Multidimensional influences on prenatal cannabis use: A reflexive thematic analysis of low-income birthing people

Objective: Prenatal cannabis use has more than doubled in recent years, disproportionately affecting birthing people with lower incomes and mental health conditions. Despite this trend, research remains fragmented, and the voices of birthing people who use cannabis are largely absent. This study aimed to explore multidimensional influences on prenatal cannabis use, centering the lived experiences of those directly affected. Methods: Researchers conducted a reflective thematic analysis of secondary qualitative data from a community-based program in Wisconsin, where cannabis remains illegal. Nineteen pregnant cannabis users participated in interviews; most were Medicaid recipients, and nearly half reported household incomes below 10, 000. Lifecourse theory guided study design and analysis. Synthesized Member Checking was used to enhance credibility. Results: Five central themes emerged: pregnancy as a turning point in cannabis use; cannabis as emotional regulation; complex ties between cannabis and mental health; relational influences on use; and contextual barriers to informed and supported decision-making. Emotional regulation and mental health were the most cited drivers of cannabis use. Discussion: Findings highlight the urgent need for holistic prenatal care that addresses both substance use and mental health, and for public health messaging that is unbiased and evidence-based. Addressing prenatal cannabis use requires community-engaged, cross-sector strategies and structural policy reform. Without tackling systemic barriers—such as racial bias in screening and care—efforts to support birthing people who use cannabis will remain insufficient.