Do Pot and Pregnancy Mix?

The evidence concerning marijuana's effect on fetuses is mixed and incomplete.


Since 1985 cigarette packages sold in the United States have carried four rotating warnings from the surgeon general, including this one: "Smoking by Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight." Since 1989 the labels of alcoholic beverages have included this government-mandated warning: "According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects." Last week the American Medical Association (AMA) proposed a similar label for cannabis products:  "Marijuana use during pregnancy and breastfeeding poses potential harms."

The proposed warning represents a concession to political reality by the AMA, which opposes marijuana legalization but seems to recognize that pot prohibition is inexorably crumbling. The AMA's wording is notably milder than the warnings for tobacco and alcohol—appropriately so, since the evidence that cannabis consumption during pregnancy can harm the fetus is less clear than the evidence that smoking and heavy drinking can. In any case, providing information about marijuana's hazards is surely preferable to the punitive moralism of the war on drugs.

The latter approach still prevails in most of the country, as illustrated by what happened to Hollie Sanford and her baby girl, Nova. After Sanford gave birth at Cleveland's Fairview Hospital on September 26, Nova was snatched away from her because the newborn's first stool tested positive for a marijuana metabolite. Against the recommendation of county social workers (who are usually the villains in stories like this), Cuyahoga County Juvenile Court Magistrate Eleanore Hilow decided the drug test result by itself justified separating Nova from her parents. They were not reunited until November 9, after a judge overruled Hilow.

Sanford used cannabis tea to treat morning sickness and severe sciatic nerve pain while she was pregnant with Nova, as she had when she was pregnant with Nova's brother, Logan, who is now almost 2. Her research convinced her marijuana was a safer choice than the painkillers she had been prescribed, and she may be right about that. The Food and Drug Administration puts opioids such as hydrocodone and oxycodone in Category C, meaning "animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans," although "potential benefits may warrant use of the drug in pregnant women despite potential risks." The evidence concerning marijuana's effects on fetuses is likewise mixed and incomplete.

The National Institute on Drug Abuse, whose raison d'etre is highlighting the hazards of illegal intoxicants, says "research in rats suggests that exposure to even low concentrations of THC late in pregnancy could have profound and long-lasting consequences for both brain and behavior of offspring." It adds that "human studies have shown that some babies born to women who used marijuana during their pregnancies respond differently to visual stimuli, tremble more, and have a high-pitched cry, which could indicate problems with neurological development." NIDA also notes that "children prenatally exposed to marijuana are more likely to show gaps in problem-solving skills, memory, and the ability to remain attentive." But it admits that "more research is needed…to disentangle marijuana's specific effects from other environmental factors, including maternal nutrition, exposure to nurturing/neglect, and use of other substances by mothers."

That's a crucial concession. While animal studies can be carefully controlled to exclude alternative explanations for a given outcome, their results are not necessarily relevant to humans. Studies with human subjects, by contrast, are observational rather than experimental, since it would be unethical to randomly assign one group of pregnant women to use marijuana and another to abstain from it. So when a study finds, for example, that the children of women who consumed cannabis during pregnancy tend to be more impulsive as teenagers than the children of women who didn't, it is hard to say whether that's an effect of prenatal marijuana exposure or other factors associated with it.

The fact that studies do not consistently find such associations adds to the uncertainty. A widely cited 1994 study, for instance, used the Brazelton Neonatal Behavioral Assessment Scale to compare the babies of 24 Jamaican women who had used marijuana during pregnancy with the babies of 20 women who had not. At three days, there was no difference between the two groups. At one month, the children of the marijuana users actually had better scores, which the researchers attributed to "the cultural positioning and social and economic characteristics of mothers using marijuana that select for the use of marijuana but also promote neonatal development."

Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws, notes that other studies with much larger samples in the U.K., Australia, and the Netherlands likewise have found no evidence of fetal harm from marijuana exposure once confounding variables such as smoking and mother's age were taken into account. After reviewing the evidence, Armentano concludes that "there is not a definitive answer" to the question of whether marijuana use is "safe for moms or not," although he adds that "it may be arguable that potential pre-natal and post-natal dangers posed by maternal pot use—particularly moderate use—are rather minimal, especially when compared to in utero exposure [to] alcohol and tobacco."

After doing her own research, Hollie Sanford concluded that the possible risks posed by marijuana were acceptable in light of its medicinal value. Patients and their doctors make that sort of judgment all the time, as reflected in the FDA's allowance that the "potential benefits" of a Category C medicine such as hydrocodone "may warrant use of the drug in pregnant women despite potential risks." In the case of marijuana, those benefits may include relief of otherwise unbearable pain (like Sanford experienced) or the severe, life-threatening nausea that afflicts some expectant mothers.

Hilow, the magistrate who ordered Nova's removal from her parents' custody, was not interested in weighing the risks and benefits of medical marijuana. All she knew was that marijuana is illegal, meaning that someone who consumes it is ipso facto an unfit parent.

In a previous case, the Cleveland Plain Dealer reports, Hilow thought it was obvious that a man caught with marijuana in his home should lose custody of his son. When the psychotherapist treating the boy disagreed, Hilow was so outraged that she sought to have the therapist replaced. An appeals court "found that the boy should live with the father and that the therapist should continue to treat him."

Despite that experience, Hilow's prejudice against cannabis consumers was strong enough to override the recommendations of county officials who said separating Nova from her parents was not in the child's best interest. "There is no need to remove this child from her parents in order to protect her," an assistant county prosecutor wrote in an October 23 motion. "At this time, removal would only serve to disrupt the bond the child would develop with her parents during this important period in her life…Rather than protecting the child, removal may be more harmful to her both in the present and in the future."

Hilow was unmoved by that argument. Fortunately, Sanford's cousin agreed to take care of Nova to keep her from being placed with strangers in a foster home, and Sanford was allowed to visit Nova at her cousin's house during the weeks when Hilow's order was in effect.

"It's outrageous," attorney Joseph Jacobs, who represents Sanford and her husband, Daniel, told The Plain Dealer. "The decision has no basis in law or science. There was no harm done to this child other than the removal from her mom and dad." Jacobs told WJW, the Fox station in Cleveland, that the hospital should not even have performed the drug test, since the baby was born "very healthy and alert," the Sanfords did not consent to testing, and they are not on public assistance or covered by Medicaid, programs that require drug screening.

No mother, regardless of where she gets her health coverage, should be branded unfit simply because she used marijuana (or any other illegal drug) during pregnancy. Since drinkers and smokers do not lose custody of their newborn babies because they failed to abstain during pregnancy, it is plainly illogical to treat cannabis consumers that way, especially when they have compelling medical reasons to use marijuana. Such disparate treatment has nothing to do with the hazards posed by such behavior; it is due entirely to the arbitrary distinctions drawn by our drug laws. The fact that Hilow's cruel order was overturned in a state where marijuana remains illegal for all uses suggests that her brand of pharmacological bigotry is losing its power.

This article originally appeared at

NEXT: Can Marijuana Save This Colorado Town?

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  1. So this is the next libertarian frontier in the fight for legalization? Smoking pot while pregnant is cool? This is the position we’re going to stake out? For the sake of freedom, of course?

    Brilliant. Very shrewd.

    1. Why yes. I’m pregnant and smoking some reefer right now. If you don’t like it fuck off.

      1. Classy!

    2. Unfortunately, yes. Your line of thikning, (“weed is bad”) along with the AMA’s and the rest of society, is based on faulty science forced on our culture and the world, by an oppressive, restrictive and overeaching government. If ‘The Devil’s Cabbage’ is bad for you, let it be deemed so by a series of legitimate studies, not the fear mongering of our federal government and an ineptitude of our society to think critically.

