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. 2025 Aug 19;16:100371. doi: 10.1016/j.dadr.2025.100371

Beliefs and perceived benefits and harms of perinatal cannabis use among pre- and post-pregnancy women

Rebecca K Denson a,b,⁎, Mayra Guerrero a, William Bond c, Anna Patterson d, Gina May a, Tamar Polatsek a, Robin J Mermelstein a,b
PMCID: PMC12410515  PMID: 40917597

Abstract

Background

Cannabis use in pregnancy is increasing, despite evidence linking perinatal cannabis use (PCU) to maternal and infant health risks. To investigate factors contributing to increasing PCU, this study used qualitative interviews to examine beliefs and perceptions of PCU.

Methods

Semi-structured qualitative interviews with pre- and post-pregnancy women examined beliefs and perceived benefits and harms of PCU. Interviews were transcribed and coded using a combined inductive/deductive approach. Thematic analysis identified themes related to beliefs, benefits, and harms associated with PCU.

Results

Twenty participants (50 % Black/African-American, 50 % White, 10 % Hispanic/Latina, mean age = 29.8 years) completed the study. Participants held contradictory beliefs about the safety of PCU, expressing ideas about both safety and potential harms. Perceived harms included themes of harm to infant/fetus, harm to pregnant women, and route of administration. Although most (75 %) participants had heard of potential PCU-related harms, participants were unsure about the accuracy of this information. Only one participant experienced PCU-related harm during pregnancy. Almost all (90 %) participants perceived benefits of PCU; these centered on coping with mental health symptoms, alleviation of pregnancy-related symptoms, and improved parenting experiences. Participants felt cannabis was effective in relieving perinatal symptoms of anxiety, depression, nausea, and vomiting.

Conclusions

Perceived benefits and perceptions that PCU is safe may underlie increasing prevalence. However, these beliefs and perceptions are nuanced, and may be influenced more by personal experience than information received about PCU risks. Education addressing pregnant women’s desire for credible, evidence-based information on PCU is crucial to inform decision-making and mitigate potential risks.

Keywords: Cannabis, Pregnancy, Perinatal, Risk, Benefit

Highlights

  • •

    In this qualitative study, beliefs about perinatal cannabis use (PCU) were nuanced.

  • •

    Most participants had heard of harms associated with PCU, but harms were often perceived as not credible or believable.

  • •

    Participants discussed PCU harms to pregnant people/infants and harms associated with route of cannabis administration.

  • •

    Participants believed PCU was beneficial in managing physical/mental health symptoms and improving parenting experiences.

  • •

    Perinatal people desire more credible education and information about the effects of perinatal cannabis use.

1. Introduction

Perinatal cannabis use (PCU) is increasing internationally (Brown et al., 2017, Tremblay et al., 2025, Singh et al., 2019). Urine-verified studies of PCU suggest a prevalence up to 22.6 % in the United States (U.S.; Howard et al., 2019) and 10 % in Canada (Drabkin et al., 2022). Globally, PCU is more prevalent among women with lower income and education levels (Singh et al., 2019), and in the U.S., among non-Hispanic Black women (Alshaarawy and Vanderziel, 2022). PCU increased following recreational and/or medical legalization of cannabis in some U.S. states and Canada (Brown et al., 2017, Taylor et al., 2021, Tremblay et al., 2025). Additionally, cannabis dispensaries have encouraged pregnant customers to use cannabis (Dickson et al., 2018).

Growing evidence suggests PCU poses health risks to pregnant women and fetuses/infants. This includes increased risk for gestational hypertension, preeclampsia, and placental abruption (Bandoli et al., 2021, Young-Wolff et al., 2024) and increased adverse fetal/infant health outcomes including preterm birth, structural malformations, neonatal intensive care unit hospitalizations, and low birth weight (Bandoli et al., 2021; Gabrhelik et al., 2021; Gunn et al., 2016; Nguyen and Harley, 2022). Long-term, PCU is associated with increased risk for adverse psychopathology and neurodevelopmental outcomes in youth (Baranger et al., 2022, Corsi et al., 2020, Paul et al., 2021).

