We read with great interest the report by Ko et al, exploring the prevalence of marijuana use among pregnant and nonpregnant women. Clearly this is a timely issue in light of the recent changes to marijuana laws in several states. Based on the data collected from several years of the National Surveys on Drug Use and Health, the manuscript suggests that women who are pregnant or are at risk of becoming pregnant should be screened for marijuana use. Given the far-reaching implications of this suggestion and the limited data reported in the current article, we believed that at least 3 issues warranted further discussion.

Universal screening of women of reproductive age for marijuana use seems unnecessarily invasive and sexist. We recognize that marijuana use, or other drug use, during pregnancy should be discouraged, but the current database does not reveal marijuana-associated fetal teratogenicity, highlighting the unjustified nature of the above proposal. Moreover, only women are proposed to be screened for marijuana use, which will uniquely expose them to legal consequences in regions in which the drug is banned.

This concern becomes even more pressing when one considers the impact of racial discrimination in the enforcement of drug laws. Black people are about 4 times more likely to be arrested for marijuana possession than their white counterparts, despite the fact that both races used the drug at similar rates. In other words, black women can expect to bear the brunt of the consequences that may follow.

Another concern is that the percentage of pregnant women who reported marijuana use is artificially inflated. Women were asked whether they were pregnant at the time of the survey; they were also asked whether they had used marijuana in the past 2–12 months. If they answered yes to both questions, then they were grouped as using marijuana during pregnancy. Because pregnancy duration is shorter than 12 months and because marijuana use could have occurred prior to becoming pregnant, it is inaccurate to refer to such women as reporting marijuana during pregnancy.

In the end, in our view the proposal to screen women for marijuana use does more harm than the drug itself, and we hope that in the future greater consideration will be given to the potential negative unintended consequences of drug policy recommendations.