Marijuana use during pregnancy: What clinicians need to know

https://www.healio.com/primary-care/womens-health/news/online/%7B68d34519-ed35-4601-b8a3-4e5daff71285%7D/marijuana-use-during-pregnancy-what-clinicians-need-to-know

Comment; Lower education level, socioeconomic status, unmarried, suffering from anxiety & depression–these are the women most likely to use pot regularly from 2005 to 2014 the use rate doubled from 5% to 10% in that group; married women use at a rate of 1%

CDC data show that 16.2% of pregnant women aged 18 to 44 years reported using marijuana nearly every day.

These findings recently prompted U.S. Surgeon General Jerome Adams, MD, to issue a warning to pregnant women, along with teenagers and young adults, about the dangers associated the drug.

“This ain’t your mother’s marijuana,” he said at a press conference.

Adams encouraged physicians to learn all they could about marijuana.

Healio Primary Care spoke with experts about the evidence regarding marijuana use among pregnant women, and what clinicians should know.

Unmarried women require ‘increased attention’

More than two dozen states and the District of Columbia currently have laws that allow marijuana use in some form, according toGoverning.

Some pregnant women are more likely to use marijuana use than others, according to study findings published in the International Journal of Epidemiology. Researchers found that, compared with women who did not use marijuana while pregnant, women using marijuana during pregnancy were younger, had lower educational levels and used alcohol more often.

Sehun Oh

Sehun Oh, PhD, an assistant professor at The Ohio State University College of Social Work, co-authored another study that analyzed marijuana use among more than 7,600 women who completed the National Survey of Drug Use and Health.

“We found that prenatal cannabis use doubled among nonmarried women — from 5% in 2005 to 10% in 2014,” he told Healio Primary Care. “On the other hand, only 1% of married pregnant women used cannabis, and the rates remained relatively stable throughout the period.”

Unmarried pregnant women who were diagnosed with anxiety and depression within the past year were also likely to use marijuana, Oh added.

“Increased attention should be paid to reducing prenatal marijuana use among unmarried women. Findings also suggest the need to attend to unmarried pregnant women’s mental health problems as well as their physical health risk behaviors,” Oh and colleagues concluded.

The American College of Obstetricians and Gynecologists’ Committee Opinion on marijuana use during pregnancy and lactation encourages physicians to ask all pregnant women about their marijuana use for nonmedical reasons.

Nora Volkow

Nora Volkow, MD, director of the National Institute on Drug Abuse, told Healio Primary Care that the Tobacco, Alcohol, Prescription Medication and Other Substance Use (TAPS) tool is a validated screening tool that physicians can use for that purpose.

“Pregnant patients should also be asked about any medications they are taking,” she added.

Marijuana’s dangers before, during and immediately after pregnancy

Maternal marijuana use before and during pregnancy has been associated with externalizing problems among offspring, which often led to aggressive and rule-breaking behavior as they grew older, according Hanan El Marroun, PhD, of the department of child and adolescent psychiatry at Sophia Children’s Hospital in Rotterdam, the Netherlands, and colleagues.

The findings were from a population-based cohort that included nearly 200,000 children whose mothers smoked marijuana.

“Shared familial confounding factors, such as socioeconomic position and parental behaviors (eg, poor diet) associated with both parental smoking and offspring behavioral problems, could confound the association of prenatal cannabis use and offspring behavior,” El Marroun and colleagues wrote.

The National Academies of Sciences, Engineering and Medicine analyzed several systematic reviews and studies. They found that mothers who smoked marijuana, either before or during pregnancy, had a significantly increased risk for anemia. There was mixed evidence whether these women were more likely to experience precipitous labor and require manual removal of the placenta. Women who used marijuana at least once a week before and throughout pregnancy gave birth to offspring that were approximately 84.2 grams lighter than offspring of women who did not use marijuana, the findings showed.

The ACOG Committee Opinion cited a study that concluded marijuana users had somewhat higher stillbirth rates vs. nonusers. However, the organization also warned that the data could not be adjusted for tobacco use and that the results became statistically insignificant when the estimates were pooled.

The National Academies National Academies of Sciences, Engineering and Medicine also found that marijuana use during pregnancy was associated with an increased risk for a shorter gestational age and neonatal ICU use. The evidence was inconsistent on how marijuana use impacted a newborn’s head circumference and infant Apgar score, particularly at 1 to 5 minutes.

Offer alternatives, be compassionate

Ellie Grossman

Ellie Grossman, MD, MPH, primary care lead for behavioral health integration at the Cambridge Health Alliance in Massachusetts, said it is important to not to refer to marijuana as illicit or illegal when treating pregnant women who use the substance.

“Women who are using marijuana to relieve a pregnancy-associated symptom should be offered options with stronger evidence for benefit and safety,” she told Healio Primary Care. “And of course, we should offer this advice in a compassionate manner, allowing women to seek help while not worrying about punishment. This ensures that the woman will stay connected to the health care system and get appropriate prenatal care.”