Several sources could be promoting misperceptions that marijuana use is safe and beneficial for pregnant and breastfeeding women. One potential source is social media, through which misinformation about maternal marijuana use receives increasing spread, attention, and engagement. Analyses of Twitter communications suggest an increasing engagement with misinformation about benefits of marijuana use during pregnancy and breastfeeding . The proliferation of online support groups advocating benefits of use while pregnant and breastfeeding suggests growing popularity in beliefs that marijuana is a safe and affordable treatment for discomfort, depression, and morning sickness ; that it is safe because it is plant-based and natural; and that it facilitates breastfeeding. Qualitative interviews with pregnant women have documented these beliefs but systematic, quantitative examinations of endorsements of these beliefs in communities remain lacking. Another potential source of misperceptions is the legalization of marijuana for recreational and medicinal use in a growing number of states and regions. This trend could foster expectations that marijuana must be a safe substance if it is legal to use and it must be healthy if it is prescribed for medicinal purposes such as pain and depression. Among pregnant women, risk perceptions about the use of marijuana during pregnancy have decreased in recent years and these decreases might partly explain the increases in marijuana use by pregnant and breastfeeding women . If maternal marijuana use is expected to rise in line with the increases in beliefs about its safety and benefits,mobile grow system then it is essential to determine which beliefs about specific risks and benefits are commonly held and which cultural and social groups are prone to misconceptions.

This information can be used to identify specific beliefs to address and target audiences for health communications aimed at promoting informed decisions about using marijuana by pregnant and breastfeeding women.Whereas it is important to understand beliefs about maternal marijuana use held by adults across societies, understanding beliefs held by vulnerable populations hold particular importance given the likely health disparities if risk-elevating beliefs common within these communities are not addressed through health communications and interventions. The San Joaquin Valley is home to vulnerable, underserved communities that struggle with significant health disparities and lack of access to health care resources . Latinos make up the majority of residents and, more generally, represent one of the fastest growing ethnic groups in the United States . Latinos face numerous adversities that heighten their risk of substance use and have seen the most growth in marijuana use across ethnicities in the U.S. , further indicating the need to understand and target misconceptions within these communities.There is a paucity of evidence, and particularly quantitative data, on the beliefs about marijuana use while pregnant and breastfeeding held by community members, and particularly those residing in vulnerable and underserved communities. The aims of the present study were to address these research gaps by surveying community residents, with an emphasis on recruiting Latino, rural, and disadvantaged residents into the sample, to gather information about their beliefs regarding marijuana use by pregnant and breastfeeding women. The survey was designed to inform two primary research questions: What beliefs about the risks and benefits of marijuana use when pregnant or breastfeeding are commonly held by adults representing these rural and vulnerable populations? And How do these beliefs vary as a function of gender, ethnicity, marijuana use, and parental status? While the study aims are primarily exploratory, we made general predictions based on prior findings of social group differences in marijuana risk perceptions, substance use beliefs, or health risk perceptions more generally.

We predicted that risk beliefs would be lower and benefits beliefs would be higher for participants who had ever used marijuana and who had used marijuana in the past six months relative to those who had not ; participants who were not of Latino ethnicity relative to Latino participants ; male relative to female participants ; and participants who were not parents relative to parents .A network of 8 promotores de salud and 20 research assistants were trained to recruit and administer the survey to residents from counties within the San Joaquin Valley, California. The promotores network enhanced opportunities to recruit “hard to reach” community members, including those who reside in isolated geographic regions. Spanish-speaking promotores and research assistants provided Spanish versions of the survey to those who preferred it. The Spanish surveys were translated and back-translated by trained translators and then validated through focus groups with Spanish-speaking promotores. Promotores and research assistants recruited residents attending local events , community organizations , organizations serving parents , and home visits by promotores to community clients. Data collection took place between April 2019 and November 2019. Promotores and research assistants distributed informational fyers inviting adults aged 18 and older to participate in a 15–20-min survey about their views on marijuana use during pregnancy and breastfeeding. Participants who could not read or write in English or Spanish were offered the opportunity to have it read to them; three participants completed the survey in this manner. Upon completion, participants received debriefng information and a $20 gift card in a Table 2 presents rates of agreement with statements about benefits and risks of marijuana use while pregnant or breastfeeding for the total sample. A slight majority were either neutral about or agreed with the statement that using marijuana while pregnant helps to reduce pain and discomfort whereas 49% disagreed with this statement. In contrast, a strong majority of participants disagreed that marijuana use during pregnancy helps to reduce depression, has no lasting harms for the baby, is safe because it is plant-based and natural, and helps to reduce morning sickness and nausea.

