Can I Smoke Legal Marijuana While Pregnant?

Women who are pregnant are increasingly using marijuana to help treat their morning sickness, among other pregnancy-related problems or pre-existing conditions. Although evidence is limited, there are concerns regarding the effects of marijuana, such as low birth weight and other health-related issues that can arise from prenatal marijuana exposure.

Although using marijuana while you’re pregnant is not against the law in all states, some mothers are curtailing their usage of the drug because they fear they will harm the health of their unborn child. Pregnancy and medical marijuana use has been determined to be unsafe, and intrauterine cannabis exposure may cause long-term adverse outcomes for a baby’s health.

Here are some facts you should consider about maternal and fetal exposure and other adverse outcomes impacting infant development.

Prevalence of Estimated Marijuana Use During Pregnancy

Several studies have attempted to determine how many women use marijuana while pregnant, and the results vary. According to the American College of Obstetricians and Gynecologists (ACOG), marijuana has been found to be the most common drug used during pregnancy, with two to five percent of pregnant women using it.

Further, its use seems to be more prevalent in particular groups of women. For instance, there are higher rates of marijuana use, reaching up to 28 percent in urban women who are young and socioeconomically disadvantaged. Results from the National Survey on Drug Use and Health (NSDUH) on more than 200,000 women 18 to 24 years old revealed that 3.9 percent of expectant women claimed that they used marijuana in the past month.

Regardless of the exact usage, as a growing number of states legalize marijuana for recreational and medicinal purposes, the use of cannabis by pregnant women throughout the U.S. could increase even further. That could have a significant negative impact on public health.

Legality of Smoking Marijuana While Pregnant

While medical marijuana may be legal for people who need it, if you’re a woman who wishes to become pregnant and is already using it for medical reasons, are already pregnant, or are breastfeeding, the American College of Obstetricians and Gynecologists (ACOG) discourages your marijuana use.

In some states, the use of controlled substances during pregnancy can result in legal action from child protective services. Keep in mind that if a baby tests positive for THC at birth, hospitals may notify child protective services, leading to potential legal repercussions for new mothers. Even if you are not engaged in cannabis use, living with someone who smokes cannabis regularly can also pose substantial health risks to the developing fetus.

Marijuana Versus Tobacco

Thanks to public health education, we now know how harmful smoking cigarettes or using tobacco products are. Most expecting mothers would avoid using tobacco because they know that carbon monoxide and nicotine may cause an increased risk of birth defects (cleft lip or palate) and slower growth and development.

Cannabis has been legalized for less than ten years in most states. Therefore, there has not been the same public health effort to educate consumers about the risks of smoking cannabis. Marijuana smoke contains harmful toxins similar to those found in tobacco smoke, often in even higher concentrations. Some people may think that cannabis is not as harmful as tobacco, when in fact, both substances can cause the same health problems for infants whether the child is exposed during pregnancy or after birth.

Why Do Some Women Choose Cannabis During Pregnancy?

Unless you have been pregnant, it is difficult to imagine all the challenges of carrying a child to full term. Women face a variety of symptoms associated with pregnancy, starting in the first trimester of the child’s development.

Some of the most challenging symptoms that pregnant women endure include:

• Loss of appetite.
• Nausea and morning sickness.
• Anxiety.
• Migraines.
• Back pain.
• Depression.
• Hypertension (high blood pressure).

The types of prescription medications and over-the-counter (OTC) remedies that pregnant women can take are very limited. For the same reasons, cannabis use is not advised for pregnant women. Some women experience very mild symptoms during pregnancy, while others endure severe and debilitating symptoms that can continue for months after the birth of their child.

It is easy to understand why using medical marijuana during pregnancy appeals, despite the warnings and the risks associated with maternal marijuana use. Mothers need to realize that cannabis, drug, alcohol exposure and low nutrition can impact brain development and cause lower birth weights, child behavior problems, learning deficits, and more.

The Risks of Consuming Cannabis During Pregnancy and Lactation: Adverse Pregnancy Outcomes

Staying stress-free, reducing pain, and eating nutritious foods are important for a healthy pregnancy and the baby’s health. However, marijuana’s active drug, tetrahydrocannabinol (THC), changes body processes from brain function to heart rate. Infants are particularly prone to genetic changes caused by exposure to cannabis.

Some researchers have also noted that many women they studied who smoked marijuana while they were pregnant also smoked cigarettes and consumed alcohol regularly. Any adverse effects on their children might be related to nicotine and carcinogens in tobacco and alcohol, and not their use of marijuana. However, no level of tobacco — or alcohol — is considered safe for pregnant women or women who are breastfeeding, and the same is held true by the medical community for marijuana use.

Medical physicians have linked an increased risk for complications and stunted fetal growth in pregnancy with marijuana use during pregnancy, including:

• Premature birth.
• Low birth weight.
• Stillbirth.
• Small length.
• Small head circumference.
• Potential impairment of cognitive functioning.

Not all newborns born to mothers who used marijuana while pregnant have congenital disabilities, but reports indicate that it increases your baby’s risk of those complications.

