Table 3 Research and practice recommendations of included studies

Further robust studies among homogeneous populations, with stricter inclusion criteria and exclusion of multi-illicit substance use that aim to examine risks of cannabis exposure for both mother and infant during pregnancy and while breastfeeding [13, 14, 26, 28, 30, 31]

Health care providers should educate and counsel women about potential risks of cannabis use in a non-judgement way [14, 28], ensuring coverage of the following topics:

- impact of prenatal use on well-being of the fetus [12, 25]

- impact of prenatal use on well-being of the mother [27]

- avoiding exposure to second-hand cannabis smoke [13];

- adverse health outcomes associated with perinatal cannabis use [25]

- social norms and perceived safety [25]

- negative effects on fertility [27]

- marijuana use while breastfeeding [31]

Research on the etiology of prenatal cannabis use and how beliefs, knowledge, and perceptions influence use [12,13,14, 29, 30]

Screening and intervention for cannabis use, even in advanced pregnancy stages [14, 25, 30]

Impact of cannabis legalization (both medicinal and recreational) on women’s cannabis use and safety perceptions [12, 31]

Health care providers should be offered training, as part of evidence-based practice programs, to better communicate scientific uncertainty with patients [25]

Research on effective approaches to reduce cannabis use during pregnancy [12]

Breastfeeding mothers should be advised not to use marijuana or marijuana-containing products in any form while breastfeeding [31]

Examination of postpartum cannabis use relapse is warranted [12]

Cannabis use as a labor analgesia should not be recommended without evidence of its safety and efficacy [26]

A further study could address the specific timing of marijuana use on the sexual domains [32]

Health care providers should consider the benefits of counselling on cannabis cessation for patients that are attempting to conceive [27]

Extent of health care provider education, knowledge, and attitudes, and how these may serve as motives for cannabis use recommendations by health care providers [30, 31]

Clear, up-to-date messaging, potentially in the form of public health campaigns, on risks of prenatal cannabis use [12, 28]

Future research should examine effects of cannabis use on female fertility, including if a reduction in use among patients with infertility can improve conception rates [27]

Fertility clinics and government-funded fertility services that typically have eligibility criteria could consider adding cannabis use cessation or abstinence to the list of requirements [27]

Future research could aim to validate the survey items used [28]

A harm-reduction approach may be optimal for women who are unable or unwilling to discontinue using cannabis during pregnancy or while breastfeeding [13]