Misinformation about Prenatal Use of Cannabis by Retailers Raises Safety Concerns: JAMA
USA: Cannabis use during pregnancy is linked to risks such as preeclampsia and low birthweight. In a secret shopper study of California cannabis retailers, about one in five incorrectly advised that cannabis use was safe during pregnancy, despite most recommending avoidance of blunts or tobacco.
These findings highlight the need for better public education on prenatal cannabis risks and clearer guidance encouraging discussions between pregnant women and their physicians.
The findings are from a cross-sectional study published in JAMA Network Open by Kelly C. Young-Wolff, Division of Research, Kaiser Permanente Northern California, Pleasanton, and colleagues.
The researchers examined how employees at licensed cannabis retailers—commonly referred to as budtenders—respond when pregnant individuals seek advice about the safety of using blunts, tobacco, or cannabis during pregnancy. As cannabis legalization expands, budtenders are increasingly viewed as accessible and trusted sources of information, raising concerns about the accuracy of guidance provided in the absence of formal medical training.
To assess real-world counseling practices, mystery shoppers posed as pregnant individuals and contacted randomly selected licensed storefront cannabis retailers across California. Telephone calls were conducted between February 26, 2024, and January 28, 2025. Callers followed one of two scripts, either mentioning a mental health reason for potential use or providing no specific indication, and asked about the safety of prenatal blunt, tobacco, and cannabis use. The study ultimately included responses from 505 retailer employees.
The key findings of the study were as follows:
- Most budtenders advised against prenatal use of blunts and tobacco, with nearly 80% stating that both were unsafe during pregnancy.
- Guidance on cannabis use during pregnancy was inconsistent, as only around 40% of employees described prenatal cannabis use as unsafe.
- About one in five budtenders explicitly indicated that cannabis use during pregnancy was safe.
- A comparable proportion reported being unable to offer advice on the safety of prenatal cannabis use.
- References to store-level or product warning labels were uncommon among budtenders.
- Many budtenders emphasized harm-reduction strategies over complete avoidance, such as recommending low- or no-THC products or reduced frequency of use.
- Non-smoking methods were often suggested, with edible cannabis products most frequently viewed as safer, while smoking was considered more harmful.
- Some employees suggested noncannabis approaches, including mindfulness or relaxation techniques, as alternatives during pregnancy.
- Fewer than half initially advised pregnant individuals to consult a physician, although recommendations to seek medical advice increased when specifically prompted.
- Responses were generally consistent regardless of whether a mental health reason for use was mentioned or whether the retailer offered delivery services.
The authors caution that the study has limitations, including its focus on licensed storefront retailers in California and reliance on single telephone interactions. The findings highlight a concerning gap between medical evidence and advice provided in cannabis retail settings.
The researchers emphasize the need for clearer, more visible health warnings and mandatory education for budtenders on the risks of prenatal cannabis exposure, ensuring that pregnant individuals receive information aligned with clinical guidelines and evidence-based research.
Reference:
Young-Wolff KC, Does MB, Negusse R, et al. Cannabis Retailer Advice on Blunt, Tobacco, and Cannabis Use During Pregnancy. JAMA Netw Open. 2025;8(12):e2548373. doi:10.1001/jamanetworkopen.2025.48373
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