Prenatal Marijuana Exposure: Effects of Marijuana on the Fetus

While there may be some pregnant women who assume that prenatal cannabis exposure doesn’t affect their developing babies, there is preliminary research that says it does. The THC in cannabis is said by experts to cross the placenta and reach the fetus, which can potentially harm birth weight, cognition, and brain development. It can also end up in your breast milk.

Again, there is no real strong evidence that cannabis use causes harm during pregnancy, but along with low birth weights, babies born to mothers who used the drug while they were pregnant might have an increased risk of becoming anemic and suffering from other health issues that require intensive care. The Centers for Disease Control and Prevention (CDC) express concern over attention and memory problems when a fetus in utero is exposed to THC.

Children’s Focus and Academics

Six-year-old children whose mothers used marijuana on a daily basis during their first trimester had difficulty understanding concepts in reading and listening. Ten-year-old children who were exposed to the drug while in utero had difficulty focusing their attention and were more impulsive than other kids.

Children whose moms heavily used marijuana during their first trimester had lower scores in math, reading, and spelling than other kids. There is growing evidence that cannabis use during pregnancy may cause moderate to severe cognitive impairment. Exposure to secondhand smoke of any kind, may also increase risks for cognitive and physical development delays.

The Brain

Numerous studies have found brain changes in 18- to 22-week-old fetuses linked to their mother’s cannabis use. Researchers have noted that exposed male fetuses showed abnormal functions in the amygdala, which is the area of your brain where emotion is regulated.

According to the neuroscientist Dr. Yasmin Hurd, marijuana is changing important neurotransmitter receptors and circuits even early in the developmental stage. These receptors are essential for regulating your reward and emotions, cognition, and motor function.

Although it’s unclear how marijuana may lead to these issues, it may be interfering with nerve cell and circuit formation in the brain during the fetus’ developmental stage. Laws that legalize medical marijuana don’t list conditions related to pregnancy among the allowed uses. Pregnancy is not considered a qualifying health condition for medical marijuana because of the potential harm.

A more recent study indicated that children born from mothers who used cannabis regularly (during pregnancy and after birth) had a higher prevalence of anxiety, aggression, hyperactivity, and higher levels of the stress hormone cortisol.

What This Means for Pregnant Mothers

Although studies on cannabis and the growing fetus are still minimal, choosing to use medical marijuana is a serious decision. You should talk with your doctor before you use marijuana during your pregnancy or while you’re breastfeeding.

Although roughly 50 percent of women marijuana users continue to use while pregnant, there is evidence that cannabis may hurt fetal neurodevelopment, leading to adverse pregnancy outcomes. The ACOG is asking OB-GYNs to urge their pregnant patients — and those contemplating becoming pregnant — to discontinue marijuana usage.

Is it okay to use marijuana while you are pregnant? It is important to discuss with a physician to weigh the benefits and the risks. The ACOG released a policy statement in 2015 urging women who are pregnant or breastfeeding to refrain from using THC.

The ACOG recommends the following:

• Women should receive consultation on their use of alcohol, tobacco, and drugs — which includes marijuana, as well as other medications used for reasons that are not medical — before and during early pregnancy.
• Women who report cannabis use should be counseled about the potential adverse health problems if they continue to use it throughout their pregnancy.
• Women who are contemplating or are pregnant should be encouraged to stop using marijuana and advised of alternative therapies that are backed by better pregnancy-specific safety information.
• Women are discouraged from using marijuana during breastfeeding or lactation as there is no conclusive way to evaluate marijuana’s effects on babies. You’re encouraged to speak with your physician about alternate FDA-approved ways to treat your morning sickness or other pregnancy-related symptoms. Your doctor may suggest a combination of medication and therapy that’s safe for you and your infant.

You should receive regular check-ups from your physician even if you’re using marijuana while you’re pregnant. Don’t let your drug use cause you to skip your doctor appointments. Prenatal visits are important to your health and the health of your baby. Prenatal care is essential during pregnancy, and you should also be honest about your drug use with your physician.

Waiting to Get Your Medical Cannabis Card

Women contemplating pregnancy, or those who have become pregnant, should explore holistic methods of coping with debilitating symptoms. The best advice from Physicians is to wait until after you have delivered your child and are no longer breastfeeding. The THC from cannabis can also expose your infant to health risks, as it can be delivered through breast milk as well.

Edibles and tinctures are the safest ways to consume cannabis when you live in a home with other adults and children. Smokable cannabis can cause health risks through secondhand smoke. If you prefer smokable medical marijuana, make sure you smoke outside to avoid creating a chemically toxic environment that can harm the health of those you love.

Dr. Jack Rothman

Dr. Rothman is a diplomate of the American Board of Obstetrics and Gynecology.  He has received multiple special awards and recognitions, including Physician of the Year, from the Pinellas County Medical Association (2014 – 2015) and the President’s Service Award from the Pinellas County Medical Society.

He attended medical school at State University of New York Upstate Medical Center in Syracuse, New York, where he also completed his Obstetrics and Gynecology residency. In addition to practicing medicine, Dr. Rothman’s professional career includes being an Assistant Professor at the University of South Florida and Clinical Instructor at the University of Tampa’s College of Nursing.

Dr. Rothman received his Florida Medical Marijuana Physicians Certification in 2016 and was one of the first recommending physicians through DocMJ in the state and is loved by many of those early patients today.