The American College of Obstetricians and Gynecologists (ACOG) has released new clinical consensus guidance recommending universal screening for cannabis use across all reproductive stages—pre-pregnancy, pregnancy, and postpartum—with a clear message: there is no safe level of cannabis use for mothers or infants.

Despite mounting evidence of risk, cannabis use during pregnancy and lactation is increasing, fueled by legalization, social acceptance, and a lowered perception of harm. ACOG emphasizes that no medical indications exist for cannabis use during pregnancy or after birth.

To support prevention and care, ACOG’s clinical consensus on Cannabis Use in Pregnancy and Lactation provides evidence-based guidelines for screening, counseling, and reducing use.

Below are key takeaways from ACOG’s new clinical consensus.

Risks to Fetus and Newborn

  • THC, the psychoactive component, crosses the placenta and reaches the fetus; THC also transfers into breast milk.
  • Prenatal cannabis exposure is associated with:
    • Increased risk of low birth weight, small-for-gestational-age infants, NICU admission, perinatal mortality
  • Altered neonatal behaviors (arousal, regulation, excitability)
  • Possible long-term neurocognitive, behavioral, and memory challenges, ADHD, and greater susceptibility to psychiatric disorders or substance use later in life
  • While more research is needed, existing evidence shows clear cause for concern.

Risks During Lactation

  • Data on cannabis use while breastfeeding are limited; ACOG discourages use during lactation due to THC transfer into breast milk and potential developmental impacts.
  • Clinicians should encourage cessation while continuing to support breastfeeding.

Recommendations for Clinicians

  1. Universal Screening & Counseling
    1. Screen all patients (pre-pregnancy, pregnancy, postpartum) via interview or validated tools (e.g. TAPS, CRAFFT, S2BI).
    2. Avoid biologic testing (urine, hair, etc.) as a routine screening tool.
    3. Educate that cannabis has no medical indication during pregnancy or postpartum.
  2. Advise Cessation or Reduction
    1. Encourage patients to stop or reduce cannabis use during pregnancy and breastfeeding, offering nonjudgmental support.
  3. Supportive Behavior Change Strategies
    1. Use motivational interviewing, address social determinants, and identify barriers to quitting.
    2. Provide access to home visits, CBT, and digital or text-based supports for behavior change.
  4. Legal, Ethical, and Equity Considerations
    1. Policies on drug testing, child protective services (CPS) reporting, and criminalization vary widely.
    2. Black and minority birthing people are disproportionately subject to drug testing and CPS referrals, despite similar substance use rates.

Clinicians should ensure informed consent, understand local policies, and work to reduce bias in maternal care

Read the full ACOG Clinical Consensus: Cannabis Use in Pregnancy and Lactation here.

Drug Free America Foundation offers a FREE virtual course on marijuana, covering its history, cultural trends, evolving potency, marketing strategies, and health effects—including dedicated modules on pregnancy and breastfeeding. Register and enter code: DFAF_FL-MJ23

You can also access a wide range of science-based educational materials at https://www.marijuanaknowthetruth.org/marijuana-and-pregnancy/.

Coming soon! New resources on marijuana impaired parenting and child safety to help families and professionals address emerging risks.

If you live in Florida, you can request free printed materials through our state grant program—shipping included!

👉 Place your request here.