At the risk of sounding like a broken record, here is another post about the use of marijuana during pregnancy.  There are several reasons we keep coming back to this issue. There has been a significant increase in the use of marijuana among women of reproductive age, and this trend is likely to continue as more states legalize recreational marijuana.  While information regarding the reproductive safety of marijuana is limited, the research we do have suggests that there may be risks associated with prenatal exposure to cannabis, including fetal growth restriction, stillbirth, and preterm birth. One of the things that concerns us the most is that there is a tendency to overestimate the safety of marijuana.  

The first state to legalize marijuana as Colorado in 2012, and what goes on in Colorado gives us some sense of what the downstream effects of marijuana legalization look like.   In a recent study, researchers contacted 400 randomly selected dispensaries across the state of Colorado in order to learn more about the advice provided by dispensaries regarding the use of cannabis during pregnancy.  

Using a mystery caller approach, the caller stated she was 8 weeks pregnant and suffering from  morning sickness. During this initial phone inquiry, 69% (277/400) of the dispensaries recommended using cannabis products for the treatment of morning sickness. The majority (65%) based their recommendations on their personal opinion, and 36% stated cannabis use is safe in pregnancy. Ultimately, 81.5% of dispensaries recommended discussion with the caller’s  health care provider; however, only 31.8% made this recommendation without prompting.

 

The article included some of the responses dispensary employees to the caller’s inquiries.  These are sometimes amusing, but on another level, deeply concerning:

“Let me call my daughter, she just had a baby, call me back in 5 minutes.”

“Technically with you being pregnant, I do not think you are supposed to be consuming that, but if I were to suggest something, I suggest something high in THC.”

“Edibles would not hurt the child; they would be going through your digestional [digestive] tract.”

“In the context of edibles, start with a low dose and see how it works out for you because those types of things would, um, not cross the blood–brain barrier so even if you have got the CBDs and the other good parts of the plants would get in your baby’s blood system but the psychotropic properties, the THC molecule, would not get near your baby, so basically would not be getting your baby stoned.”

“I am not sure, I do not really know, I am not really too familiar with this, cause I do not want to give you the wrong information and find out it can be harmful to your baby, so I do not want to tell you the wrong thing; just one of my coworkers, she was pregnant and she was using flower and vaping.”

 

When you go to your doctor and request medical advice, there is an assumption that your doctor has received extensive training and has knowledge regarding the treatment of various medical conditions.  When you discuss your medication with your pharmacist, you also assume that they have received specialized training and knowledge regarding the use of medications.

But cannabis seems to live in a different realm.  Despite the term “medical marijuana”, we have limited information regarding the appropriate medical uses of cannabis.  One of the most alarming findings in this study is that medical marijuana dispensaries were more likely to recommend cannabis for morning sickness than dispensaries with a retail license (medical 83.1%, retail 60.4%, both 61.7%).  And exactly what kind of training do these employees receive? Who is at the end of the phone line. A doctor? A nurse? Do consumers know who is doling out this medical information?

At this point, we have no studies to indicate that cannabis is effective for the treatment of  nausea and/or vomiting during pregnancy; nor is there enough data to declare that marijuana is “safe” during pregnancy.

The American College of Obstetricians and Gynecologists is very clear on this one, stating that “obstetrician–gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during preconception, pregnancy, and lactation.”

 

Even the label, which the state of Colorado requires all dispensaries to use, states that there might be risks associated with using marijuana if you are pregnant or breastfeeding, or planning on becoming pregnant.  Based on this study, it seems that many of the dispensaries were either unaware of or did not believe the recommendations on the label.

Earlier this month, the Colorado’s Department of Health moved forward with the second phase of a public education program called “Responsibility Grows Here,” which will specifically target pregnant and breastfeeding women.  Their website outlines the limited information regarding the use of marijuana by pregnant and breastfeeding women and encourages women to discuss the use of marijuana with their health care providers.  Hopefully we can learn from Colorado’s experience.

Ruta Nonacs, MD PhD

 

Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use.

Dickson B, Mansfield C, Guiahi M, Allshouse AA, Borgelt LM, Sheeder J, Silver RM, Metz TD.  Obstet Gynecol. 2018 May 7.