Importance: As rates of prenatal cannabis use increase and cannabis legalization spreads across the US, studies are needed to understand the potential impacts of legalization from the perspectives of pregnant individuals who use cannabis.

Question: Is cannabis legalization for adult use associated with cannabis use behaviors among pregnant individuals?

Findings: This qualitative study of 53 pregnant individuals who used cannabis found consistent beliefs that legalization led to easier cannabis access (via retailers and delivery), greater acceptance (including reduced stigma, more patient-clinician discussions about prenatal cannabis use, and fewer concerns about Child Protective Services involvement), and trust in cannabis retailers (including safety and effectiveness of diverse products sold and perceptions of employees as knowledgeable, nonjudgmental, and caring).

Meaning: These findings suggest that pregnant individuals perceive legalization as having reduced barriers to prenatal cannabis use, which creates challenges and opportunities for supporting the health of pregnant individuals.