Is Cannabis Safe to Use During Pregnancy?

The utilization of cannabis, with its multifaceted properties, has been growing in popularity in recent years. While some may find relief from various symptoms through cannabis use, its impact during pregnancy poses a significant concern. This article aims to delve deeply into the available research and provide a comprehensive exploration of this topic.

A Changing Landscape and the Perception of Safety

Cannabis use has dramatically risen due to shifting societal perspectives and regulatory landscapes. According to the American Journal of Public Health, the prevalence of cannabis use among pregnant women has almost doubled in the past 15 years. This spike is, in part, due to the perception of cannabis as a ‘natural' and ‘safer' alternative for managing pregnancy-related symptoms such as nausea and anxiety.

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

Current research is starting to shed light on potential long-term consequences of prenatal cannabis exposure. There are suggestions of subtle changes in brain development leading to problems with cognitive functions, behavior, and academic performance later in life. For instance, a study in the journal ‘Drug and Alcohol Dependence‘ found associations between prenatal cannabis exposure and increased impulsivity and hyperactivity in school-aged children.

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.

The need for more definitive answers necessitates discussing the research methodologies and limitations inherent in current studies. The fact that cannabis is still a Schedule 1 drug according to the US federal law makes rigorous, randomized control trials challenging to conduct. 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. Several ongoing studies are aiming to fill the gap in our knowledge. One such study is the Healthy Start study, funded by the National Institute on Drug Abuse. This study plans to follow a large cohort of women and their children over time to examine the impact of prenatal cannabis exposure on developmental outcomes.

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

Given the potential adverse effects and the increasing trend of cannabis use during pregnancy, this topic deserves an in-depth and unbiased consideration. While we navigate through the complexities of this issue, the paramount concern should be ensuring the health and safety of both the mother and the developing fetus. Although definitive answers are currently lacking, the mounting evidence suggests that caution should be exercised with cannabis use during pregnancy. As more research unfolds, public health education and guidelines will need to be updated accordingly. Meanwhile, healthcare providers should emphasize open dialogue and provide evidence-based advice to women considering cannabis use during pregnancy.