Cannabis Use In The Childbearing Years

In this era marijuana is becoming legalized across the globe. Researchers and doctors are finding beneficial medicinal and medical treatments for the plant substance to treat conditions such as: nausea, anxiety and physical pain. It is a prevalent fear that cannabis use during pregnancy contributes to low birth weight, preterm birth, anemia and impaired higher order executive functions. However, as studies from JAMA, Obstetrics & Gynecology and Caleton University have shown, marijuana use during pregnancy has NOT been proven to be linked to adverse birth or child development outcomes. In at least one study, using cannabis prenatally actually showed to improve cognitive and reflexive function. 

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A recent study done by JAMA in 2017 noted that THC (tetrahydrocannabinol), an active ingredient in marijuana has anti-nausea treatment properties, and can be prescribed for this purpose in areas where the herb is legal and this can be an indication to treat morning sickness with marijuana. Marijuana, when available, is also used to help treat anxiety and physical pain or discomfort. JAMA reports that marijuana use is increasing in women of childbearing age (ages 18-44); from 2.37% in 2012 to 3.85% in 2014. In California, these numbers significantly increased from 4.2% in 2009 to 7.1% in 2016. In the pregnant teen population (under the age of 18) these numbers have soared from 12.5% to 21.8%. It is a prevalent fear that cannabis use during pregnancy contributes to low birth weight, preterm birth, anemia, and impaired higher order executive functions (JAMA, 2016).

In contrast, the 2016 journal of Obstetrics and Gynecology, found that cannabis use during pregnancy does not have significant impacts on birth weight or preterm birth. They also report, “We found that maternal marijuana use during pregnancy is not an independent risk factor for low birth weight or preterm delivery after adjusting for factors such as tobacco use. There also does not appear to be an increased risk for other adverse neonatal outcomes such as SGA and placental abruption once we account for other influencing factors” (Conner, Bedell, Lipsey, Macones, Cahill, Tuuli, 2016). There is a big question in this research about the toxic effects of any smoke entering the body versus strictly the characteristics and effects of marijuana on the body, or fetus, itself. Inhaling smoke (the byproducts of combustion) decreases oxygen supply to the brain, and can impair fetal growth, but this damage can be related to the properties of smoke, not cannabis itself. 

One study done in 1992 from Caleton University in Canada found that exposure to cannabis prenatally did not have any measurable impact on fetal development. This supports Dr. Melanie Dreher’s research in the 1980s that infants who were exposed to marijuana during the prenatal period actually performed better on cognitive function and reflex tests than infants in the control group. The Caleton University research studied 59 children in Jamaica from birth to 5 years of age using the Brazelton Neonatal Behavioral Assessment Scales (autonomic stability and reflexes) and the McCarthy Scales of Children's Abilities, direct observation and standardized questionnaires. No significant differences were reported in relation to child development or testing. 

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These studies are flawed because they do not state the amount of cannabis use that actually can bring harm to a fetus. They also do not differentiate between CBD or THC marijuana use, or smoking versus non-smoking digestive methods. CBD cannabis is used therapeutically due to its non psychoactive properties, as THC is the psychoactive component of marijuana.  These studies also do a poor job of doing long term studies on large sample sizes, and factoring in socio-economic and racial factors and elements.

In 2011 The University of Queensland and Mater Medical Research Institute stated, “it can happen that those who are not typical cannabis users (e.g., those from a higher socioeconomic background) may be more likely to underreport drug use. If this is the case, underreported cannabis use among women who maintain better birth outcomes may lead to overestimation of the association between cannabis use and adverse birth outcomes” (Hayatbakhsh, Flenady, Gibbons, Kingsbury, Hurrion, Mamun, & Najman, 2011). In addition, obtaining reliable data on quantity and quality of marijuana use, and isolating it from other factors such as tobacco and alcohol use, has been challenging. 

Another study done in 2017, also conducted by The University of Queensland and Mater Medical Research Institute reported that in a majority of cases, the report of cannabis use by a client was ignored by their medical provider, or even treated as a confession to a crime. 23% of healthcare providers failed to acknowledge the disclosure; while 48% did not provide any specific marijuana counseling in relation to its effects during pregnancy. The focus of these situations was focused more on legal implications and investigation by child protective services. Clients of African descent were reported to be ten times more likely to be recommended punitive counseling, and in contrast, clients of higher socioeconomic standing are more likely to have healthier pregnancies for reasons totally unrelated to marijuana consumption.

In conclusion, research reflects that cannabis use alone during pregnancy is not a contributing factor to adverse neonatal or birth outcomes. It is problematic to base actual research off of observational cohort studies, in relation to marijuana use, because they can miss factoring in subtle or indirect factors such as lifestyle or other substances involved. Self reports also have questionable validity by their nature. Pregnant women, in many situations and decision making processes, have to make the choices that are right and best for them and their baby. In relation to cannabis use during pregnancy, women should take caution during all forms of substance use, and use non-biased, informed decision making to the best of their abilities. 

References

Conner S.N., Bedell V., Lipsey K., Macones G.A., Cahill A.G., & Tuuli M.G. (2016). Maternal 

marijuana use and adverse neonatal outcomes: A systematic review and meta-analysis. 

Obstetrics & Gynecology, 128:713–23. doi:10.1097/AOG.0000000000001649

Hayatbakhsh, M., Flenady, V., Gibbons, K., Kingsbury, A., Hurrion, E., Mamun, A., & Najman, 

J. (2011). Birth outcomes associated with cannabis use before and during pregnancy. 

Pediatric Research, 71(2), 215-219. doi:10.1038/pr.2011.25 

Hayes, J., Lampart, R., Dreher, M., & Morgan, L. (1991). Five-year follow-up of rural Jamaican 

children whose mothers used marijuana during pregnancy. The West Indian Medical 

Journal, 40, 120-123. doi:unknown 

Mark, K., & Terplan, M. (2017). Cannabis and pregnancy: Maternal child health implications 

during a period of drug policy liberalization. American Journal of Preventive Medicine, 

104, 46-49. doi:10.1016/j.ypmed.2017.05.012

Volkow N.D., Compton W.M., & Wargo E.M. (2016). The Risks of Marijuana Use During 

Pregnancy. JAMA, 317(2):129–130. doi:10.1001/jama.2016.18612