Women Getting Bad Advice on Cannabis Use in Pregnancy, Study Finds

 

• Cannabis use in pregnancy is associated with health risks including preeclampsia and low birthweight.
• In this secret shopper study, one in five cannabis retailers told callers that cannabis use was safe in pregnancy.
• The findings support a need for more public education about the risks of prenatal cannabis use and for guidance to discuss its use with physicians.

While most cannabis retailers recommended women not use blunts or tobacco while pregnant, about one in five suggested prenatal cannabis use was safe, according to a cross-sectional study of California retailers.

Out of 505 cannabis retailers, or "budtenders," surveyed by secret shoppers, roughly 80% said that prenatal use of blunts (cigar wrappers filled with cannabis) and tobacco was unsafe, but only 40% said using cannabis while pregnant was unsafe, reported researchers led by Kelly Young-Wolff, PhD, MPH, of Kaiser Permanente Northern California in Pleasanton, in JAMA Network Open.

Far more retailers called prenatal cannabis use safe (20.6%) compared with prenatal blunts or tobacco (0.8% each), another 19% said they weren't sure about the safety of prenatal cannabis (versus 3% and 6% for blunts and tobacco, respectively), and 14% to 20% of the retailers said they could not provide medical advice.

Although rates of prenatal cannabis use are rising, it is associated with health risks for mothers and their children, including gestational hypertension, preeclampsia, and low birthweight, Young-Wolff noted.

Pregnant people turn to retailers for advice about product safety, viewing retailers as "trusted sources of information" who are "nonjudgmental and relatable," said Young-Wolff, based on her group's prior research.

"That's why these interactions matter. People aren't just walking into a store -- they're seeking trusted advice. But when that trust isn't paired with accurate information, it can leave pregnant individuals with mixed or misleading messages about risk," she told MedPage Today.

While advice to not use tobacco was "very clear and consistent," messages about cannabis varied. "Some budtenders described cannabis as unsafe, while others said it was safe or suggested certain cannabis products that might be safer, despite the lack of supporting evidence," she said.

Some budtenders recommended using low- or no-tetrahydrocannabinol (THC) cannabis products, using products less frequently, or using non-cannabis options such as mindfulness. Edibles were most frequently recommended as a safe form of cannabis, while smoking cannabis was most often deemed harmful, Young-Wolff and team noted. However, some retailers suggested smoking was safest.

Altogether, 44% of budtenders recommended without prompting that pregnant women speak to their doctors, and 46% recommended doing so after prompting.

And while warning labels exist in California, they rarely came up in conversations with budtenders, Young-Wolff noted. Only 5.7% of retailers referred to store or product warnings. In all, 45.2% of retailers based recommendations on personal experience, 35.6% used general knowledge, 9.1% cited online sources, and 7.9% suggested their advice was based on published research.

"I used with my daughter, and she is perfectly healthy," said one retailer quoted in the study. Another suggested edible use was safer than smoking due to "fewer carcinogens," whereas a different retailer noted, "Edibles go into your digestive system and anything you eat the baby eats."

The research team wrote two phone scripts for mystery callers to 505 randomly selected licensed storefront retailers across California. One script highlighted mental health reasons for using cannabis, and the other did not. Retailers were asked whether or not prenatal blunt use was safe; whether tobacco, cannabis, or both were unsafe; and which types and modes of cannabis are safer or more harmful during pregnancy. Retailers were also asked whether the caller should talk to their doctor and whether the retailer delivered products.

A strength of the study was the secret-shopper approach, which helped capture "real-world conversations, not hypothetical responses," said Young-Wolff.

A limitation was that the authors surveyed only California retailers, and "patterns of retail culture and budtender advice may differ in other states," she noted.

Altogether, the study's "findings suggest the need for more public education about the risks of prenatal cannabis use and guidance that pregnant people should discuss prenatal cannabis use with their physicians," Young-Wolff said.

Disclosures

Young-Wolff reported receiving grants from Kaiser Permanente Northern California Community Health, the National Institute on Drug Abuse, and the Tobacco-Related Disease Research Program. Co-authors reported relationships with Pfizer, Moderna, UpToDate, and the Industry PMR Consortium.

Primary Source

JAMA Network Open

Source Reference: Young-Wolff KC, et al "Cannabis retailer advice on blunt, tobacco, and cannabis use during pregnancy" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.48373.

https://www.medpagetoday.com/obgyn/pregnancy/119022