Previous research suggests that perinatal women’s perceptions of harm associated with PCU are mixed; for example, some studies have found high perceptions of risk associated with PCU (e.g., Beatty et al., 2012), whereas others have reported that many perinatal women believe cannabis is safe to use in pregnancy (e.g., Foti et al., 2023; Macario & Thomas, 2022; Mark et al., 2017). Thus, it is unclear how pregnant women may view the safety or risks of cannabis use in pregnancy and how beliefs about risk perceptions may be formed.

The discrepancy between research demonstrating PCU-related harms and increasing prevalence of PCU may indicate that pregnant women are unaware of PCU risks or perceive greater benefits from PCU that contribute to use. To address this incongruity, this study qualitatively examined beliefs about PCU. This study expanded on prior work by probing specifically for perceptions about how harms may relate to administration mode (e.g., smoking, vaping, edibles) and examining perceptions of how cannabis impacts parenting among a racially and socioeconomically diverse sample.

2. Methods

2.1. Participants

Eligible participants were females ages 21–40 who had been pregnant or planned to become pregnant; used cannabis ≥  once/week; were fluent in English; and had Zoom access. Currently pregnant women were excluded due to the requirement for mandated reporting of prenatal cannabis use in Illinois at the time of the study.

2.2. Procedures

Recruitment included online postings, university listservs, and flyers. Eligibility screening included an online survey followed by a phone interview. Eligible individuals provided informed consent and completed an online questionnaire assessing demographics (see Table 1), pregnancy history, substance use, and the Cannabis Use Disorders Identification Test-Revised (CUDIT-R, Adamson et al., 2010). Participants completed 90-minute focus groups or individual interviews via Zoom, led by the first and last author using a semi-structured guide (see Supplementary Material). Three participants completed individual interviews due to other scheduled participants not arriving at the time of their scheduled focus group; all interviews and group discussions followed the same interview guide. The guide covered reasons for use, modality of use, beliefs, perceptions, and information received about PCU. Interviews were audio-recorded and transcribed verbatim for qualitative coding by graduate and undergraduate research assistants (RD, GM, TP). All procedures were approved by the University of Illinois Chicago Institutional Review Board.

Table 1.

Participant demographics, substance use, and pregnancy history (N = 20).

Variable Mean (SD) or Percent (N)
Age 29.8 (5.9)
Gender Identity
Woman 95 % (19)
Non-Binary 5 % (1)
Race/Ethnicity
Hispanic/Latina 10 % (2)
Black or African American 50 % (10)
White 50 % (10)
Annual Household Income
$0–19,999 15 % (3)
$20,000–39,999 20 % (4)
$40,000–69,999 25 % (5)
$70,000–99,999 20 % (4)
$100,000 + 20 % (4)
Pregnancy History
Been pregnant in past 75 % (15)
Number of pregnancies 1.35 (1.35)
Plan to become pregnant in the future 60 % (12)
Cannabis Use
CUDIT-Ra 11.5 (5.4)
Current cannabis use (days/week) 4.4 (2.2)
Current Tobacco Use
Cigarette use 25 % (5)
E-cigarette use 15 % (3)
Other tobacco/nicotine product use 35 % (7)
Current Alcohol Use
Never 5 % (1)
Monthly or less 30 % (6)
2–4 times/month 45 % (9)
2–3 times/week 20 % (4)
4 +  times/week 0 % (0)
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a

CUDIT-R =  Cannabis Use Disorders Identification Test-Revised. Possible scores range 0–32, with higher scores indicating more problematic cannabis use. Scores ≥ 13 indicate possible cannabis use disorder (Adamson et al., 2010).

