Abstract Background Cannabis is rapidly becoming legalized in the United States. While its effects on the developing fetus are not fully understood, current recommendations advise against cannabis use and exposure during pregnancy due to its association with negative outcomes, such as preterm birth, fetal growth restriction, low birth weight, and developmental deficits. If drug exposure is suspected, umbilical cord tissue (UCT) testing is growing in frequency as a tissue of choice when testing infants. Neonatal testing protocols vary between hospitals, including both targeted or universal collection and targeted or universal testing of neonatal specimens. Based on the current environment of legalization, we were curious to see what the changes in cannabis use were over the previous five years, from 2019-2023. Methods We queried our laboratory information system for reported findings from screening and confirmatory umbilical cord testing, both of which were analyzed via liquid chromatography tandem-mass spectrometry (LC-MS/MS). Results were analyzed using R coding software. Results Overall, annually, 2019-2023 positivity rates for testing in general ranged from 41% - 44% positivity and maintained at 44% from 2020 onwards (n=90384 total workorders 2019-2023, n=40551 total positive workorders). Cannabinoids were starkly the most common drug found, accounting for 59-63% of all positive workorders annually from 2019-2023. There were no statistically significant differences in the cannabinoid positivity rates between 2019-2023. Of note, cannabinoid-only (delta-9-carboxy THC) workorders accounted for 28% of all positive workorders (n=25962) during that time frame. This was followed by methamphetamine-only (n=2485 workorders) and buprenorphine-only (n=1765 workorders). The combination of cannabinoids and methamphetamine, the most common drug combination found in UCT testing, had a range of positive results from 2019 - 2023 of 2.9 - 3.6% (n=1327 workorders). Cannabinoids and cocaine, the second most prevalent drug combination, ranged in positivity from 1.3 - 1.6% from 2019-2023 (n=616 workorders). Conclusions Cannabinoid exposure is prevalent in pregnant individuals undergoing UCT testing. Physicians should take care to keep informed on the impacts of cannabis exposure on the developing fetus and educating clients on the effects of cannabis exposure during pregnancy.