Impact of warning signs on cannabis use during pregnancy


In a recent study, beliefs on cannabis use during pregnancy were not associated with exposure to warning signs.

Impact of warning signs on cannabis use during pregnancy | Image Credit: © Iarygin Andrii - © Iarygin Andrii -

Impact of warning signs on cannabis use during pregnancy | Image Credit: © Iarygin Andrii - © Iarygin Andrii -

According to a recent study published in JAMA Network Open, warning sign policies are not associated with reduced cannabis use during pregnancy (CUDP).

Policies regulating cannabis have been introduced in states where recreational cannabis is legal, including required warning sign policies in some states. However, data on the impact of these warning signs is lacking.

Increased rates of cannabis use have been observed and use during pregnancy has been linked to adverse outcomes such as low birthweight and adverse child psychological outcomes. Cannabis use after pregnancy discovery further increases these risks. 

This dataindicates a need for public health strategies to provide evidence-based information on the risks of cannabis use during pregnancy, but there is little evidence on the efficacy of warning signs. There are also risks of warning signs leading individuals to avoid prenatal care because of fears of punishment.

To determine the impact of warning signs on CUDP, investigators conducted a cross-sectional study. Participants were recruited from Ipsos’ web based KnowledgePanel. Eligibility criteria included being aged 18 to 49 years, a noninstitutionalized English- or Spanish-speaking individual, assigned female at birth, currently or recently pregnant, and living in a study state.

All states with legalized cannabis use were included as survey states. Recruitment occurred from May 23 to June 28, 2022, with up to 5 additional emails sent to potential participants as reminders. Investigators estimated a sample size of 2400 participants, expecting cannabis use would be reported by 25% of respondents.

Exposure was determined by living in a state with a warning sign policy or reporting having seen a warning sign within the previous 12 months. Beliefs about CUDP and warning signs were measured as outcomes of the study. These beliefs included believing use isn’t safe, perceived community stigma, warning signs perspectives, message fatigue, and support for punishment.

Survey questions were developed using peer-reviewed literature and community advisory board feedback. A 5-point Likert scale was used to measure responses. CUDP was also measured, along with covariates including age, education, sexual or gender minority status, race and ethnicity, marital status, gravidity, and pregnancy outcome.

There were 3571 participants in the final analysis, 2063 of which lived in states where recreational cannabis use was legal. Participants were aged an average 32 years, 71% had a recent pregnancy end in birth, 22.2% were currently pregnant, and 6.8% had a recent pregnancy without birth.

Cannabis use only before pregnancy was reported by 18.8% of participants, while CUDP was reported by 17.2%. Warning signs were seen by 14.3% of participants.

The presence of warning sign policies in states was not associated with changes in beliefs. In these states, an association between warning signs and a belief CUDP was safe was seen in those with CUDP, while an association between warning signs and a belief CUDP was unsafe was seen in those without CUDP.

When evaluating beliefs, only a belief in support for punishment was significantly associated with exposure to warning signs among individuals with CUDP. A belief that CUDP during pregnancy was safe in individuals who used cannabis before but not during pregnancy was also associated with warning signs.

Warning signs were not associated with belief outcomes in individuals not using cannabis. Overall CUPD was also not associated with living in a state with a warning signs policy. This indicates a lack of association between warning signs and CUDP.


Roberts SCM, Zaugg C, Biggs MA. Association of mandatory warning signs for cannabis use during pregnancy with cannabis use beliefs and behaviors. JAMA Netw Open. 2023;6(6):e2317138. doi:10.1001/jamanetworkopen.2023.17138

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