Cannabis communication during prenatal care visits and perinatal health outcomes: A multi-state examination using a health equity and policy lens.

Cannabis use during pregnancy is a growing maternal and child health (MCH) issue in the US. At the same time that prenatal cannabis use prevalence has increased nascent evidence has found that in utero cannabis exposure is linked to adverse neonatal health outcomes (i.e. preterm birth small for gestational age (SGA) and admittance to the neonatal intensive care unit). Upward ticks in maternal cannabis use in recent years may be a result of the COVID-19 pandemic. Significant disparities exist in prenatal cannabis use across maternal sociodemographic characteristics and social determinants of health (SDOH). Thus prenatal cannabis use may further exacerbate health disparities in MCH outcomes. Effective clinician-patient communication holds great opportunity to reduce prenatal cannabis use and subsequent outcomes but has yet to be examined at a populationlevel in the US � a gap this research will fill. GOAL(S) AND OBJECTIVES: To reduce health disparities in MCH outcomes we will: (1) examine cannabis communication received during prenatal care visits across states and over time including variations in communication received across maternal sociodemographic characteristics SDOH and cannabis policies; (2) examine the association between cannabis communication during prenatal care visits and perinatal health outcomes including prenatal cannabis use and neonatal health outcomes and potential moderators of these associations; and (3) examine the impact of the COVID-19 pandemic on maternal cannabis use and maternal health outcomes and cannabis communication received during prenatal care visits.