      Assuming another culture’s perspective, smoking cannabis could be good for (or harmless to) the fetus, as the study suggests…

      1. I’m skeptical, and I say that as someone who has a financials stake in legal pot. If it were my wife, I would advise against it during pregnancy, similar to smoking cigarettes. It’s not like the shit is overly healthy anyway. Just not the huge death sentence prohibitionists make it out to be.

      2. Nor can you prove anything to mystical bigots. To let someone trip or snort or smoke right there on camera in front of a Senate Inquisition would only show the world that the prohibitionist position is pure superstition and fear of demonic possession. So it’s illegal to even research. Religions require people be miserable and suicidal enough for churches to pander to… freedom, pursuit of happiness, science and truth only get in the way of that.

        1. Funny that the use of cannabis was determined to be a sin by some 14th century Pope! But, since I was raised Catholic, I am fully aware of the fact that their errors are nothing new to society. Being a rebellious convert I have no reason, at all, to adhere to their beliefs.

          It find it irritating that some people assume that cannabis has any adverse effects with pregnant women, when it is hundreds of times less toxic than alcohol or cigarettes, when smoked! It is also magnitudes less dangerous in the tea form! To that person, Suicidy, that formed the opinion about the dangers of cannabinoids, without any proven research to back it up, and ignoring the fact that many people don’t smoke it…let the logical adults make their own decisions! I know how most wives respond to authoritarians! Anything else you won’t let your wife do?!

    3. She didn’t smoke, and I doubt marijuana is somehow worse for her child than the prescription nausea and sciatic nerve pain medication she would have been given.

    4. You should see what the average glibertarian thinks about DUI laws! It’s part of why I disagree with conservative Republicans and simply mock glibertarians.

    5. Chiperson is only saying that if our ultimate goal is to make libertarianism a viable political alternative to what we currently have, pot smoking pregnancy is a stupid fucking hill to die on.


      1. Exactly. It’s a stupid fucking argument to make if you’re hoping for anyone to take you seriously. Right up there with ‘stoned drivers are actually safer than sober drivers’.

        At some point common sense needs to kick in and tell you that these are simply not viable positions.

        1. Except that she’s not doing anything wrong. She is drinking a spiked tea to reduce nausea and decrease sciatic nerve pain.

          You can’t tell me that this is somehow inferior or even straight-out worse than the NSAIDs or Opiods she would be prescribed by a doctor. Those touch the fetus, too, but newborns aren’t even tested for those, much less having mothers arrested for it. The double standard is plain to see.

          1. In this case it probably is the lesser of two evils.

          2. THC’s palliative effect on nausea is well-documented. Brewed as a tea, it could have medicinal effects that benefit the mother and the baby as well. This type of usage should be treated differently than recreational usage in combination with tobacco, alcohol, meth, etc.

        2. Actually, experienced cannabis users are not statistically-significantly less safe drivers that non-users. Although scientific studies reveal this, to the uninformed, the statistics are counter-intuitive, which is why legalizers should avoid such arguments. Legalization is not about what someone should or shouldn’t do, but instead, about what government shouldn’t do.

        3. One man’s common sense is another more enlightened man’s counter intuitive recognition. Particularly in the absence of clear evidence that has been replicated many times over. Because “them” science researcher phuckers get it wrong with disconcerting frequency.

          Chip, you are so reasonable in expecting others to cave on their principles and reasoned understanding. You must be one of those reach around the aisle mavericks.

      2. Less stupid than more goddam pigs with loaded guns and altruistic murder in mind.

    6. Go ahead, make the case for goons with guns to shoot up the neighborhood and nationalize people’s assets instead. The looters have ALREADY TRIED coercion, and anyone who can add and subtract sees that murder is not viable policy. By the way, Trump Perot came out for applying the 21st Amendment to weed, and the GOP machine infiltrating Reason is struggling for a way to ignore or deny it.

