Although still illegal at the federal level, marijuana has been legalized for medical and/or recreational use in 29 states, causing a dynamically changing legal and social landscape. While the legalization of marijuana at the state level provides criminal protection for use by adults, there remain civil legal implications for families brought about by mandated reporting laws. Mandated reporting requirements have not been updated to account for the movement toward legalization, risking overload of community child protection resources. There is little evidence to inform development of guidelines and protocols for screening, educating, testing of mothers and newborns, and reporting. There are perinatal issues in this evolving environment as well. Discriminatory testing, length of time the drug remains in the system, potential for compromised provider-patient relationships, inconsistent education and referrals, breastfeeding during marijuana use, punitive or legal interventions that may have a negative psychosocial impact on a new family, and the risk for development of community standards of care based on opinion rather than science are just a few of the issues realized after marijuana legalization. These legal and perinatal issues are discussed in detail, along with considerations for practice and policy in caring for cannabis-exposed pregnant women and newborns.