Pediatrician Report Says Risk of Marijuana Use During Pregnancy Remains Uncertain

Doctors' groups recommend abstinence, but expectant mothers who suffer from severe nausea may reach different conclusions.


Oregon Health Authority

A new report from the American Academy of Pediatrics (AAP) provides a useful summary of the evidence concerning the effects of cannabis consumption during pregnancy, which remains mixed, ambiguous, and incomplete. Given the uncertainty, the AAP, like the American College of Obstetricians and Gynecologists, recommends abstinence during pregnancy and breastfeeding. But prospective mothers may reach different conclusions, especially if they suffer from severe nausea and find that marijuana relieves it more effectively than other medications.

"The evidence for independent, adverse effects of marijuana on human neonatal outcomes and prenatal development is limited," the AAP notes in its journal, Pediatrics, "and inconsistency in findings may be the result of the potential confounding caused by the high correlation between marijuana use and use of other substances such as cigarettes and alcohol, as well as sociodemographic risk factors. However, the evidence from the available research studies indicate reason for concern, particularly in fetal growth and early neonatal behaviors."

The AAP also looked at two longitudinal studies that have tracked the children of cannabis consumers through adolescence and early adulthood. "For more distal outcomes, such as later childhood and adolescent cognition and behavior, studies were limited in the environmental and sociodemographic variables that the authors could control, which could be expected to influence development across childhood and adolescence," it notes. "Despite these limitations and the relative paucity of research in this area, the findings regarding growth variables and neurodevelopmental and behavioral outcomes can be used to suggest that marijuana use during pregnancy may not be harmless."

Research on marijuana use during breastfeeding is even more limited, although a study reported in the same issue of Pediatrics found that THC could be detected in breast milk up to six days after the mother's last use of marijuana. The AAP says mothers should be "strongly encouraged" to "abstain completely from using marijuana as well as other drugs, alcohol, and tobacco" while breastfeeding. But it notes that the risks of exposing babies to cannabinoids do not necessarily outweigh the benefits of breastfeeding.

According to the National Survey on Drug Use and Health, the AAP notes, 4.9 percent of pregnant women used marijuana in 2016, compared to 11 percent of nonpregnant women. Those rates were up from 3.4 percent and 10.3 percent, respectively, the previous year. The AAP worries that "the use of marijuana is being touted on social media as an effective and safe treatment of nausea and vomiting of pregnancy," even though "there are currently no indications for its use during pregnancy." It says "pregnant women who are using marijuana or other cannabinoid-containing products to treat a medical condition or to treat nausea and vomiting during pregnancy should be counseled about the lack of safety data and the possible adverse effects of THC in these products on the developing fetus and referred to their health care provider for alternative treatments that have better pregnancy-specific safety data."

Yet cannabis is undeniably effective at relieving nausea, an indication for which synthetic THC has been approved by the FDA since 1985. Some women may find the alternatives to be less effective or less tolerable, and it's not as if they are completely risk-free. Here is what says about Compazine, for instance: "Animal studies have revealed evidence of harmful effects, and there is a possibility of teratogenic effects in humans. There are no controlled data in human pregnancy." There are similar concerns about Zofran, which an UpToDate summary nevertheless lists (along with Compazine) as an anti-nausea medication that is "safe to take during pregnancy," since it is not "known to be harmful." By that standard, cannabis also could be considered "safe," which really means that the risk is acceptable given the benefit, which may be huge for women who experience debilitating nausea during pregnancy.

The AAP does mention one well-established hazard of marijuana use during pregnancy: It can result in state-sanctioned kidnapping. "The 2010 Child Abuse and Prevention and Treatment Act requires all states to have policies and procedures for reporting newborns and other children who are exposed to illicit substances under the definition of child abuse and/or neglect," the AAP notes. "Because marijuana is still an illicit substance under federal law, this law applies to marijuana exposure in all states regardless of the legal status of marijuana use by adults in each state."

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  1. Those are going to be some chill babies

    1. Ha, is that real?

      1. Snopes said it was back when snopes was first a thing and still pretty honest. I strongly suspect real, yes.

  2. The articles premise buys into the idea that substances should be regulated if there is potential harm. Isn’t that contrary to libertarian philosophy?

    1. This comment conflates recommendation with litigation or legislation and personal harm with interpersonal harm. Isn’t that contrary to common sense?

    2. Actually it is very libertarian.

      Organizations like AAP (an excellent resource) are not the government. They are entirely internal to the profession. They cannot make any laws, rules or regulations. You do not need to be a member or anything. They are simply a resource for practicing docs who are not bound to follow any of the recommendations they make.

      They do not just issue a set of guidelines. As you can see in the link, they do extensive review of studies and present a referenced synopsis of the findings and relevant issues as well as strengths and limitations of the data so the docs can make their own informed conclusions.

      They are what keeps government from being even more intrusive in medical practice.

      1. People who disdain expertise, reject science, and resent accomplishment seem unlikely to make exceptions for babies and physicians.

