In Reply We would like to thank Takakuwa and Schears for their interest in our Research Letter1 that showed an elevated prevalence of marijuana use among women with nausea and vomiting in pregnancy (NVP) by using data from a large California health care system. As noted in our letter, our cross-sectional study does not demonstrate causality. Although some women may use marijuana to treat NVP, marijuana use might also contribute to or worsen NVP. As such, further research is needed to tease apart the direction of effect.