Kay Roussos-Ross

Many pregnant women are unsure if it’s safe to use marijuana or products containing cannabidiol, an active compound in marijuana, even as they increasingly turn to them to combat morning sickness, anxiety or insomnia, a recent University of Florida Health study shows. The American College of Obstetricians and Gynecologists advises against the use of marijuana and cannabidiol, or CBD, during pregnancy. Marijuana use has been associated in some studies with adverse fetal neurodevelopmental outcomes. Evidence of cannabidiol safety is sparse in human studies, but researchers remain concerned that it might nonetheless pose a danger. CBD is not intoxicating. The UF Health researchers said their study shows a need for the medical community to better educate women about the potential hazards to the fetus from using marijuana, also called cannabis. One worry is that some people believe the spreading legalization of marijuana or CBD around the nation equates to the government giving its stamp of approval that the products are safe, researchers said. Medical marijuana is legal in Florida, although its recreational use is not. “If a medication is legal, we assume that maybe it’s safe, although other things like tobacco and alcohol are also legal and we know that those can be harmful to pregnancies,” said Kay Roussos-Ross, M.D., the study’s senior author and a professor in the UF College of Medicine’s Department of Obstetrics and Gynecology. “We see a good deal of data out there that shows that there is increased risk of psychiatric and behavioral issues related to marijuana use in pregnancy, but we need more,” she added. “We need more so that we can be correct in our assessments and our educational efforts to women of reproductive age who are using marijuana.” It’s difficult to quantify the rise of marijuana and CBD use during pregnancy, with most estimates showing an increase predating COVID-19. A 2021 federal survey reported 7.2% of pregnant women used marijuana. The UF Health study noted that emerging evidence from obstetrics care shows more pregnant women are trying the products, perhaps because of increased legalization. The study, published in Medical Cannabis and Cannabinoids, surveyed 261 women and used focus groups to explore participants’ perceptions of the products. The women were either pregnant, breastfeeding or caring for a child 5 years old or younger, and reported use of marijuana or CBD products, such as vapes, smoking, tincture oils or ointments. “There seems to be a disconnect,” said Amie Goodin, Ph.D., an assistant professor in the UF College of Pharmacy’s Department of Pharmaceutical Outcomes and Policy and the study’s lead author. “About one in six pregnant women are telling us, ‘Yes, I have used marijuana or a CBD product while I’m pregnant.’ But half are saying, ‘I don’t know what the risks are.’” About 40% of the pregnant women surveyed said they were unsure how risky it was to use marijuana once or twice a week during pregnancy, compared with 34.5% of women who were not pregnant when surveyed for the study but who had children. Asked the same question about CBD, more than 52% of pregnant women were unsure of the risk, compared with 41.8% for mothers who weren’t pregnant when surveyed. About 36% of pregnant women reported using marijuana, compared with 65% of mothers not currently pregnant, perhaps reflecting at least some increased caution among those in the former group. CBD use was 19.9% for pregnant women and 38.2% for women who were not pregnant. “Some women did mention that the legalization of marijuana has made marijuana more socially acceptable,” said study co-author Deepthi Varma, Ph.D., an assistant professor in the College of Public Health and Health Professions’ Department of Epidemiology. The researchers said they were especially concerned that women were even less sure of the safety of CBD use because it is widely available and often seen as harmless. “You might notice that it’s even something that you can buy at a gas station or a grocery store,” Goodin said. “CBD in a purified form has actually got an FDA approval to treat certain types of pediatric epilepsy on its own … but pharmaceutical-grade CBD is not quite the same thing as you would expect to get if you were purchasing CBD oil at a smoke shop or a gas station.”

