{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:22:51Z","timestamp":1782922971749,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In recent years, state\u2010level recreational cannabis legalization has bourgeoned throughout the United States, which may explain increasing rates of cannabis use among pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our objectives were to: (1) comprehensively explore policies and practices related to screening, testing, and reporting prenatal cannabis use across a multi\u2010state sample, and (2) describe variations in policies and practices by state\u2010level recreational cannabis legalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an exploratory, multiple\u2010case qualitative case study of perinatal nurses using a combination of convenience and snowball sampling. Interviews were analyzed using content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 22 registered nurses from 15 states of mixed recreational cannabis legalization statuses (legal:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096, illegal:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099), universal verbal screening was reported in all but one state, which had recreational cannabis legalization. Nurses from nearly one\u2010quarter of states described universal maternal toxicology testing, which is inconsistent with current clinical recommendations. Although discouraged as a standard practice, nurses from most states described policies in which positive toxicology results were reported to social work and\/or child protective services. In response to positive toxicology results, changes in clinical practice reported by nurses included discouragement of breastfeeding, which may have concerning health equity implications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In contrast to clinical guidelines, nurses in one\u2010third of states reported universal maternal toxicology testing. Nurses reported ethical concerns about testing practices, including biased rationales for testing, failure to conduct informed consent, and threatening with punitive consequences to accomplish testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/birt.70083","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:21:02Z","timestamp":1780982462000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["An Exploratory Qualitative Study of Screening, Testing, and Reporting Prenatal Cannabis Use by Recreational Legalization Status"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6954-2903","authenticated-orcid":false,"given":"Stacey E.","family":"Iobst","sequence":"first","affiliation":[{"name":"Department of Nursing, College of Health Professions Towson University  Towson Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Fendish","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy and Occupational Science, College of Health Professions Towson University  Towson Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4531-0534","authenticated-orcid":false,"given":"Kara R.","family":"Skelton","sequence":"additional","affiliation":[{"name":"Health, Behavior and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"A.Leeds MatthewsandC.Hickey \u201cMore US States Are Regulating Marijuana. See Where It's Legal Across the Country \u201d CNN April 19 2024 https:\/\/www.cnn.com\/us\/us\u2010states\u2010where\u2010marijuana\u2010is\u2010legal\u2010dg\/index.html."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.15418"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.13651"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0138"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","unstructured":"United States Drug Enforcement Administration \u201cDrug Scheduling \u201dhttps:\/\/doi.org\/10.1201\/9781420009835.ax1.","DOI":"10.1201\/9781420009835.ax1"},{"key":"e_1_2_10_7_1","unstructured":"Centers for Disease Control and Prevention (CDC) \u201cCannabis and Pregnancy \u201dhttps:\/\/doi.org\/10.1007\/s11920\u2010024\u201001536\u2010x."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018\u20101889"},{"issue":"4","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/AOG.0000000000006053","article-title":"Cannabis Use During Pregnancy and Lactation","volume":"146","author":"The American College of Obstetricians and Gynecologists","year":"2025","journal-title":"Obstetrics & Gynecology"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018\u20101076"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0892\u20100362(90)90129\u2010z"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390\u2010022\u201002315\u20101"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13886"},{"key":"e_1_2_10_14_1","volume-title":"Guidelines for Perinatal Care","author":"American Academy of Pediatrics","year":"2017"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010022\u201004677\u20100"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010023\u201007009\u20105"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2022\u2010006897"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010020\u201003010\u20105"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100453"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2023.01.012"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.2058"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2020\u2010005765"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005385"},{"key":"e_1_2_10_24_1","unstructured":"D.Bishop L.Borkowski M.Couillard A.Allina S.Baruch andS.Wood \u201cBridging the Divide White Paper: Pregnant Women and Substance Use: Overview of Research and Policy in the United States \u201d (2017) https:\/\/publichealth.gwu.edu\/sites\/default\/files\/downloads\/JIWH\/Pregnant_Women_and_Substance_Use_updated.pdf."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002354"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2024.100274"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.07.010"},{"key":"e_1_2_10_28_1","volume-title":"Case Study Research and Applications: Design and Methods","author":"Yin R. 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