A recent study published in JAMA Network Open surveyed 2063 pregnant or recently pregnant people living in US states with legalized recreational cannabis, 585 of whom reported using cannabis during their pregnancy (CUDP). Researchers from the University of California, San Francisco supported by a grant from the California Department of Cannabis Control reported that among those who used cannabis during their pregnancy, living in a state with warning signs about the use of cannabis during pregnancy was associated with beliefs that cannabis use during pregnancy was safe, and that those who used cannabis during pregnancy should not be punished. Among people who did not use cannabis before or during pregnancy, living in a warning-signs state was associated with beliefs that use was not safe, and with greater support for punishment regarding pregnant people’s cannabis use.
"Considerable questions remain as to why warning signs for substance use during pregnancy may have unintended adverse consequences," the study's authors write. "One possibility is that warning signs increase fears of punishment and thus influence pregnant people to avoid prenatal care. Another is that warning signs may lead people to believe their substance use has already irreversibly harmed their baby and thus it is too late to stop use. From the larger health communications literature, people who use cannabis could experience message fatigue and tune out or distrust information in messages."
Of 585 people reporting CUDP, 226 participants (32.4%) agreed that warning signs scare people too much, and only 171 participants (29.3%) trusted information in signs. Regarding message fatigue, of people reporting CUDP, 302 participants (48.4%) agreed they were tired of hearing how cannabis is bad for their baby’s health, and 266 participants (49.1%) agreed they have heard more than enough about how important it is to not use during pregnancy.
The authors looked to similar policies around alcohol, reporting that while "studies are mixed as to whether alcohol consumption during pregnancy is lower when alcohol warning signs are in effect, policies requiring alcohol warning signs are associated with increased adverse birth outcomes and decreased prenatal care utilization." Consistent with the alcohol warning signs and adverse birth outcomes findings, a 2022 analysis found that Washington state’s cannabis warning signs policy was associated with a 7.03-gram lower birth weight and slightly (0.3%) increased low birthweight, something that has been associated with cannabis use during pregnancy. This translates to 269 babies born with low birthweight in Washington June 2016–June 2017 related to the warning-sign policy.
Living in a state with a warning signs policy was not associated with CUDP overall, or when restricted to people who used cannabis before or during pregnancy. "We also found no evidence that exposure to warning signs was associated with decreased cannabis use during pregnancy," the authors wrote. "The finding that having seen warning signs was associated with increased odds of cannabis use during pregnancy among the overall sample likely reflects that only people who use cannabis likely see warning signs, as signs are in specialized dispensaries, visited by people who use cannabis. The possibility that exposure to warning signs could affect quantity or frequency of use during pregnancy is something to explore in future research."
Noting that "research suggests that legalizing cannabis does not make pregnant people comfortable talking with health care practitioners about cannabis," the authors suggest that future research "should explore ways warning signs may influence interactions between pregnant people and health care practitioners."
Meanwhile, another new study has concluded that cannabis clinical trial participants "are skewed toward overrepresentation by white males in their 20s and 30s."
Also see: Cannabis and Pregnancy During Legalization
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