Understanding Marijuana Use During Pregnancy & Breastfeeding
Risks and Considerations for mom and baby
Increased legalization and increased use
Across the United States, increasing legalization of marijuana use in some states has been associated with greater public perception that marijuana use is safe, including among pregnant women. Some pregnant women view cannabis as a “safer alternative” to prescription medications for managing their nausea and vomiting symptoms and their pain.
As a result of legalization, cannabis use has increased nationally and is the most common illicit substance used during pregnancy, affecting up to 10% of births in some states. Pregnancy is a sensitive period in a woman’s life in which the health and well-being of both the mother and the developing fetus are paramount. Tetrahydrocannabinol (THC), the psychoactive compound in marijuana, crosses the placenta and reaches the developing fetus.
Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) advise against marijuana use during pregnancy and lactation. Your understanding of the potential effects on the developing fetus and risks of marijuana use during pregnancy is essential for making informed decisions. This article delves into the implications of using marijuana while pregnant, providing valuable insights for expectant mothers.
Prevalence of Marijuana Use During Pregnancy
With changing laws and attitudes towards marijuana, marijuana use is more widespread, including among pregnant women. Some expectant mothers turn to marijuana to alleviate pregnancy-related symptoms such as nausea, vomiting, pain, stress, and anxiety. However, it is crucial to weigh these potential benefits of THC use for the mother against the risks to the fetus and infant associated with marijuana use during pregnancy.
Marijuana and Pregnancy Symptoms - Nausea and Vomiting:
Some pregnant women use cannabis to manage severe morning sickness. While marijuana may provide temporary relief for severe nausea, the lack of long-term safety data and potential risks to the fetus make it a less advisable option. Alternative treatments, such as prescribed medications and dietary adjustments, should be considered first.
Marijuana and Pregnancy Symptoms - Stress and Anxiety:
Pregnancy can be a stressful time, and some women may use marijuana to cope with anxiety and stress. However, the potential adverse effects on fetal development outweigh the benefits to mom. Stress management techniques such as prenatal yoga, meditation, breathing exercises, and counseling are safer and more effective alternatives. Most prescription medications given for anxiety are compatible with use in pregnancy. Very few have been shown to alter in any significant way either fetal or infant neurodevelopment.
The Effects of Marijuana During Pregnancy
Pregnancy is a time of critical development and growth for the unborn baby, making it essential for expectant mothers to be cautious about their health choices. The use of drugs during pregnancy can have profound and lasting effects on fetal development, leading to various complications and health issues.
Research suggests an increased risk of stillbirth. It is not known if this is only because of marijuana use or due to use of other substances along with marijuana, such as cigarettes or alcohol.
Marijuana can make people dizzy and fall. Falls can be dangerous for pregnant women.
Marijuana also can alter your judgment, putting you at risk of injury.
Smoking marijuana lowers your body’s level of oxygen, which increases the risk of breathing problems, and smoking cannabis can damage your lungs.
Marijuana use can be addictive. Current estimates are that 1 in 10 marijuana users fit the definition of addiction. With addiction, a woman has difficulty stopping use of a substance even though it causes problems with relationships, work, or school.
Marijuana users also can develop marijuana use disorder. This disorder can cause withdrawal symptoms when you try to stop using marijuana. Symptoms include irritability, trouble sleeping, cravings, and restlessness. About 1 in 3 users can show marijuana use disorder.
Effects of Marijuana on Fetal and Infant Development
Marijuana use among women is more prevalent than ever before and marijuana is now more potent than ever before. In addition, there are some new practices for use, such as vaping which produces higher levels of THC in users.
Tetrahydrocannabinol (THC), the psychoactive compound in marijuana, crosses the placenta and reaches the developing fetus. Research indicates that exposure to THC during pregnancy can affect the brain development of the fetus. Potential risks include impaired cognitive functions, behavioral issues, and lower academic performance later in life.
Research has demonstrated that a mother’s prenatal marijuana use increases the risk of sudden infant death syndrome (SIDS), and cognitive and behavioral problems in her child(ren).
Studies have shown that marijuana use during pregnancy is associated with lower birth weights and an increased risk of preterm birth. These outcomes can lead to further health complications for the newborn, including respiratory issues, prolonged hospital stays, and developmental delays.
Emerging evidence suggests a link between prenatal marijuana exposure and neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders. While more research is needed to establish a definitive connection, these potential risks highlight the importance of caution.