    7. Libertarianism is legal reform movement, not a “do anything you want” movement. I know plenty of libertarians who don’t use drugs, alcohol or tobacco. Decades ago, a reporter for a major market newspaper reported that I was encouraging high school students to get high after I was invited to give a cannabis legalization presentation to a college class on “Drugs and Society”. It’s important to emphasize that legal reform is not an endorsement of the behavior being legalized.

      1. That distinction is perfectly valid. But this article by Sullum is not about legalization. It is a pseudo-endorsement of marijuana usage during pregnancy. Just like a recent article in which he said a legal pot industry couldn’t possibly have a pesticide poison problem (despite the reality of that existing now). And in all honesty, many libertarians really do get a hard-on simply opposing the evil ‘prohibitionists’ every time they can and they don’t care that they get left arguing in quicksand.

        Easiest way to marginalize many libertarians is to encourage them to open their mouth and start talking. In no time at all they’ll be siding with NAMBLA, ISIS, White Citizens Council, and crack-addict mothers. And then complaining about why they are irrelevant.

        1. I call BS, JaintFree. Most Libertarians adhere to the no harm principal. I’m pretty sure that crack addicted babies and pedophilia would fall under that. Nice try at disinformation if it were not so obvious, you trolling phucker.

    8. False Choice Chip. How about tolerance in the context of not prosecuting or kidnapping. No Libertarian endorsement of coolness desired, required or inferred. No one was stating it be put on the pregnancy food pyramid.

  2. Just give them thalidomide. That will solve all their problems.

    1. And many of those decrying the dangers of cannabinoids, in pregnancy, would not know why your comment is so damned sarcastic!…(;-P……….. LOL!

    2. Surely someone is working on a vaccine to eradicate another unsubstantiated health risk.

  3. I mean, I definitely wouldn’t think getting your fetus stoned can be a “good” thing. But considering the other things that are regularly prescribed to pregnant women such as SSRIs and opiates, how much worse can pot be?

    1. It likely isn’t. I just wish the title to this article made the situation more clear. I would certainly never recommend pregnant women smoke pot recreationally. Which is connotation the title leaves. Not a good way to sway the uninitiated to libertarianism.

    2. The alternative is men with guns pointed at their faces, pointed at farmers, grocers, druggists… Hello police murders?

  4. Is this the same AMA that in 1963 editorially shrieked that LSD and similar drugs “have the power to cripple the mind permanently?” The one that later fanned chromosome damage hysteria that soon impaired the nuclear industry? Media whores like the AMA are directly responsible for every death caused by agents with guns kicking in doors and shooting mostly teenage hippies over that pandering superstitious documendacity. There really are dangerous drugs. Morphine, whether acetylized into heroin or not is an addictive poison that atrophies the body’s ability to produce natural dopamines and also leads to wars. It is for this very reason that the principle of harm reduction calls for decriminalizing all of the relatively safe drugs like hemp, LSD, MMDA, MDMA, mescaline, psilocybin so as to reduce the demand for opiates. A similar consideration would call for decriminalizing cocaine in order to undermine demand for benzedrine-type synthetics. This prostitution of medical science to the whims of organized crime and superstition endangers lives because it prompts idiots to point loaded guns at peaceful citizens, crippling the minds and bodies of those that survive. Only the LP has a rational platform on these substances.

    1. Well said!!

  5. My mom smoked tobacco while she was pregnant with me, and I turned out all right. Some people may disagree because I was born a libertarian atheist.

    1. Wow, you were BORN Libertarian?

      1. And an atheist? I didn’t know that at one second old, the brain was developed enough to take political and religious positions.

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  7. Well, it’s only anecdotal evidence, but I’m a medical coder, which means I review thousands of medical charts a year, and on almost all the delivery charts I see where the mother smoked pot, the baby has intrauterine growth retardation, and a lot of those end up in the NICU. Of course, that is probably just the ones who smoke it regularly. The same is true of the women who smoke a lot of cigarettes, so I would advise against doing both. Babies with low birth weights can have a lot of problems.

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