        1. In other words, you.

  3. Once again, the worst thing that can be demonstrated about marijuana use is what the government will do to you and your children if it finds out you are using marijuana.

    1. This is untrue, smoking it is still pretty bad for you. Not really any worse than if you smoke cigarettes or lit pretty much any stick you picked up off the ground on fire and inhaled the combustion products. However, I’m pretty sure lots of lung cancer patients would consider serving time in the clink a trade up.

      1. The University of Southern California did a study to prove that very point; that smoking marijuana is bad and will cause lung cancer, etc.

        The study called for “heavy marijuana smokers”, described as one who smokes a joint a day for three weeks. The average participant admitted to three joints a day for fifteen years.

        The conclusion of the study? Heavy marijuana smokers are 16% less likely to develop lung cancer compared to those people who have never smoked anything.

  4. How about drinking a beer when you’re pregnant?

    Will the little one get drunk?

    1. Yes. Alcohol passes right though the placenta so whatever amount is is mom’s blood some of it is in the fetus.

      Is one beer or glass of wine harmful? Probably not. Is a bottle of vodka? Probably yes.

    2. I would not have expected to find an American adult unfamiliar with the term fetal alcohol syndrome.

      1. Drinking a single beer will not cause Fetal Alcohol Syndrome. I’d expect someone even the least bit familiar with the problem to know that. Which obviously leaves you out.

  5. “Some women may find the alternatives to be less effective or less tolerable, and it’s not as if they are completely risk-free. ”

    You don’t even mention Diclegis which is very effective and basically an antihistamine and vitamin b6 with virtually no side effects. Definitely fewer side effects than marijuana. I don’t care if a pregnant woman wants to smoke, it seems dumb to make that illegal even though it is legal to kill the fetus. But let’s not pretend she is doing it because she has no alternative. It’s a habit.

    1. And here’s the problem: it is known that there are (or at least can be) effects on the newborn, it just isn’t known what exactly those effects might be or their severity. My grandson’s mother smoked marijuana up to three days before delivery, my grandson was born “marijuana exposed” and spent the first five weeks of his life in NICU detoxing. In my view, if a mother’s drug use carries an unknown risk to the fetus then the only wise course is to abstain and find some other way to deal with the nausea or whatever. The first rule here is to protect the most vulnerable.

  6. That should have been a same-sex couple in the ad. Or maybe a threesome.

    1. At first, I thought it was two dudes which didn’t jive with the whole ‘pregnant mother’ thing.

      It really needs to have more infants holding bongs, maybe a crib with a mobile glowing under black lights.

  7. This reminds me about yesterday seeing Instapundit commenters freak out about “measurable” THC in nursing moms’ milk days after using weed.

    I did the math from what the linked article there said and it ended up being nanograms of THC per day for an infant.

    Sure, that’s six orders of magnitude (call it five, adjusting for mass differences) less than a “Get you high” dose in an adult, but they were just sure that the devil weed was gonna hurt babies and nobody should ever consider even the slightest chance of any exposure.

    The precautionary principle remains bullshit.

  8. This reminds me of an article in the Sept 1963 Alabama JAMA by one “Dr. Dana L. Farnsworth, Cambridge, Mass.”, variously reprinted, alleging that LSD has the power to Permanently Cripple the Mind. Chromosome damage fantasies soon followed. Then there were the 1980s articles about how freon over a chlorine-spewing volcano in Antarctica (pop 1000, in the Southern Hemisphere where 1/9 of humanity lives) was somehow causing a “man-made” ozone hole, therefore “we” must ban CFCs. When air conditioners began failing, articles soon warned that CO2 has the power to permanently cripple us with Global Warming. These things are presstitution for coercion at its gamy worst.

  9. A brief primer on how drug safety in pregnancy is reported, from the previously linked site.

    The key point being that very few drugs get an A rating, and those that do largely receive that rating because they are nothing more than an exogenous form of a substance naturally present in the human body (e.g. all three of the cited agents – levothyroxine, and liothyronine are synthetic versions of naturally occuring T4 and T3 thyroid hormone; and folic acid is a vitamin.) The rationale being, if we know they are already present in the healthy human, then at appropriate doses they must not pose a harm to the fetus.

    Beyond that everything else is based upon animal studies or anecdotal data, because any other form of testing in pregnant women is considered unethical, so is not done.

    Dronabinol (the synthetic THC mentioned in the article) is currently classified category C.

  10. Why of course expectant mothers should always abstain from using the evil marijuana.

    But don’t forget to get your flu shot!

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  12. Remains uncertain? I wonder what woman can consume cannabis purposefully during pregnancy even if it is considered as a cure of nausea and vomiting of pregnancy? And those numbers are immense to my mind, I’m shocked. You are responsible for your child even if it is on a fetus stage. After the first signs of pregnancy, I stopped using everything that even remotely might be harmful to a future child. Women, be conscious!

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