Nearly all the information in the literature on the effects of cannabis in pregnancy have come from the users of delta 9 tetrahydrocannabinol (THC), and not cannabidiol (CBD) because the cannabis that was bought and sold up until about 10 years ago, had predominantly THC in it.
What are endocannabinoids and why are they important in pregnancy?
Cannabis produces phytocannbinoids and our bodies create endocannabinoids. Endocannabinoids are vital for successful fertilization, growth of the fetus, and survival of the newborn.
Immediately after fertilization, the endocannabinoids guide passage of the embryo through the oviduct and then assist in successful implantation of the embryo into the uterus. Endocannabinoids are instrumental in brain development as they help direct the undifferentiated cells to become the nerves that will eventually become the cerebrum, cerebellum, and brainstem. After the child is born, the endocannabinoids, already present and functioning in the newborn’s brain, stimulate postnatal suckling.
Prevalence of cannabis use in pregnancy
Cannabis use in pregnancy ranges from 3-16%. There is under reporting of its use due to the stigma that remains attached to it by the medical profession, and also because cannabis remains illegal in many states. The percentage of women who use cannabis in pregnancy progressively declines from 32% in the first trimester to 16% in the third trimester.
Barriers to measuring the benefit vs. risk of cannabis in pregnancy
It is difficult to determine the effects of cannabis on the unborn child because many mothers who use cannabis also engage in the use of alcohol, nicotine cigarettes, illicit drugs, and unhealthy lifestyle habits which may potentially jeopardize the health of the newborn.
In many cases, because of the problems caused by these drugs and the unhealthy lifestyle habits, the mother seeks out cannabis for self-treatment.
Cannabis & Structural Abnormalities in the Neonate
In two well-performed prospective studies, no association was found between cannabis use and structural abnormalities. (Linn et al 1983 n=1246) (Gibson et al 1983)
In one carefully done retrospective study, no association was found between cannabis use and neural tube defects. (Shaw et al 1996)
Cannabis & Preterm birth
No association was seen in several studies that were conducted comparing the duration of the use of cannabis in pregnancy with the length of the pregnancy. (Freed et al 1980 n=291), (Higson et al 1982 n=1690) (Zuckerman et al 1989 n=1226) (Linn et al 1983 n=1246).
Multiple prospective cohort studies and secondary analyses have failed to provide a definitive answer regarding the incidence of preterm birth. However, most of the studies performed suggested the absence of an increased risk of preterm birth with cannabis use.
Cannabis and Neurodevelopment
In persistent heavy users of cannabis, there were subtle effects observed in memory, language, IQ, focus, impulsivity, hyperactivity, behavioral problems, delinquency, executive functions, and depression. However, when considering all the confounding variables, (such as concurrent alcohol use, opioid use, tobacco use, & illicit drug use) there appeared to be no association between cannabis use and neurodevelopment.
In the only prospective study to-date, there was no association between cannabis use and normal brain development: forty-four Jamaican children were followed from birth to age five. Throughout pregnancy, twenty-four mothers used cannabis and twenty mothers did not. The children that were born to these mothers were all assessed serially from the day they were born until age five. No differences were seen in their developmental testing outcomes.
American College of Obstetrics & Gynecology (ACOG)
ACOG discourages all use of cannabis during pregnancy. The main reason is because there is an absence of governmental regulation. As a result of this, cannabis consumed by the public does not have appropriate federal oversite. Unfortunately, the absence of FDA approval also results in a lack of funding and support for the much-needed clinical trials needed to further our knowledge in cannabis use during pregnancy.
Professor Orna Diav-Citrin, M.D., works at the Ministry of Health in Jerusalem, Israel. She has an expertise in Epidemiology & Clinical Pharmacology. She has already published 67 articles which have been cited 3,199 times. In a lecture she gave at the 3rd International Medical Cannabis Conference held in Tel-Aviv October 2018 (which I attended), she discussed the use of cannabis during pregnancy and the health of the newborn.
Dr. Citrin explained that because all the studies to date have been performed on cannabis with THC, no conclusions can be drawn about the safety of CBD. However, the expert opinion is that CBD is safe.
Take home points:
Read next: Cannabis And Pregnancy, The Real Story: Getting Pregnant & Fertility (part 1)
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“Prenatal marijuana exposure and neonatal outcomes in Jamaica: an ethnographic study.”, Pediatrics. 1994 Feb;93(2):254-60.
“Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth.”, Clin Chem. 2010 Sep;56(9):1442-50.
“ACOG Committee Opinion.” The American Collee of Obstetricians & Gynecologists #722, October 2017
“Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring.”, Neurosci Biobehavioral Rev. 2006;30(1):24-41.
“Cannabis, the pregnant woman and her child: weeding out the myths.”, J Perinatology. 2014 Jun;34(6):417-24.
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“Chronic toxicology of cannabis”. Clin Toxicology (Phila). 2009 Jul;47(6):517-24.
“It’s not your mother’s marijuana: effects on maternal-fetal health and the developing child.”, Clin Perinatology. 2014 Dec;41(4):877-94.
“Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring.”, Br J Psychiatry. 2009 Oct;195(4):294-300.
“Safety and Toxicology of Cannabinoids.” Neurotherapeutics. 2015 Oct; 12(4): 735–746.
“Cannabis use during pregnancy: Pharmacokinetics and effects on child development.” Pharmacol Ther. 2018 Feb;182:133-151.
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