Claims for ocean space are growing while marine ecosystems suffer from centuries of insufficient care. Human pressures from runoff, atmospheric emissions, marine pollution, fishing, shipping, military operations and other activities wear on habitats and populations. Ecosystem-based marine spatial planning (MSP) has emerged worldwide as a strategic instrument for handling conflicting spatial claims among competing sectors and the environment. The twofold objective of both boosting the blue economy and protecting the environment is challenging in practice and marine planners need decision support. Cumulative Impact Assessment (CIA) was originally developed to provide an overview of the human imprint on the world's ocean ecosystems. We have now added a scenario component to the CIA model and used it within Swedish ecosystem-based MSP. This has allowed us to project environmental impacts for different planning alternatives throughout the planning process, strengthening the integration of environmental considerations into strategic decision-making. Every MSP decision may entail a local shift of environmental impact, causing positive or negative consequences for ecosystem components. The results from Swedish MSP in the North Sea and Baltic Sea illustrate that MSP certainly has the potential to lower net cumulative environmental impact, both locally and across sea basins, as long as environmental values are rated high and prevailing pressures derive from activities that are part of MSP. By synthesizing innumerous data into comprehensible decision support that informs marine planners of the likely environmental consequences of different options, CIA enables ecosystem-based MSP in practice.