Pubdate: Wed, 14 Aug 2019
Source: USA Today (US)
Copyright: 2019 USA TODAY, a division of Gannett Co. Inc
Author: Claire Thornton and Jayne O'Donnell


Claire Alcindor's fourth pregnancy last year was the hardest. The only 
way she could keep food down was by smoking marijuana, which also helped 
with her depression.

She was living in Maryland, in a location where marijuana is legal, but 
still worried "people would think I'm a bad mom" - or worse. Friends 
warned Child Protective Services might start investigating her. But it 
seemed worth the risk, especially given the reported effects of some 
prescription nausea and depression drugs.

"I needed to eat, I needed to stay alive and survive this pregnancy," 
says Alcindor, who now lives in Las Vegas.

As more communities legalize or decriminalize marijuana use across the 
country, federal regulators and many doctors, however, say pot is not a 
risk worth taking while pregnant.

"I would say we are really rolling the dice with our kids if we expose 
them to it," says Dr. Neeraj Gandotra, chief medical officer at the 
Substance Abuse and Mental Health Services Administration at the 
Department of Health and Human Services. "We have a preponderance of 
evidence marijuana does affect brain development."

Studies out this summer in the Journal of the American Medical 
Association also reported a sharp increase in the number of pregnant 
women smoking marijuana and an alarming link between cannabis use and 
preterm births, defined as 37 weeks or earlier. Canadian researchers 
compared the outcomes of birth by 5,639 mothers who reported cannabis 
use during pregnancy with 92,873 mothers who said they didn't use it.

The authors concluded marijuana is "likely unsafe" because preterm 
births were twice as common in marijuana users vs. non-users. (12% vs. 
6.1%). That's despite finding a positive effect between marijuana use 
and lower incidences of preeclampsia - a dangerous condition that 
includes high blood pressure - and gestational diabetes,

There are a lot more skeptical women to convince, however.

Between 2002 and 2017, pregnant women who used marijuana in the previous 
month increased from 3.4% to 7% overall and from nearly 6% to just over 
12% during the first trimester, according to new federal data published 
in the Journal of the American Medical Association. There are more than 
16,000 members of the group "Ganja Mamas" on the What to Expect website.

Dr. Emily Dossett, a psychiatrist and professor at the University of 
Southern California's medical school, now heads Women's Health and 
Reproductive Psychiatry for Los Angeles County's Department of Mental 
Health. She also works at the USC Medical Center, where an increasing 
percentage of her patients smoke marijuana during pregnancy.

She has had patients who were on medication for depression and anxiety 
or even prescriptions for epilepsy who stopped taking them for the "more 
natural choice" of marijuana, despite the lack of knowledge about 
exactly what's in even medical marijuana.

"We don't have any evidence it is safe, but many women at this point 
don't even question it as a potential problem," Dossett says. "It is 
often coupled with a distrust of the medical system and particularly 
medications for mental illness."

Car crashes, psychosis, suicide: Is the drive to legalize marijuana 
ignoring major risks?

Doctors are especially worried because THC - tetrahydrocannabinol, the 
ingredient in marijuana that gets people high - crosses the placenta. 
That means babies' brains could be being altered, says Dr. Cynthia 
Rogers, director of the Perinatal Behavioral Health Service at 
Washington University in St. Louis, Mo.

The parts of the brain exposed are involved in emotion processing and 
executive functioning, Rogers says. Recent studies looking at older 
children related behavioral problems to exposure to marijuana in utero, 
she says.

Yet even doctors who support medical marijuana say medical professionals 
aren't warning women enough. They say there is misinformation and an 
overall lack of information on using cannabis products during pregnancy. 
Medical marijuana is now legal in 33 states.

A National Institutes of Health study released in June 2018 that 
included more than 400 Colorado dispensaries found nearly 70% 
recommended treatment of morning sickness with cannabis.

"Women aren't getting a consistent message," says Dr. Jordan Tishler, 
president of the Association of Cannabis Specialists and an advocate for 
legalizing medical marijuana.

Tishler, an emergency physician who teaches at Harvard Medical School, 
says marijuana dispensaries push their products for all sorts of 
ailments, including nausea caused by morning sickness. "There's an 
industry out there that wants to sell a lot of marijuana-based products 
regardless of whether it's safe or good for anybody," Tishler says.

In the NIH study, officials called dispensaries and told them that they 
were pregnant and suffering from extreme nausea. Transcriptions of phone 
conversations were recorded. In one case, a dispensary employee told a 
woman, "Edibles wouldn't hurt the child, they'd be going through your 
[digestive] tract."

