Advice About Cannabis Use While Breastfeeding, Maternal Risk Perceptions, and Perinatal Cannabis Use: A Cross-Sectional Study of 2017–2021 PRAMS Data

Background Clinical guidelines discourage cannabis use during pregnancy and lactation. The extent to which prenatal advice about cannabis use while breastfeeding is associated with maternal risk perceptions and perinatal cannabis use, however, remains unclear.Methods We analyzed 2017–2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 10 U.S. sites that included questions on cannabis counseling, examining the association between prenatal advice received during prenatal care about cannabis use during pregnancy and lactation and perceived safety of cannabis use while breastfeeding and perinatal cannabis use patterns. We conducted descriptive analyses using weighted descriptive statistics and chi-square tests.Results Among the weighted sample (N = 794,866), 25.46% (95% CI: 24.32, 26.62) reported receiving advice. There were significant sociodemographic differences in women who reported they were advised against breastfeeding while using cannabis compared to those that were not advised. Women who were asked about breastfeeding intentions more frequently reported receiving advice (27.77% vs. 6.1%, p < 0.001). Women who received advice were also more likely to report that cannabis use while breastfeeding was not safe (p < 0.001).Conclusions Prenatal counseling about cannabis use while breastfeeding remains limited but is associated with maternal risk perceptions. Strengthening patient–provider communication during prenatal care may improve maternal understanding of cannabis-related risks.