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Past 30-day self-reported prenatal cannabis use was assessed at nuMoM2b study visit 2 (16\u2009weeks and 0\u2009days-21\u2009weeks and 6\u2009days), visit 3 (22\u2009weeks and 0\u2009days-29\u2009weeks and 6\u2009days), and at delivery. Biologic detection of cannabis metabolite (11-nor-9-carboxy-delta-9-tetrahydrocannabinol) was performed with urine samples from visit 2 and visit 3 and the umbilical cord at delivery. The agreement between self-report and biologic assay was evaluated with a Kappa statistic. Factors associated with discordance were evaluated with multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings:<\/jats:title>\n                    <jats:p>Nine thousand one hundred sixteen participants were included, and 434 (4.76%) used cannabis by either self-report or biologic assay. Among participants who used cannabis, 74.5% of prenatal cannabis use at visit 2 and 79.6% of prenatal cannabis use at visit 3 was detected via urine assay and not self-report. Eighty-nine point seven percent of prenatal cannabis at delivery use was detected via cord assay and not self-report. The agreement between self-report and biospecimen assay was fair at visit 2 (Kappa 0.30, 95% confidence interval [CI] 0.24-0.36), fair at visit 3 (Kappa 0.23, 95% CI 0.17-0.29), and slight at delivery (Kappa 0.11, 95% CI 0.01-0.21). Age &lt;30\u2009years, being unmarried, government insurance, and moderate or high perceived stress were associated with discordance between self-reported use and biologic assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Nearly threefold more prenatal cannabis use was detected by biologic assay compared with self-report. The agreement was fair between self-report and urine assay during pregnancy and slight between self-report and umbilical cord assay at delivery. Several sociodemographic factors were associated with discordance between self-reported use and biologic assay results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342251389751","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T11:48:37Z","timestamp":1765367317000},"page":"576-582","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Self-Reported and Biologic Assessments of Prenatal Cannabis Use: Ancillary Analysis of a Prospective Observational Cohort"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7069-041X","authenticated-orcid":false,"given":"Paulina M.","family":"Devlin","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda 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Indianapolis, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Pippen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyagriv 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