Dispensary employees also sometimes told women to consult with their 
health care provider, but few did so without being prompted. The study 
also found 36% of recommendations said cannabis use is safe during 

Weed vs. prescription drugs: What's safer for nausea?

Carmen, who is four months' pregnant in Georgia, had to be hospitalized 
to treat nausea during her first pregnancy six years ago. She decided to 
use marijuana during her pregnancy now because she's afraid about 
pharmaceutical side effects and also doesn't want to be hospitalized 
again. USA TODAY is not using Carmen's last name or hometown because 
marijuana isn't legal in Georgia.

Carmen had to triple the dose of the prescription drug Zofran during her 
first pregnancy to relieve her extreme symptoms. She was so nauseous 
that she couldn't consume food for long periods of time.

  "Using marijuana was more effective than taking multiple pills," she says.

Carmen says she researched side effects of marijuana on the fetus when 
figuring out whether to use cannabis during pregnancy. But she says the 
studies she saw covered both smoking marijuana and smoking cigarettes, 
without differentiating. She says that because marijuana is more natural 
than the tobacco products in cigarettes, she didn't know how to 
interpret the studies.

What especially worried Carmen were reports about birth defects in 
babies whose mothers had taken Zofran, the brand name for odansetron. 
But Samantha Parker, assistant professor of epidemiology at Boston 
University and lead author of a study on odansetron, "this is a 
relatively safe medication for treatment of nausea and vomiting during 

In fact, HHS' Gandotra says ondansetron and Phenergan, the branded 
version of promethazine, are his top choices for nausea in pregnant 
women. The others are diphenhydramine and metoclopramide.

Up to 13% of pregnant women with nausea and vomiting take Zofran, Parker 

There is more data on the possible effects of prescription drugs on 
fetuses compared with effects from cannabis, even though doing actual 
studies on pregnant women raises ethical concerns.

HHS' National Institute of Drug Abuse awarded grants to four 
universities, including the University of Washington, to study pregnant 
women who smoked marijuana during pregnancy with other pregnant women 
who didn't.

Pamela McColl, a Canadian child rights activist, is working with an 
international group of physicians and the advocacy group Smart 
Approaches to Marijuana to stop the research because something that puts 
babies at risk shouldn't be done unless it's a medical necessity. She 
also says the researchers have a responsibility to report the very women 
they are studying under mandatory reporting laws.

"We have enough science to go out there with public health messages that 
pregnant women should not touch marijuana," says McColl, citing research 
including a May study of 12 million births that was published in the 
Journal of Obstetrics and Gynecology Canada.

Tricia Wright, a Hawaii doctor who runs a research center for pregnant 
women struggling with substance addiction, says patients tell her their 
doctors haven't told them cannabis use during pregnancy isn't safe.

National Institute for Drug Abuse Director Nora Volkow says marijuana 
during pregnancy "Is not worth the risk" but defended the agency's 
research funding because "I don't want us to cry wolf."

With mixed messaging on marijuana, pregnant women in need of relief are 
not able to make fully informed decisions, physicians say.

"I don't think any woman goes into pregnancy wanting to hurt her child, 
so if she's using it it's either because she doesn't understand the 
science or hasn't heard the science,"  Wright says.

Rogers stressed that women experiencing side effects of pregnancy need 
to speak with an obstetrician.

Many, however, are reticent about speaking to their doctors about 
marijuana use. Online pregnancy groups are filled with women worried 
about what will happen if they test positive for pot. Claire Alcindor 
says that's one of the reasons she is so skeptical about the research on 
marijuana - there's a far larger universe of babies she believes are 
unaffected by the exposure and not considered because their mothers 
didn't speak up.

Alcindor, whose content creation firm is called Big Black Brands, is 
also the owner of Zarico herbal skin care products, which include 
postpartum baths. She has about 10,000 followers on Facebook, where "I 
always share my story" of her natural lifestyle, including home births.

"I did a ton of research" on marijuana, Alcindor says. "It was my first 
pregnancy where I was exploring marijuana, and I never read anything 
about it being harmful to the fetus. The moms were a lot more calm, able 
to eat, able to be happier."

Alcindor may be unconvinced, but Gandotra says she should be.

"I'm worried about this from a public health standpoint that we are 
allowing our better judgement to be swayed and, most importantly, we are 
not fully realizing the risks and we won't see the full impact until a 
generation later."