Is Cannabis Safe to Use During Pregnancy?

Cannabis is not recommended during pregnancy or breastfeeding. A product being natural, legal, or sold for medical use does not establish safety for a developing baby. If you use cannabis for nausea, sleep, pain, or anxiety, discuss alternatives and support with your prenatal clinician.

A Changing Landscape and the Perception of Safety

Changes in availability can influence perceptions of safety, but they do not replace pregnancy-specific evidence. The American College of Obstetricians and Gynecologists advises avoiding cannabis during pregnancy and breastfeeding.

The Science of Cannabis Use in Pregnancy

Cannabis houses numerous cannabinoids, with delta-9-tetrahydrocannabinol (THC) being the most recognized and studied. It is vital to note that THC can readily cross the placental barrier and reach the developing fetus. There’s a rich expression of endocannabinoid receptors in the fetal brain that THC can interact with. This interaction presents concerns about THC’s potential interference with essential processes of fetal neurodevelopment.

Adverse Pregnancy Outcomes – What Does Current Research Show?

Prenatal cannabis exposure has been associated with multiple adverse pregnancy outcomes in various studies. These include reduced birth weight, premature birth, smaller head circumference, and even stillbirth. However, it is crucial to understand that these findings need to be interpreted with caution, as many studies struggle to separate cannabis’s impact from other confounding factors such as alcohol, tobacco use, and socioeconomic variables.

Unfolding the Long-term Consequences

The CDC describes associations between prenatal cannabis exposure and later attention, memory, problem-solving, and behavioral difficulties. Observational findings do not predict an individual child’s outcome and can be affected by other exposures and circumstances. Uncertainty does not establish a safe dose or safe stage of pregnancy.

Professional Medical Guidance

Despite certain gaps in research, many professional medical bodies, including the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the American Medical Association (AMA) advise against cannabis use during pregnancy due to potential adverse developmental effects.

Safer Alternatives for Symptom Management

Cannabis’s popularity among pregnant women can, in part, be attributed to the relief it provides from pregnancy-induced nausea, vomiting, or anxiety. However, safer alternatives for managing these symptoms exist and should be considered. Prescription medicines, lifestyle modifications, dietary changes, and psychotherapy have proven effective in managing these symptoms. Consultation with healthcare providers is essential in exploring these alternatives.

In-depth Discussion on Current Research and its Limitations

The need for more definitive answers necessitates discussing the research methodologies and limitations inherent in current studies. Federal scheduling has changed for qualifying medical products under the 2026 medical-marijuana rule. These legal changes do not establish pregnancy safety, and ethical constraints remain central to research involving fetal exposure. Much of the research available to us comes from observational studies, which, although valuable, are subject to confounding variables and cannot definitively establish causality.

One of the more comprehensive studies on the topic comes from the Ottawa Prenatal Prospective Study (OPPS). The OPPS followed a cohort of pregnant women who used cannabis and their offspring over several decades, allowing for a long-term view of potential effects. While this study indicated certain deficits in higher cognitive functioning among offspring exposed to cannabis prenatally, it also highlighted the challenges of controlling for confounding variables like tobacco use, socioeconomic status, and postnatal environment.

An important nuance to consider is the changing potency of cannabis over the years. The cannabis used today is markedly more potent than the cannabis used in many historical studies. Therefore, the results from older studies might not apply to the cannabis used currently.

Filling the Gap – Ongoing Studies and Future Research

The growing popularity of cannabis use during pregnancy and the consequent public health implications underline the urgency for more research. Longitudinal research can help clarify associations, but findings from older exposure patterns may not transfer directly to today’s products. Clinical guidance should be based on the overall evidence rather than a promise that an ongoing study will establish safety.

Patient-Provider Dialogue

Despite the growing body of evidence leaning towards potential risks, a significant number of pregnant women continue to use cannabis, often without discussing it with their healthcare providers. There can be many reasons for this, including the stigma associated with drug use, fear of legal repercussions, or inadequate knowledge about potential risks. There is an urgent need for open, non-judgmental patient-provider communication about cannabis use during pregnancy.

Conclusion

Discuss cannabis use openly with your prenatal care team, including products used before you knew you were pregnant. Exposure is not a diagnosis of harm. The next step is individualized prenatal care and support for stopping, without replacing necessary prescribed treatment on your own.

CBD is not an established safe alternative in pregnancy. THC can also reach a baby through breast milk and can persist after use stops. Ask the clinician for a feeding and treatment plan if you are breastfeeding and finding it difficult to stop.