Opinion: Cannabis has become more legal. It’s time to update laws around use by pregnant people

STAT News · Mar 2, 2026 · Collected from RSS

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By Lauren Micalizzi and Elizabeth Tobin-TylerMarch 2, 2026 Micalizzi is a maternal-child health researcher and assistant professor of behavioral and social sciences at Brown University School of Public Health. Tobin-Tyler is a lawyer and professor of health services, policy, and practice at the Brown University School of Public Health and professor of family medicine and medical science at Brown’s Alpert Medical School. In December, President Trump signed an executive order to reschedule cannabis from a Schedule I to Schedule III controlled substance, meaning it is now considered to have accepted therapeutic uses and a lower potential for abuse. The move signaled acknowledgement of the medical potential of cannabis and its relative safety. More broadly, the moment marked a shift away from decades of strict prohibition and criminalization and towards legal acceptance and medical legitimacy. Unfortunately, that shift likely stops short when it comes to pregnant people. Most Americans live in a state that has legalized recreational cannabis use and 74% live in a state where it is legal for medical or recreational use. But counterintuitively, even in states where cannabis is legal for medical or recreational use, pregnant people are often reported to Child Protective Services and/or face criminal sanctions for use. As of 2024, 24 states define substance use as in-utero child abuse or neglect. Even in states that have legalized recreational use of cannabis, there have been cases of newborns being removed by CPS based solely on a mothers’ use of cannabis. In states in which possession and use of cannabis are still illegal, pregnant people have been arrested for using it based on alleged danger to their fetus. By comparison, alcohol exposure is less consistently tested for or reported, even though we have much stronger scientific evidence that it can harm a developing baby. Research shows that punitive cannabis policies disproportionately harm women of color, lead pregnant people to delay or avoid prenatal care, and often result in worse outcomes for babies. For this reason, the ethics of mandated reporting and criminalization have been called into question by many clinicians, researchers, and professional organizations. We share these concerns. To be clear, we still don’t have all the answers about cannabis use during pregnancy. Some studies suggest it may pose risks for pregnant people and their babies, while others find little to no effect. These mixed results likely have less to do with cannabis being uniformly “safe” or “unsafe” and more to do with differences in how studies are conducted. Regardless of what the science ultimately shows, the legal system does not always distinguish between the use of substances based on the legality or classification of the substance. As a growing number of states enact fetal personhood laws, the legality of cannabis use will likely mean little in protecting pregnant people from criminal or civil liability if state officials interpret cannabis use as harmful to the fetus. Trump’s executive order and the rescheduling of cannabis may further confound an already confusing landscape for pregnant people who are unsure about their legal rights. There is a strong possibility that rates of cannabis use in pregnancy will increase post-reclassification. Unfortunately, without a reevaluation of punitive policies in conjunction with the reclassification of cannabis, more pregnant people will likely be subject to punitive actions, such as CPS investigation and criminalization. Because substantial uncertainty surrounds the effects of cannabis use during pregnancy, calls to reconsider punitive policies should not be interpreted as tacit endorsement of prenatal cannabis use. The current evidence base contains too many unresolved questions to support such a conclusion. But even if cannabis is harmful, the current approach does not protect children or pregnant people. The reclassification of cannabis prompts broader discussions about the effectiveness and fairness of current drug laws and policies. We can and should use the rescheduling of cannabis as a catalyst for reevaluating and reforming punitive substance use laws to better align with scientific understanding. Drug policy reform that is grounded in scientific evidence would favor stigma-free counseling and treatment over punitive measures. If harmful laws remain unchanged, rescheduling risks becoming a Pyrrhic victory. State mandatory reporting laws that equate substance use with child abuse or neglect are not evidence based and can cause real harm to pregnant people and their families. Without reform, expanded cannabis legality may paradoxically increase legal consequences for those who are pregnant — undermining the very public health goals rescheduling is meant to advance. Lauren Micalizzi, Ph.D., is a maternal-child health researcher and assistant professor of behavioral and social sciences at Brown University School of Public Health. Elizabeth Tobin-Tyler, J.D., M.A., is a lawyer and professor of health services, policy, and practice at the Brown University School of Public Health and professor of family medicine and medical science at the Warren Alpert Medical School of Brown.