Women’s Health
Impact of recreational cannabis legalization on prenatal cannabis use Summer Sherburne Hawkins* Summer Hawkins Rebekah Levine Coley Christopher F Baum
Cannabis use among pregnant women has increased more than 60% over the past decade during a time of increasing liberalization of cannabis policies. However, gaps remain in understanding the effects of legalization on prenatal cannabis use and whether they vary across groups.
Using 2016-2021 data on 94,347 women from 21 states and DC in the Pregnancy Risk Assessment Monitoring System, we conducted fixed effects probit regression models to examine the impact of recreational cannabis legalization on prenatal cannabis use controlling for demographics, other cannabis policies, year and state fixed effects. We included interactions to test for differential effects by demographic (age, education, race/ethnicity) and higher-risk (depressive symptoms, prenatal smoking) strata. We report average marginal effects.
Overall, 5.8% of women reported prenatal cannabis use. Nine states and DC legalized recreational cannabis by 2021. Recreational cannabis legalization increased prenatal cannabis use by 2.13 percentage points (0.021; 0.008, 0.034), with differential effects by race/ethnicity (p=0.02) and prenatal smoking (p=0.02). Recreational cannabis legalization increased use among white women by 2.57 percentage points (0.026; 0.012, 0.040), but not among other racial/ethnic groups. Legalization also increased use among women who smoked prenatally by 9.90 percentage points (0.099; 0.048, 0.150), but not non-smokers. There were trend interaction effects by education (p=0.07) and depressive symptoms (p=0.06), suggesting increased use post-legalization among women with less education and depressive symptoms. There was no evidence of age interactions.
Results indicate that recreational cannabis legalization had unintended consequences of increasing prenatal use, particularly among women who were white and from higher-risk groups. We will further test spillover effects of legalization on other substances to better understand the broader effects of cannabis policies on pregnant women.