2.3. Data analysis

Transcripts were thematically analyzed using a combined inductive (e.g., data-driven) and deductive (e.g., literature-based) approach (Braun and Clarke, 2006, Braun and Clarke, 2023). At the time of data analysis, there was no existing framework to the authors’ knowledge for understanding cannabis use in pregnancy via qualitative research. Thus, a literature review was conducted focused on factors related to PCU (e.g., reasons for PCU, information on PCU). We then summarized findings from the literature review to construct a preliminary set of primary (i.e., deductive) themes, including reasons for use, beliefs, and perceived harms and benefits of PCU. Subsequently, an iterative coding process was used to analyze transcripts and generate participant- and data-driven (i.e., inductive) subthemes that fell within broader categories of primary themes. For example, within the primary theme of PCU Benefits, subthemes of Coping with Mental Health Symptoms, Alleviation of Physical Health Symptoms, and Improved Parenting Experience were generated. First, two research staff (RD, GM) each independently analyzed transcripts from the first two focus groups line-by-line and generated lists of possible subthemes within each primary theme. Then, both lists of possible subthemes were examined and were refined and collapsed to develop a preliminary codebook, made up of main themes and subthemes. This codebook was entered into Dedoose (Version 10.0.25, 2025) to apply codes. Research staff (RD, GM, and TP; graduate and undergraduate research assistants) were trained on the codebook, and then two staff independently reviewed and coded each focus group/interview transcript. Primary themes and subthemes were refined throughout multiple, iterative rounds of coding and review of each transcript, and research staff and the codebook were updated accordingly. This allowed for researchers to generate new themes and refine previously generated themes across the entire dataset. At regular (weekly or biweekly) meetings between research staff, staff reviewed coding discrepancies, construction or refinement of themes, and application of codes. Kappa scores evaluating inter-rater reliability exceeded 0.9 (McHugh, 2012).

3. Results

Twenty participants completed the study. Half of participants identified as Black/African-American, half as White, and10 % as Hispanic/Latina; participants had a mean age of 29.8 years (Table 1). Main themes included PCU beliefs, PCU benefits, and PCU harms. No subthemes emerged within the main theme of PCU beliefs; this theme captured overall beliefs about safety, risk, and acceptability. Within benefits, subthemes of physical health symptom alleviation, coping with mental health symptoms, and improved parenting experiences were identified. Within harms, subthemes of infant/fetus harms, pregnant women harms, and administration route were identified.

3.1. Perinatal cannabis use beliefs

Participants’ beliefs about PCU safety and acceptability were influenced by personal experiences, comparisons to other substances, and skepticism toward traditional health messaging. Additionally, participants expressed a desire to learn more about the health effects of PCU. Sixty-five percent of participants (n = 13) expressed that PCU was safe, often citing their own experiences to challenge health warnings. Participants compared cannabis to other substances in considering risks. For example, one participant shared, “I smoked [cannabis] during my pregnancies. I didn’t see a problem with it…Anything I looked up was basically giving the same warnings as cigarettes–low birth weight…I don’t know, I had two pretty heavy babies. So, I think it was fine.”

Another shared, “I don’t think marijuana or even smoking cigarettes [during pregnancy] is as terrible as the information we’re given is.”

3.2. Perinatal cannabis use benefits

Almost all (n = 18) participants believed cannabis had benefits in pregnancy, and 45 % discussed personal experiences with PCU benefits.

3.2.1. Alleviation of physical health symptoms

Most participants (65 %, n = 13) perceived that cannabis could alleviate pregnancy-related symptoms including nausea, vomiting, pain, and difficulty sleeping, and 35 % (n = 7) described experiences with cannabis alleviating pregnancy-related symptoms. One shared her belief that cannabis was more effective than prescription medication for nausea:

“I had very bad morning sickness, and the only thing that helped was cannabis. They offered me Phenergan, and that didn’t help…It was to the point of losing weight, throwing up.”

Another described how cannabis improved sleep during pregnancy: “It would help me sleep…my mind would be racing, and I’d be able to go to sleep easier.”

3.2.2. Coping with mental health symptoms

Over half (55 %) of participants perceived that cannabis helped in coping with symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) during pregnancy. One shared, “I was very depressed during…pregnancy, and [cannabis]…relieved my tension.”

