Table 2. Potential Interventions and Research Opportunities to Leverage Legalization of Cannabis for Adult Use to Reduce Harms for Pregnant Individuals.

Theme and subthemes from focus groups	Potential interventions and research opportunities31
Greater access and exposure to cannabis
Retailer availability and delivery	Limit density of cannabis storefront retailers and delivery services Place caps on the number of retailers per inhabitant Mandate a required distance between retailers
Exposure to ubiquitous marketing and advertising	Increase advertising restrictions Test the effectiveness of requiring health warnings for prenatal cannabis use on cannabis advertisements, limiting advertisements (eg, banning all billboards), prohibiting discounts, and requiring plain packaging (eg, as done in Canada)32
Increased acceptance
Reduced stigma, more discussions with health care practitioners, reduced concerns about CPS	Leverage reduced stigma and the willingness of a pregnant patient to discuss prenatal cannabis use with health care practitioners Screen pregnant patients for self-reported prenatal cannabis use Empower and invest in training obstetric clinicians to initiate conversations about prenatal cannabis use and provide education about health risks in a nonjudgmental, supportive manner Connect patients with alternative medications or supplements that have been proven safe for pregnancy-related symptoms (eg, morning sickness) Repeal punitive policies related to prenatal substance use33
Trust in cannabis retailers
Trust in cannabis product safety	Alert consumers effectively about potential health risks of prenatal cannabis use Test the effectiveness of more prominent warnings on cannabis products Prohibit health and therapeutic claims on cannabis products related to cannabis use during pregnancy or while breastfeeding
Diverse product selection	Conduct research to understand the relative risks of different products and modes of use in pregnancy Seek a safer market of products Place stricter limits and taxes on high-potency cannabis products Prohibit cannabis products that are attractive to younger individuals (with the highest prevalence of prenatal cannabis use),34 including through flavors and imagery Clinicians should recommend and encourage abstinence while recognizing that patients have autonomy to make their own choices. If pregnant individuals choose to continue using cannabis, clinicians should encourage them to switch to safer products (eg, without tobacco) with potentially safer modes of administration (eg, from smoking to topicals).
Cannabis retailer staff as caring and nonjudgmental	Invest in training and education for budtenders and leverage their strong relationship with customers Conduct interviews and focus groups with budtenders to understand their willingness to talk with pregnant customers about cannabis Create educational materials and trainings for budtenders about the health risks associated with prenatal cannabis use and train them to share this information with customers Create educational materials and trainings to discourage budtenders from recommending cannabis use while pregnant or nursing and making therapeutic claims related to pregnancy symptoms (eg, nausea)