September 19, 2025
3 min read
ACOG’s Updated Recommendations on Cannabis Usage and Screening
The American College of Obstetricians and Gynecologists (ACOG) has released updated guidelines advocating for cannabis use screening across all stages of pregnancy and the postpartum period. This recommendation is crucial as the prevalence of cannabis use among pregnant women continues to rise, a trend that necessitates proactive discussions and interventions by healthcare providers.
Key Recommendations
- Universal screening should occur pre-pregnancy, during pregnancy, and postpartum.
- Interviews and self-reported questionnaires are preferred over drug testing to minimize bias and eliminate racial disparities in healthcare.
Growing Use and Perception
According to Dr. Melissa Russo, a co-author of the guidance, the increasing acceptability and legalization of cannabis have contributed to misconceptions about its safety during pregnancy. “There is a perception in the public that cannabis is safe to use during pregnancy with minimal adverse effects,” she explained.
Research has documented a notable increase in cannabis consumption among pregnant women in the U.S., doubling from 2002 to 2017, with a rise in the percentage of past-month usage from 3.4% to 7%.
Reasons for Cannabis Use
Many individuals use cannabis to alleviate symptoms of preexisting conditions such as chronic pain, anxiety, and insomnia, as well as pregnancy-related issues like nausea and stress. However, it is essential to note that ACOG does not endorse cannabis use during pregnancy or lactation due to potential risks, including:
- Low birth weight
- Small for gestational age
- Increased admissions to neonatal intensive care
- Perinatal mortality and neurocognitive impairments
Guidance for Clinicians
The new guidelines emphasize the importance of healthcare providers in guiding patients toward safe alternative options for managing health concerns. Clinicians are encouraged to engage in discussions regarding the risks associated with cannabis and explore suitable alternatives, which may include:
- Medications for anxiety and nausea
- Cognitive behavioral therapy and counseling for mental health disorders
Avoiding Racial Disparities
The guidance also highlights the need to avoid drug testing as a primary assessment tool, emphasizing that this method does not accurately measure substance use disorder severity. ACOG points out the disproportionate rates of drug testing among underrepresented racial populations, particularly Black women. This inequity could lead to unnecessary mandatory reporting to child protective services, which ultimately does not enhance neonatal health outcomes.
“For these reasons, ACOG recommends universal screening of all pregnant individuals during prenatal care for cannabis use by patient report,” Russo reiterated, stressing that biological testing should not be implemented as a screening strategy.
Conclusion
As societal attitudes towards cannabis continue to evolve, it is vital for healthcare professionals to remain informed and proactive in their screening practices. ACOG’s updated guidance aims to equip clinicians with the necessary tools to address cannabis use among pregnant individuals while ensuring equitable and informed care across all demographics.