Another described substituting cannabis for medication to manage PTSD:

“When I was pregnant with my youngest…I was on anti-anxiety meds, PTSD was kicking in. They told me it’s not very safe to take Xanax and stuff like that while pregnant, so I stopped taking that. I was still smoking weed…While pregnant and not being able to take the medication for the PTSD, it did help me relax a lot more.”

Participants also wondered about long-term benefits of cannabis to mitigate mental health symptoms:

“I imagine if someone is…self-medicating for anxiety with cannabis, and they become pregnant, I know being really stressed during a pregnancy is bad for a baby. So, if [cannabis] was needed to…maintain your mental equilibrium, that would be a good thing for the mom and baby.”

3.2.3. Improved parenting experience

Participants believed cannabis enhanced their parenting by improving their capacity to be present with their children:

“Weed has made me a better mom in that…I'm not losing my patience with them…It's easier to unplug my brain from work, from the daily stressors…and let me focus on spending this time with my children.”

Another described how cannabis reduced parenting stress: “My son is pretty stressful…I usually go smoke, and then I come back in a better attitude.”

3.3. Perinatal cannabis use harms

Overall, 75 % (n = 15) of participants heard of PCU-related maternal/fetal health harms. However, most (60 %) doubted the accuracy of this information.

3.3.1. Harms to infant/fetus

Participants’ knowledge and perceptions about PCU-related fetal health risks varied. Seventy percent (n = 14) had heard of risks. One shared, “I’ve [heard] some stuff with regards to lower birth weight, or…preterm birth.” However, of these participants, 64 % doubted the believability of what they heard, often due to lived experiences or experiences of other pregnant women that appeared to contradict health warnings. For example, one participant described how personal experiences made her doubt information about PCU-related fetal health risks:

“My oldest came out and is a genius…So you’re telling me that this is gonna fry my baby’s brain, but I’ve had a baby who is unbelievably smart. There’s no way what you’re telling me could be 100 % accurate.”

Participants wanted to know more about long-term PCU-related health outcomes. One stated, “For me, hearing more stuff about down the line…could potentially make a difference.” Another wanted clearer information regarding harm: “I would like to see a timeline of when cannabis becomes harmful to the baby…Knowing when these sensitive timelines are that can really cause the most harm would be helpful.”

3.3.2. Harms to pregnant women

Only 10 % of participants perceived cannabis harmed pregnant individuals. One wondered about reproductive health harms:

“The only disadvantage for myself is [cannabis use] can affect my periods…If my periods keep being affected, what would be the worst case? Can it cause infertility, can it be linked to miscarriage?”

Only one participant endorsed experiencing harm during pregnancy: “I was coughing a lot; it was uncomfortable to cough with that big of a stomach.”

3.3.3. Route of administration

Approximately one third (35 %) of participants believed that administration route could impact PCU risks, although participants differed in which routes they perceived as harmful. One stated, “The smoking part, I’m gonna say no to when you’re pregnant, because the baby’s vitals are really particular about carcinogens and smoke being inhaled through the lungs…Then there’s edibles and gummies…I think that is a really big gray area.” In contrast, another shared her belief that ingested cannabis could be harmful: “I know that pregnant women’s diet changes… so I would assume if [cannabis] is ingested, it’s going to have some repercussions on the baby.”

Another participant was told by a healthcare provider to avoid administration routes that would expose her to tobacco:

“The gynecologist I had gone to, when I was complaining about the extreme nausea, I said the only thing that would help was weed. She just asked how I smoked it…and she’s like, okay, as long as you’re not smoking in blunts, ‘cause the blunts [have] tobacco in the wrappings…that can affect your lungs negatively. She didn’t say don’t do it. She said if you’re gonna do it, use it this way.”