Over 60% of participants agreed that use during pregnancy poses risks to the baby including attention and learning difficulties, lowered IQ, THC addiction, behavioral problems, brain damage, preterm birth, low birth weight,mobile vertical rack and pregnancy complications. Proportions who were neutral or disagreed with these statements ranged from 29.0% for risk of behavioral problems to 39.0% for risks of preterm birth and low birth weight. Comparable patterns of agreement emerged for beliefs about use while breastfeeding. A slight majority were neutral about or agreed that it helps to reduce pain and discomfort whereas a majority disagreed with the other five statements about benefits. Proportions of participants who were neutral or agreed with these five statements ranged from 24.7% for use helps calm the baby to 44.2% for use helps reduce depression. Over 60% agreed that use while breastfeeding poses risks to the baby including attention and learning difficulties, lowered IQ, THC addiction, behavioral problems, and brain damage. Proportions of participants who were neutral or disagreed with these statements ranged from 29.0% for risk of attention and learning difficulties to 31.9% for risk of brain damage. In response to items assessing beliefs about the presence and effects of THC in breast milk, 65.6% of participants believed that THC passes to the baby and has negative effects on the baby whereas 21.0% believed it passes to the baby and has positive effects on the baby and 13.4% believed that none to some THC passes to the baby and has no effect on the baby. Only 20% of participants gave the most scientifically accurate response that THC lasts in breast milk for 6 days to 2 weeks; 42% believed it lasts 0 h to 2 days and 37.3% believed it stayed in breast milk permanently.We used χ2 tests to determine differences in agreement with potential risks and benefits of marijuana use during pregnancy and breastfeeding as a function of marijuana use, Latino ethnicity, gender, and parental status. Table 3 presents the proportions of agreement with benefits and risk statements by participants who had ever versus never used marijuana. As predicted, those who had ever used marijuana were significantly more likely to be neutral about or agree with all statements about potential benefits of marijuana use while pregnant or breastfeeding, and to be neutral about or disagree with all statements about potential health risks of marijuana use while pregnant or breastfeeding. Analyses of differences between participants who had used marijuana in the past 6 months and those who had not revealed similar patterns of group differences.

Those who had used marijuana in the past 6 months reported higher agreement with all benefits statements and lower agreement with all risk statements for marijuana use in pregnancy and while breastfeeding . Latino and non-Latino participants were generally comparable in their agreement about benefits and risks of marijuana use while pregnant and breastfeeding, with the following exceptions in which, as predicted, Latino participants reported relatively more health-cautious beliefs . Fewer Latino than non-Latino respondents endorsed the beliefs that marijuana use during pregnancy reduces pain and discomfort and that it reduces morning sickness and nausea, and more Latino than non-Latino respondents agreed that use could lower a child’s IQ. For statements about marijuana use while breastfeeding, fewer Latino than non-Latino respondents were neutral about or agreed that it helps calm the baby and more Latino than non-Latino respondents believed that use increases the risk of attention and learning difficulties.In terms of gender differences, predictions that benefits beliefs would be higher and risk beliefs would be lower for male than female respondents were supported for 10 of the 24 beliefs . More males than females agreed that marijuana use during pregnancy reduces pain and discomfort whereas more females than males agreed that marijuana use during pregnancy increases the risks of preterm birth and low birth weight. With respect to marijuana use during breastfeeding, more males than females agreed that it helps to reduce pain and depression, poses no lasting harms to the baby, is safe because marijuana is plant-based and natural, and increases a mother’s milk supply. In contrast, more females than males indicated agreement that use during breastfeeding can lead to infant THC addiction and increase the risk of behavior problems.The present study revealed distinctive patterns of beliefs about marijuana use while pregnant and breastfeeding in a sample of residents in primarily rural, Latino-majority, and disadvantaged communities in California, a state that has legalized the use of marijuana for recreational and medicinal purposes. Taken together, the levels of endorsement of beliefs about benefits of use and lack of endorsement of beliefs about risks to infant health and well-being highlight the need for public health education about risks of maternal marijuana use in these communities and identify specific beliefs and community groups to prioritize in these educational efforts. Overall, the most common beliefs regarding marijuana use both during pregnancy and while breastfeeding are that it helps to reduce pain and depression. These beliefs are not supported by empirical research. In contrast with modest support that cannabis can reduce pain for people with chronic pain conditions , evidence that it reduces pain sensitivity is inconsistent , and research on the effects of marijuana on pain during pregnancy and while breastfeeding remains lacking. For depression, the evidence base suggests that cannabis can worsen rather than improve depression and, to our knowledge, no studies have tested its impact on depressive symptoms for pregnant and breastfeeding women. Almost 30% of participants reported neutral or positive beliefs that marijuana reduces nausea during pregnancy, another belief that is not empirically supported. Although some evidence suggests that cannabis can aid in pain relief and nausea in cancer patients , it is also positively linked with episodes of nausea and vomiting in cancer patients and the general public . Despite perceptions that cannabis reduces nausea during pregnancy and prevalent advice from cannabis dispensaries to use cannabis to alleviate pregnancy-related nausea , evidence remains lacking. In addition to the substantial endorsement of beliefs that use provides symptom relief for maternal users, up to 25% of participants were neutral about or agreed that it is safe because it is plant-based and natural and that it poses no lasting harms to the infant. Beliefs that use while breastfeeding helps calm the baby received the least endorsement, suggesting that it might be given lower priority in health communications and guidelines. Overall, these survey results are consistent with qualitative findings of benefit beliefs held by pregnant women and demonstrate that they are shared by community members more generally.