A new qualitative study published in Drug and Alcohol Dependence finds that many pregnant people who use cannabis do not disclose their use to prenatal care providers, even in a context where recreational cannabis use is legal. Patients’ fear of having their children removed from them by Child Protective Services (CPS) is a major reason they do not disclose. This suggests that prenatal care providers' role as potential reporters to CPS continues to pose a significant barrier to effective, supportive counseling and education on cannabis use in pregnancy.
Unfortunately, patients are justified in their fears: many families are unnecessarily targeted and separated by governmental agencies such as CPS. Learn more about the consequences that mothers face for using cannabis in the resources section below.
Funded by PTBi, this is the first study to investigate these interactions from the pregnant person’s perspective. Recreational marijuana is now legal in 19 states and more states are soon to follow. As marijuana legalization spreads, many health professionals are concerned that use may be growing including among pregnant populations.
“Our study strongly suggests that it is fear of CPS report, not the legal status of cannabis per se, that inhibits patients from discussing cannabis use with their providers,” said Katie Woodruff, lead author and Public Health Social Scientist at UCSF’s Advancing New Standards in Reproductive Health (ANSIRH). “This fear persists even when cannabis use is legal, and remains a barrier to comprehensive and compassionate patient-provider interactions on cannabis use in pregnancy.”
![Silhouette of a pregnant black woman saying, "I can talk to friends and family. [But] it's another thing to open up to people who are actually in the health field. They've studied our bodies, they could actually help us, but then it becomes real scary to disclose certain information, if we're being threatened."](/sites/g/files/tkssra2851/f/wysiwyg/2_3.png)
Conducted in 2019, the researcher team sought to shed light on the perspectives, decision-making processes, and experiences of the participants who used marijuana weekly or more prior to and/or during pregnancy. The participants, all of whom were recruited in California, included women from a diverse spread of socioeconomic classes, racial and ethnic backgrounds, and levels of educational attainment. More than half the participants reported stopping or reducing their cannabis use after finding out they were pregnant.
Two-thirds of the women stated that they did not disclose their cannabis use to providers even if asked directly, citing fears of CPS reporting and judgement. About one-third of the sample also reported that their providers never asked them about cannabis use, and some participants interpreted this silence as approval of continuing cannabis use.
One participant said, “[Cannabis is]s going to show up in my urine and my blood work. And I give a lot of blood to that freaking doctor, it’s ridiculous. So, I’m pretty sure he knows, but he just hasn’t said something.”
When asked what she interpreted that silence as, she replied, “That he's perfectly fine with it.”
In light of these findings and the increasing evidence that cannabis use during pregnancy is related to negative birth outcomes like low birth weight and preterm birth, perinatal providers need to reexamine their practices when addressing marijuana use. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers ask all pregnant people about their substance use and, if substances are being used, to provide counseling rather than punitive measures.
However, Woodruff and her team found that even when patients and providers did have conversations about marijuana, patients reported hearing a wide range of messages in response. Participants reported messages from their providers ranging from approval of cannabis use for morning sickness to harsh health warnings and even legal threats. These findings suggest that there are significant gaps in how prenatal care providers address marijuana use with their pregnant patients.
“Our recommendations are twofold. Revisit and revise mandatory CPS reporting policies and practices for cannabis use in pregnancy, and provide more professional education for prenatal care providers around this topic,” Woodruff said. “Providers should have a robust medical education based on evidence of cannabis-use and health outcomes, and be trained and supported to implement harm reduction approaches as well as patient-centered counseling and communication practices.”
This research was conducted by Katie Woodruff, Karen A. Scott, and Sarah C.M. Roberts, with the support and expert advice of Lori Freedman, Cynthia Gutierrez, Anisha Johnson, Amanda Reiman, Alicia Swartz, Signy Toquinto, and Sonia Waters and invaluable guidance from the PTBI Community Advisory Board. The authors thank all the study participants who shared their views and experiences so generously.
