This originally appeared at https://www.sciencedirect.com/science/article/abs/pii/S0091743517301755
Abstract
Cannabis use is common and increasing among women in the United States. State policies are changing with a movement towards decriminalization and legalization. We explore the implications of cannabis liberalization for maternal and child health. Most women who use cannabis quit or cut back during pregnancy. Although women are concerned about the possible health effects of cannabis, providers do a poor job of counseling. There is a theoretical potential for cannabis to interfere with neurodevelopment, however human data have not identified any long-term or long lasting meaningful differences between children exposed in utero to cannabis and those not. Scientifically accurate dissemination of cannabis outcomes data is necessary. Risks should be neither overstated nor minimized, and the legal status of a substance should not be equated with safety. Decreasing or stopping use of all recreational drugs should be encouraged during pregnancy. Providers must recognize that even in environments where cannabis is legal, pregnant women may end up involved with Child Protective Services. In states where substance use is considered child abuse this may be especially catastrophic. Above all, care for pregnant women who use cannabis should be non-punitive and grounded in respect for patient autonomy.
Introduction
The medicinal use of cannabis for ailments of the female reproductive tract has been recorded as early as 2737 BCE and has been used for treatment of migraines, menstrual cramps, labor pains and even induction of labor (Russo et al., 2002). Cannabis was a common ingredient in (so-called) “patent medicines” marketed specifically to women from the 19th into the early 20th century. Concern for cannabis-related social ills led to its criminalization in 1937 just a few years after the prohibition on alcohol was revoked. Medical literature consequentially shifted to focus on potential harms of use including during pregnancy and postpartum.
Although, at the federal level, cannabis remains classified as a schedule 1 drug, many states have liberalized cannabis laws allowing for medical and recreational use. As cannabis use is common and as changes in state policy may influence use patterns in pregnancy, we review the implications of policy changes for maternal and child health.
Section snippets
Background
Cannabis is a commonly used substance with 9.5% of reproductive aged women reporting past month use (SAMHSA, 2015). Use has increased over the past decade among both pregnant and non-pregnant reproductive-aged women and is most prevalent in women aged 18–25 (Brown et al., 2017). Pregnant women report less cannabis use (4.5% overall) compared with non-pregnant women and use decreases markedly through pregnancy (Mark et al., 2016 and SAMHSA, 2015). Pregnant cannabis users are more likely than
Patient motivation and provider counseling
Many pregnant women who use cannabis are concerned for their health and that of their baby-to-be and seek information about cannabis and pregnancy. However women report little receipt of concrete information from health care providers and turn instead to friends and the internet (Jarlenski et al., 2016).
Indeed providers do not appear to provide adequate counseling. In recent study evaluating providers' responses when patients self-disclosed cannabis use during a prenatal care visit, 23% of
Available evidence and its limitations
In fact, there is ample evidence concerning the health effects of cannabis during pregnancy. Neonatal outcomes of cannabis use in pregnancy were first described in 1982 (Hingsonet al., 1982) and there have been a wealth of publications since, as demonstrated in Fig. 1. Using the search strategy “pregnancy AND cannabis OR marijuana” in PubMed and limiting to human studies only reveals a marked increase in publications since 1990, with over 800 per year since 2000. The literature is robust enough
Legalization and its potential implications
In the non-pregnant population it is anticipated that use will increase with legalization (Hall and Lynskey, 2016), but it is unclear whether and how women's perceptions of cannabis and use patterns in pregnancy will change as states move towards de-criminalization and legalization. There are two small studies (published as abstracts only) from Colorado evaluating use before and after legalization. One, based on combination of self-report and urine toxicology, showed an upward trend in use (
Conclusion
Cannabis use is common and increasing among women in the United States. Liberalization of cannabis at the state level both reflects and will influence use and attitudes towards use during pregnancy. Although there is a theoretical potential for cannabis to interfere with neurodevelopment, human data drawn from 4 prospective cohorts have not identified any long-term or long lasting meaningful differences between children exposed in utero to cannabis and those not. Scientifically accurate