Research studies have found an association between prenatal marijuana use and reduced neurodevelopmental scores in both verbal and memory domains on neuropsychological assessments of children at 4 years of age.
Prenatal marijuana use has been correlated with decreased attention, increased hyperactivity, and greater impulsivity in children at 10 years of age.
Prenatal marijuana use is also correlated with lower scores in reading, math, and spelling at 14 years of age.
Bottom line: Marijuana (cannabis) use during pregnancy and breastfeeding is risky.
Marijuana Use During Breastfeeding
Breastfeeding offers numerous short- and long-term benefits for both the mother and the baby, including optimal nutrition, decreased allergies and asthma, decreased infections such as otitis media, bronchiolitis and diarrheal disease, and decreased type 1 diabetes. However, substances consumed by the mother can transfer to the baby through breast milk, potentially affecting the infant's health and development.
Marijuana or cannabis use during breastfeeding exposes the baby to tetrahydrocannabinol (THC), the psychoactive component of cannabis, through breast milk. THC can accumulate in the baby's system and potentially affect neurodevelopment.
The psychoactive component of marijuana, tetrahydrocannabinol, is found in significant quantities in breastmilk after both weed inhalation and consumption of edibles. THC is bound to the fate in breastmilk.
Peak cannabis concentrations in human milk usually occur within 1-hour post ingestion and dissipate over time with a half-life of 17 hours. Unlike alcohol and other substances, THC stays in the body for a longer periods of time. In a 2018 study, detection of THC in breast milk was possible for up to 6 days. The THC concentration decreased very slowly about 3% per hour after exposure. One study showed that marijuana persists in breast milk for up to 6 weeks after use. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) advise against marijuana use during both pregnancy and lactation.
Similarly, the Academy of Breastfeeding Medicine (ABM) recommends that breastfeeding mothers reduce or eliminate marijuana use. ABM states that postnatal exposure to marijuana via breastmilk has been shown in some studies to negatively affect infant motor development.
Breastfeeding mothers are encouraged to abstain from marijuana use or seek alternative feeding options. Recommendations against marijuana use during lactation are based on the available evidence for adverse neurodevelopmental outcomes and other safety risks among exposed children.
Postnatal exposure to marijuana via breastmilk has been shown by some to negatively affect infant motor development.
Studies in older children suggest that marijuana use by preteens and adolescents is associated with lower intelligence quotients, impaired executive functioning, and slower cognitive function compared with healthy controls.
More recently, functional magnetic resonance imaging studies found evidence of altered brain function among adolescents with cannabis use disorder.
Collectively, these findings suggest that any marijuana used during pregnancy and while breastfeeding has the potential for short- and long-term adverse neurodevelopment among exposed children.
Secondhand smoke from marijuana may be as harmful as secondhand smoke from cigarettes, especially for young children.
Here is this pediatrician’s rationale for caution. If marijuana use among preteens and adolescents (whose brains are still developing) is associated with abnormal development, then it logically follows that any exposure to marijuana during a period of fetal and infant development would be equally, if not more, detrimental.
Advice for pregnant women and new mothers
By understanding the risks associated with marijuana, or cannabis, and making informed decisions, expectant mothers can ensure a healthy pregnancy and the best possible outcomes for their babies. Consulting healthcare providers, avoiding any potentially harmful substances, and exploring safer alternatives are key steps in safeguarding the health of both mother and baby.
It is crucial for pregnant women and new mothers to discuss any substance use, including marijuana, with their obstetrical and pediatric healthcare providers. Medical professionals can offer guidance, support, and alternative treatments to manage pregnancy-related symptoms without jeopardizing fetal health.
Given the potential risks associated with cannabis use during pregnancy, the safest approach is to avoid it altogether. Abstaining from marijuana ensures that the developing fetus is not exposed to THC and other potentially harmful compounds.
References:
Marijuana use during pregnancy and breastfeeding: Implication for neonatal and childhood outcomes
Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Academy of Breastfeeding Medicine Protocol #21.
Marijuana and pregnancy – FAQs. The American College of Obstetricians and Gynecologists.
Ko JY, Coy KC, Haight SC, et al. Characteristics of Marijuana Use During Pregnancy — Eight States, Pregnancy Risk Assessment Monitoring System, 2017. MMWR Morb Mortal Wkly Rep 2020;69:1058–1063. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a2.