4. Discussion

This study explored PCU-related beliefs, perceived benefits and harms among a diverse sample of women who use cannabis. PCU is more prevalent among lower income women and non-Hispanic Black women (Alshaarawy and Vanderziel, 2022, Singh et al., 2019), groups at-risk for worse maternal health outcomes (Hoyert, 2023, Jeong 2020). In this study, 50 % of participants identified as Black, and 35 % had annual household incomes < $40,000 (Table 1); thus, these findings may be relevant to a wider population of women compared to previous studies with less diverse samples.

The majority of participants believed cannabis was safe to use in pregnancy; however, participants held complicated and sometimes contrasting beliefs about safety. This suggests PCU beliefs are nuanced, and points to factors that may influence how these beliefs are developed or maintained. Participants described how lived experiences contributed to safety beliefs and contrasted health messaging about PCU-related risks. Thus, simply presenting information on PCU health risks may be insufficient to inform safety beliefs. Low believability of PCU health information may reflect overall decreased trust in the U.S. healthcare system post-COVID-19 pandemic (Perlis et al., 2024, Pollard and Davis, 2022).

Participants desired credible information on PCU harms, consistent with findings that pregnant individuals seek better PCU education (Jarlenski et al., 2016). Only one participant reported personally experiencing a PCU-related harm. This suggests a possible intervention point for healthcare providers and community health organizations centered on education from credible sources about PCU-related health risks. Pregnant women seek PCU information from online forums (Micalizzi et al., 2024), family and friends (Jarlenski et al., 2016), cannabis retail employees (Young-Wolff et al., 2022), and medical providers (Satti et al., 2022). Delivering accessible and accurate PCU information across multiple sources perceived as credible may be more effective for pregnant women (Hocevar et al., 2017; Trivedi et al., 2022).

Cannabis was perceived as beneficial in reducing pregnancy-related and psychiatric symptoms and improving parenting experiences, consistent with other studies (Barbosa-Leiker et al., 2020, Chang et al., 2019, Gunn et al., 2024). Benefit perceptions suggest a need for alternatives to help pregnant women manage overall well-being. Education about pharmaceuticals may also be beneficial, as some participants believed cannabis was safer or more effective than prescribed medications.

The study had several limitations. First, the study’s sample was comprised of pre- and post-pregnancy women, but pregnant women were excluded from the study due to mandated reporting requirements. Future research focused on beliefs about PCU safety and benefits should aim to assess perspectives of pregnant women who use cannabis. Additionally, the present study’s sample was small, limiting generalizability and preventing analysis of racial differences in themes, beliefs, and perspectives related to PCU. Given differences in PCU prevalence across racial and ethnic groups, future research should aim to recruit larger, diverse samples of perinatal women to further assess racial differences in experiences, beliefs, and perspectives related to PCU. Further, it is possible that the group discussion format of data collection may have influenced participants’ responses and contributions; for example, participants may have been reluctant to share some experiences and beliefs due to perceived social pressures.

The belief that PCU is safe was prominent in this sample of pre- and post-pregnancy women who use cannabis. While most had heard of PCU-related health harms, information received was often not perceived as credible. Participants wanted to learn more about maternal and fetal health effects of PCU. Research is needed to determine effective ways of communicating about PCU with pregnant women and alternative coping strategies for health concerns in pregnancy.

CRediT authorship contribution statement

Denson Rebecca: Writing – original draft, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. William Bond: Writing – review & editing, Funding acquisition, Conceptualization. Mayra Guerrero: Writing – review & editing, Methodology, Funding acquisition, Conceptualization. Gina May: Writing – original draft, Formal analysis, Data curation. Anna Patterson: Writing – review & editing, Writing – original draft. Robin J. Mermelstein: Writing – review & editing, Supervision, Resources, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Tamar Polatsek: Writing – original draft, Formal analysis, Data curation.

Funding

This project was funded in part by a grant from the Community Health Advocacy grant program of OSF HealthCare. RD was supported by grant number T32CA057699 from the National Cancer Institute. This paper’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Appendix A

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.dadr.2025.100371.

Appendix A. Supplementary material

Supplementary material

mmc1.docx (25.9KB, docx)

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