A program spearheaded by University of Florida physicians recently expanded to improve care for new mothers throughout the state, using tools they have right at home. Five years ago, a team of obstetricians and researchers at the UF College of Medicine launched MOMitor™, a smartphone app that allows new mothers to answer health screening questions and check vitals like blood pressure in the comfort of their own homes, using tools given to them by their health care providers. Depending on the data, the clinical team can then follow up with patients as needed for further medical intervention. Now, the app is expanding beyond North Central Florida — where nearly 4,400 mothers have participated in the program — to other areas in the state. Clinicians are also teaming up with data scientists at the College of Medicine who are using artificial intelligence to study data and identify trends that can lead to more personalized care. Program expansion Thanks to funding from the Florida Department of Health to support the state’s Telehealth Maternity Care Program, MOMitor™ has recently expanded for use in Citrus, Hernando, Sumter, Flagler, Volusia, Martin, St. Lucie and Okeechobee counties, said Kay Roussos-Ross, M.D. ’02, MPAS ’98, a UF professor of obstetrics/gynecology and psychiatry who is leading the program. “The Florida Legislature was really motivated and interested in improving maternal morbidity and mortality, and through this program we’re touching additional parts of the state and helping patients beyond North Central Florida,” she said. Maternal mortality is a serious concern in the United States, with more than 18 deaths recorded per 100,000 births in 2023, according to the latest data available from the U.S. Centers for Disease Control and Prevention. This is a much higher rate than most other developed countries, Roussos-Ross said. Common factors that may lead to maternal mortality, which is measured from pregnancy through the first year after giving birth, include infection, mental health conditions, cardiovascular conditions and endocrine disorders. Many of these complications can go unnoticed or unmonitored, particularly if at-risk mothers are not reporting complications to clinicians. A 2025 study published in the Journal of the American Medical Association shows that up to 40% of women do not attend postpartum visits. “By leveraging AI, we have the opportunity to target moms and moms-to-be who might be at greater risk of complications ... and encourage them to participate in the program to mitigate these.” — Tanja Magoc, Ph.D. “Whereas we’re used to seeing patients pretty routinely during pregnancy, after delivery visits quickly drop off and some women don’t make it back for postpartum care, so we may not have an opportunity to continue supporting them,” Roussos-Ross said. “This can often be because of barriers such as housing, transportation or food insecurity. We offer referrals to help with some of these services.” With MOMitor™, patients can let their clinician know how they are recovering without visiting the clinic, improving access to care in situations where that is not always an easy option for new mothers. “It’s a way to be proactive,” Roussos-Ross said. “Instead of waiting for a patient to come to us when they haven’t been doing well for a while, we connect with them through the app and follow up when they initially begin not doing well, so we can address concerns more quickly.” Studying data to personalize care Roussos-Ross’ team is collaborating with data scientists from the College of Medicine’s Quality and Patient Safety initiative, or QPSi, to determine how AI can assist in finding ways to further improve processes. “By leveraging AI, we have the opportunity to target moms and moms-to-be who might be at greater risk of complications, such as developing postpartum depression or hypertension, and encourage them to participate in the program to mitigate these complications,” said Tanja Magoc, Ph.D., the associate director of QPSi’s Artificial Intelligence/Quality Improvement Program. David Hall, Ph.D., a QPSi data scientist, said his team is working alongside the clinical team to analyze data that can be used to create recommendations for patients. “Everything we do comes from information supported in the patients’ charts,” Hall said. “We also make sure the data upholds compliance standards and protects patients’ privacy.” “We’re interested in finding out what areas might be hot spots and determining what makes them this way, so we can ... better identify areas where there may be high-risk patients and provide interventions to those who need it most.” — David Hall, Ph.D. The teams aim to intervene before patients encounter postpartum complications, addressing potential issues before they become significant problems. After taking into account a patient’s personal and family medical history, the team looks at information such as geolocation, drilling down to areas much smaller than the ZIP code level in order to find points of potential concern. “We’re interested in finding out what areas might be hot spots and determining what makes them this way, so we can study these patterns throughout the state and better identify areas where there may be high-risk patients and provide interventions to those who need it most,” Hall said. Roussos-Ross said she is proud of the work her team has done to improve patient outcomes through the program so far and is excited to empower more patients. “Every year, the participants give us recommendations on how to improve the app, which we love. But they also say, ‘This is so great. It helped me think about myself and not just my baby. It helped me learn about taking care of my own health. It made me remember I’m important too, and it’s not just about the baby,’” Roussos-Ross said. “And that is so gratifying, because women are willing to do anything to ensure the health of their baby, sometimes at the expense of their own care. This is a way for us to let them know they are still important, and we care about their health as well.”