Pregnancy and BreastFeeding

Marijuana and Pregnancy

Marijuana use during pregnancy can be harmful to a baby’s health and cause many serious problems, including stillbirth, preterm birth, and growth and development issues.

https://www.samhsa.gov/marijuana/marijuana-pregnancy


Maternal cannabis use is associated with suppression of immune gene networks in placenta and increased anxiety phenotypes in offspring

November 15, 2021

Significance

Cannabis use is becoming more prevalent, including during developmentally sensitive periods such as pregnancy. Here we find that maternal cannabis use is associated with increased cortisol, anxiety, aggression, and hyperactivity in young children. This corresponded with widespread reductions in immune-related gene expression in the placenta which correlated with anxiety and hyperactivity. Future studies are needed to examine the effects of cannabis on immune function during pregnancy as a potential regulatory mechanism shaping neurobehavioral development.

Abstract

While cannabis is among the most used recreational drugs during pregnancy, the impact of maternal cannabis use (mCB) on fetal and child development remains unclear. Here, we assessed the effects of mCB on psychosocial and physiological measures in young children along with the potential relevance of the in utero environment reflected in the placental transcriptome. Children (∼3 to 6 y) were assessed for hair hormone levels, neurobehavioral traits on the Behavioral Assessment System for Children (BASC-2) survey, and heart rate variability (HRV) at rest and during auditory startle. For a subset of children with behavioral assessments, placental specimens collected at birth were processed for RNA sequencing. Hair hormone analysis revealed increased cortisol levels in mCB children. In addition, mCB was associated with greater anxiety, aggression, and hyperactivity. Children with mCB also showed a reduction in the high-frequency component of HRV at baseline, reflecting reduced vagal tone. In the placenta, there was reduced expression of many genes involved in immune system function including type I interferon, neutrophil, and cytokine-signaling pathways. Finally, several of these mCB-linked immune genes organized into coexpression networks that correlated with child anxiety and hyperactivity. Overall, our findings reveal a relationship between mCB and immune response gene networks in the placenta as a potential mediator of risk for anxiety-related problems in early childhood.

https://www.pnas.org/doi/10.1073/pnas.2106115118


Associations Between Prenatal Cannabis Exposure and Childhood Outcomes -Results From the ABCD Study

September 23, 2020

Key Points

Question  Is prenatal exposure to cannabis associated with child outcomes?

Findings  This cross-sectional analysis of 11 489 children (655 exposed to cannabis prenatally) found that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology during middle childhood, even after accounting for potentially confounding variables.

Meaning  Prenatal cannabis exposure may increase risk for psychopathology; consistent with recent recommendations by the Surgeon General of the United States, these data suggest that cannabis use during pregnancy should be discouraged by clinicians and dispensaries.

Conclusions and Relevance  This study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2770964


931: Recommendations from cannabis dispensaries on first trimester marijuana use

Results

Of the 400 dispensaries contacted, 37% were licensed for medical (n=148), 28% for retail (n=111), and 35% were for both (n=141). The majority, 69% (277/400), recommended treatment of “morning sickness” with cannabis products (95%CI 64-74%). Medical dispensaries were more likely to recommend cannabis products (medical 83.1%, retail 60.4%, both 61.7%, P<0.001). However, recommendations for use did not differ by dispensary location (urban 70.9% vs rural 62.5%, p=0.14). Of dispensaries that recommended cannabis use (n=277), 26% encouraged use of cannabidiol (CBD) only products. The majority (65%) based their recommendation for use in pregnancy on personal opinion (Table) and 36% stated cannabis use is safe in pregnancy. While 78% ultimately recommended discussion with a health care provider, only 19% made this recommendation without prompting.

Conclusion

Nearly 70% of randomly selected Colorado marijuana dispensaries recommended cannabis products to treat nausea in the first trimester. Few dispensaries encouraged discussion with a health care provider without prompting. Policy and education efforts should target dispensaries as legalization expands.

https://www.ajog.org/article/S0002-9378(17)32282-2/fulltext


What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding

Cannabis and Cannabis-derived products have become increasingly available in recent years, with new and different types of products appearing all the time. These products raise questions and concerns for many consumers. And if you are pregnant or breastfeeding, you might have even more questions about whether these products are safe for you.

FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.

https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding


Parental Cannabis Use Tied to Child Psychosis Risk

April 11, 2018

FLORENCE, Italy — Both mothers and fathers who use cannabis during pregnancy are more likely to have children who experience psychotic symptoms, new research suggests.

An analysis of more than 3500 families showed that maternal cannabis use was linked to a 38% increased risk for psychotic symptoms in offspring at 10 years of age; cannabis use among fathers was associated with a 44% increased risk.

Led by Koen Bolhuis, MD, Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands, the investigators also found there was a similar association with offspring psychotic symptoms and maternal cannabis use both before and after pregnancy.

They conclude that these findings demonstrate “that maternal and paternal cannabis use were each associated with offspring psychotic symptoms at age 10 years, well before the risk period of adolescent cannabis use initiation.”

The findings were presented here at the Schizophrenia International Research Society (SIRS) 2018 Biennial Meeting.

Noting that the impact of maternal and paternal cannabis use was comparable, the investigators say this suggests that “common etiologies, rather than solely causal intrauterine mechanisms, underlie the association between parental cannabis use and offspring psychotic symptoms, shedding potential new light on the debated causal path from cannabis use to psychosis.”

They believe that “diagnostic screening and preventive measures need to be adapted for young people at risk for severe mental illness,” and they offer a family-focused approach.

Family Vulnerabilities

To determine whether parental cannabis use during pregnancy increases the risk for psychotic experiences in offspring, the team studied participants in the Generation R Study, a population-based birth cohort from Rotterdam, the Netherlands.

They included 3692 individuals for whom data on maternal cannabis use during pregnancy, assessed via self-report and the presence cannabis metabolites in urine, were available.

Paternal cannabis use was determined via self-report and maternal report. The presence of psychotic experiences in the offspring was assessed via self-report when the child was aged 10 years.

The team found that 183 mothers used cannabis; 98 did so before pregnancy, and 85 did so during pregnancy. In addition, 386 women continued tobacco smoking during pregnancy. Cannabis use was reported by 297 fathers.

On multivariate analysis that took into account various sociodemographic and psychiatric confounders, maternal cannabis use was associated with a significantly increased risk for offspring psychotic experiences (odds ratio [OR], 1.38; = .031).

Analyzing cannabis before pregnancy and during pregnancy separately, the ORs were 1.39 (= .097) and 1.37 (= .145), respectively, indicating a similar degree of association for both time points.

https://www.medscape.com/viewarticle/895073


Cannabinoids Exacerbate Alcohol Teratogenesis by a CB1-Hedgehog Interaction

November 2019

Abstract

We tested whether cannabinoids (CBs) potentiate alcohol-induced birth defects in mice and zebrafish, and explored the underlying pathogenic mechanisms on Sonic Hedgehog (Shh) signaling. The CBs, Δ9-THC, cannabidiol, HU-210, and CP 55,940 caused alcohol-like effects on craniofacial and brain development, phenocopying Shh mutations. Combined exposure to even low doses of alcohol with THC, HU-210, or CP 55,940 caused a greater incidence of birth defects, particularly of the eyes, than did either treatment alone. Consistent with the hypothesis that these defects are caused by deficient Shh, we found that CBs reduced Shh signaling by inhibiting Smoothened (Smo), while Shh mRNA or a CB1 receptor antagonist attenuated CB-induced birth defects. Proximity ligation experiments identified novel CB1-Smo heteromers, suggesting allosteric CB1-Smo interactions. In addition to raising concerns about the safety of cannabinoid and alcohol exposure during early embryonic development, this study establishes a novel link between two distinct signaling pathways and has widespread implications for development, as well as diseases such as addiction and cancer.

https://www.nature.com/articles/s41598-019-52336-w


New research shows marijuana THC stays in breast milk for six weeks

Date: March 8, 2021Source:

Children’s Hospital ColoradoSummary:

Researchers have found that tetrahydrocannabinol (THC), the psychoactive component of marijuana, stays in breast milk for up to six weeks, further supporting the recommendations to abstain from marijuana use during pregnancy and while a mother is breastfeeding.

https://www.sciencedaily.com/releases/2021/03/210308131719.htm


What do we know about the effects of CBD use during pregnancy and while breastfeeding?

