use during pregnancy is increasing despite declines in alcohol and tobacco use.
  
• Mental health, relief of nausea and vomiting, and pain are the most common reasons for use.
  
• Over 80% of users report more than one motive, with frequent or daily use more common among them.
  
• Motivations are consistent across sociodemographic groups.
  
• Screening and supportive care before conception may potentially reduce use and improve outcomes.

The use of cannabis among women of reproductive age has increased markedly as more states legalize both recreational and medical use. Despite declining rates of alcohol and tobacco use during pregnancy, cannabis use during pregnancy continues to rise. Many studies have raised concerns about the potential impact of prenatal cannabis exposure on child development and behavior. Given these concerns, we encourage all patients to refrain from using cannabis during pregnancy.

While abstaining may be relatively easy for women who use cannabis occasionally, daily users may require additional support to discontinue use during pregnancy. Some women may also use cannabis to manage mood or anxiety symptoms or to alleviate sleep problems. In such cases, offering evidence-based alternatives for managing these symptoms may help reduce cannabis use. A recent study sheds light on the reasons individuals report using cannabis during pregnancy.

In this study, researchers analyzed data from the 2017–2021 Pregnancy Risk Assessment Monitoring System (PRAMS) Marijuana Supplement, which assesses self-reported motivations for cannabis use during pregnancy. PRAMS states randomly survey women between two and six months postpartum on maternal behaviors and experiences before, during, and after pregnancy. The Marijuana Supplement gathers information on maternal cannabis use, including prevalence, reasons for use, and modes of consumption.

This study included data from 10 states using the Marijuana Supplement: Alaska, Illinois, Maine, North Dakota, New Jersey, New Mexico, New York, Pennsylvania, Virginia, and West Virginia.

Among a sample representing approximately 802,954 live births, most participants were aged 18–24 years (70.31%), non-Hispanic (86.95%), and White (72.60%). About 3.68% reported cannabis use during pregnancy. 

The most common motivations for prenatal cannabis use were:

• Mental health symptoms (82.81%; 95% confidence interval [CI]: 77.52–87.06)
• Relief of gastrointestinal symptoms (77.10%; 95% CI: 70.51–82.59)
• Pain relief (48.67%; 95% CI: 41.84–55.56)
• Fun or relaxation (40.18%; 95% CI: 33.69–47.04)
• Management of chronic condition–related symptoms (26.31%; 95% CI: 20.55–33.01)

Most participants (84.32%) reported two or more reasons for use. Women citing multiple motivations were more likely to report daily use compared with those reporting only one reason (86.96% vs. 10.40%).

Women who reported using cannabis for mental health issues or gastrointestinal symptoms were more likely to use cannabis frequently. Motivations for use were broadly similar across sociodemographic groups.

Clinical Implications

Using multi-year national surveillance data, researchers identified the primary reasons women use cannabis during pregnancy. Although mental health concerns were the most frequently reported reason, many women also cited pregnancy-related symptoms, findings that are consistent with prior research.

These findings highlight the complex motivations underlying cannabis use during pregnancy and emphasize the need for individualized, patient-centered interventions before and during pregnancy. Given that many pregnant individuals report using cannabis to manage mental health symptoms, cannabis use during pregnancy may signal an increased risk for psychiatric illness during the perinatal period.

Ideally, screening for mood and anxiety disorders—as well as substance use—should occur before conception. This approach allows clinicians to discuss safe and effective treatment options for mental health conditions, with the goal of improving psychological well-being while minimizing cannabis use during pregnancy.

—Ruta Nonacs, MD PhD