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An Exploratory Qualitative Study of Screening, Testing, and Reporting Prenatal Cannabis Use by Recreational
Stacey E Iobst1, Yasmin Fendish2, Kara R Skelton3
1Department of Nursing, College of Health Professions, Towson University, Towson, Maryland, USA.
Birth (Berkeley, Calif.)
|June 9, 2026
Summary
State policies on prenatal cannabis use vary significantly, with universal maternal toxicology testing occurring in one-third of states, often against clinical guidelines. Nurses report ethical concerns regarding these testing practices.
Area of Science:
- Perinatal Health
- Public Health Policy
- Cannabis Research
Background:
- State-level recreational cannabis legalization is increasing, potentially contributing to higher rates of cannabis use among pregnant women.
- Understanding current practices for managing prenatal cannabis use is crucial.
Purpose of the Study:
- To examine policies and practices for screening, testing, and reporting prenatal cannabis use across multiple states.
- To identify how these policies differ based on state recreational cannabis legalization status.
Main Methods:
- An exploratory, multiple-case qualitative study was conducted.
- Perinatal nurses were interviewed using convenience and snowball sampling.
- Content analysis was used to analyze interview data.
Main Results:
- Universal verbal screening for cannabis use was common, except in one state with recreational legalization.
- Maternal toxicology testing was universally applied in nearly 25% of states, contradicting clinical recommendations.
- Positive test results often led to reporting to child protective services and discouragement of breastfeeding.
Conclusions:
- A significant portion of states (one-third) reported universal maternal toxicology testing, diverging from clinical guidelines.
- Nurses raised ethical concerns about testing, including biased reasons, lack of informed consent, and coercive practices.
- Current testing practices may have unintended health equity consequences, particularly concerning breastfeeding.