There is no comprehensive research studying the effects of CBD on the developing fetus, pregnant mother, or breastfed baby. FDA is continuing to collect and study the data on the possible harmful effects of CBD during pregnancy and while breastfeeding. However, based on what we do know, there is significant cause for concern.

High doses of CBD in pregnant test animals have caused problems with the reproductive system of developing male fetuses2 . In addition, based on what we already know about CBD, we expect that some amount of CBD will be transferred to babies through breast milk.

We also know that there is a potential for CBD products to be contaminated with substances that may pose a risk to the fetus or breastfed baby, including THC. We have also heard reports of CBD potentially containing other contaminants (e.g., pesticides, heavy metals, bacteria, and fungus); we are investigating this.

Moreover, CBD has known risks for people in general. Based on clinical studies in humans, risks can include the following:

  • liver toxicity (damage)
  • extreme sleepiness
  • harmful interactions with other drugs

FDA is studying the effects of CBD use from different angles, such as: (1) the use of CBD-containing products, like food, cosmetics, or supplements, over a person’s entire life; and (2) the effects of using these various products in combination. There are many unanswered questions about the science, safety, and quality of products containing CBD.

We especially want to learn more about the effects of CBD during pregnancy and while breastfeeding, including, for example, whether and to what extent the presence of CBD in human milk harms the breastfed baby or the mother’s milk production.

Has FDA approved any CBD products and are there any benefits?

FDA has not approved any CBD products except for one prescription drug to treat rare, severe forms of seizure disorders in children. It is still unclear whether CBD has any other benefits.

Other than the one approved prescription drug, CBD products have not been evaluated or approved by FDA for use as drug products. This means that we do not know:

  • if they are safe and effective to treat a particular disease
  • what, if any, dosage may be considered safe
  • how they could interact with other drugs or foods
  • whether they have dangerous side effects or other safety concerns

The clinical studies that supported the approval of the one available CBD drug product identified risks related to the use of CBD, including liver toxicity (damage), extreme sleepiness, and harmful interactions with other drugs.

What about hemp seeds?

FDA recently completed an evaluation of some hemp seed-derived food ingredients and had no objections to the use of these ingredients in foods. THC and CBD are found mainly in hemp flowers, leaves, and stems, not in hemp seeds. Hemp seeds can pick up miniscule amounts of THC and CBD from contact with other plant parts, but these amounts are low enough to not raise concerns for any group, including pregnant or breastfeeding mothers.

What should you remember about using cannabis or cannabis-derived products?

If you are considering using cannabis, or any products containing THC or CBD, you should be aware of the following:

  • FDA strongly advises that during pregnancy and while breastfeeding, you avoid using CBD, THC, or marijuana in any form.
  • Although many of these products are being sold, FDA has not approved these products, other than one prescription CBD drug product and two prescription drug products containing dronabinol, a synthetic version of THC (which are approved to treat certain side effects of HIV-AIDS or chemotherapy). All three of these prescription products have associated risks and side effects.
  • Always talk with your doctor, nurse, or pharmacist before taking any medicines, vitamins, or herbs while pregnant or breastfeeding.

Do not put yourself or your baby at risk by using cannabis products while pregnant or breastfeeding. Check out these links to learn more about cannabis, marijuana, CBD, and THC, and about taking medicines while you are pregnant.


  1. https://drugabuse.gov/publications/research-reports/marijuana/can-marijuana-use-during-pregnancy-harm-baby
  2. Dalterio SL, deRooij DG. Maternal cannabinoid exposure. Effects on spermatogenesis in male offspring. Int J Androl. 1986 Aug;9(4):

    https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding