How Cannabis Can Play A Medicinal Role During Pregnancy

Updated 9/8/2022

The conventional wisdom in modern medicine is that women shouldn’t consume cannabis (marijuana) while pregnant because it has negative consequences for the fetus. However, there are well conducted studies, published in the Pediatrics Journal of the American Academy of Pediatrics, that conclude the opposite. Moreover, anyone who understands the Endocannabinoid System and its role in regulating various bodily functions, knows that cannabis can play a medicinal role during pregnancy, especially for women suffering from hyperemesis gravidarum. But before continuing, it must be pointed out that smoking cannabis (which means combusting it) is not a good way to consume cannabis. Although there are no harmful compounds in cannabis, when you smoke cannabis, the process of combustion creates harmful substances like benzene, carbon monoxide, naphthalene, toluene and polycyclic aromatic hydrocarbons (commonly known as PAHs). But studies have shown that using a vaporizer decreases these unwanted toxins by approximately 90% (please be advised that I’m not talking about vape pens but vaporizing devices for cannabis flower). Vaporizers don’t combust cannabis, instead they heat the cannabinoids to their boiling point which evaporates them, allowing them to be inhaled. Therefore, it’s recommended that if pregnant women do choose to consume cannabis for medicinal purposes, they should use a vaporizer instead of smoking it. Health tips on vaporizing and other forms of consuming cannabis will be addressed at the end of this article.

Probably one of the most famous studies on cannabis and pregnancy, “Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study”, was conducted by Dr Melanie Dreher who is the Dean of Nursing at Chicago’s Rush University Medical Center. This study was published in 1994 in the Pediatrics journal of the American Academy of Pediatrics. To quote the “Measurements and main results” of this study: “Exposed and nonexposed neonates were compared at 3 days and 1 month old, using the Brazelton Neonatal Assessment Scale, including supplementary items to capture possible subtle effects. There were no significant differences between exposed and nonexposed neonates on day 3. At 1 month, the exposed neonates showed better physiological stability and required less examiner facilitation to reach organized states. The neonates of heavy marijuana using mothers had better scores on autonomic stability, quality of alertness, irritability, and self regulation and were judged to be more rewarding for caregivers.” In addition, the study found no differences in birth weight, birth length and gestational period. A five year follow up study found:”no significant differences in developmental testing outcomes between children of marijuana-using and non-using mothers…”

The next study, “Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation” which was also published in the Pediatrics journal, is even more of an eye opener. It found a dramatic decrease in the mortality rate of babies born testing positive for cannabis. “A total of 2964 infants were studied. At birth, 44% of the infants tested positive for drugs: 30.5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids…Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births)…The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively.” However, many of the babies that tested positive for cannabinoids, also tested positive for cocaine and/or opioids. Once they screened the babies for those that only tested positive for cannabinoids and no other drugs (157 babies), the mortality rate was 0.0 per 1000 live births. No, that is not a typo — zero deaths. The other fact that stands out in this study is that the overall drug positive death rate (13.7 deaths per 1000 live births) was lower than the drug negative rate (15.7 deaths per 1000 live births). What would account for this? If you look at the death rate for cocaine (17.7) and opiate (18.4) positive babies, they are higher than the drug negative death rate. But the death rate for babies whose mothers consumed both cocaine and cannabis or opiates and cannabis was much lower (8.9 deaths per 1000 live births). Therefore, it seems that cannabis provided some sort of protection for babies exposed to cocaine and opiates. A possible reason why cannabis exposed babies had a much lower mortality rate is because they had a more robust Endocannabinoid System, due to the fact that their mothers consumed cannabis while pregnant.

The latest study ”Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis“, looked at 31 studies that assessed the effects of maternal marijuana use on adverse neonatal outcomes and concluded that: “Maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors. Thus, the association between maternal marijuana use and adverse outcomes appears attributable to concomitant tobacco use and other confounding factors.”

At this point, an important fact needs to be brought up — when it comes to funding cannabis studies in the US, the National Institute on Drug Abuse (NIDA) is the primary gatekeeper. Yet, as reported in the New York Times, NIDA stated that “our focus is primarily on the negative consequences of marijuana use.”. In other words, NIDA’s objective is clearly biased against the medical use of cannabis. To quote Dr Melanie Dreher on her Jamaica study:”it was clear that NIDA was not interested in continuing to fund a study that didn’t produce negative results. I was told not to resubmit. We missed an opportunity to follow the study through adolescence and through adulthood.” In 2014, Dr Carl Hart of Columbia University wrote an opinion piece in the Dallas Morning News entitled “Why research is biased against pot to focus on its harm and not its benefits”. In it he writes: “So why do scientists focus almost exclusively on the detrimental effects of drugs when they are, in fact, a minority of effects? Are scientists dishonest? Probably not. They are more likely to be responding to their perceptions of NIDA’s interests. NIDA funds more than 90 percent of all research on the major recreational drugs. Its mission “is to lead the nation in bringing the power of science to bear on drug abuse and addiction” (emphasis mine)…Scientists seeking research money from NIDA are well aware of this fact. As a result, they emphasize the negative effects of drugs to get their research funded.” That is hardly the right scientific environment to carry out objective studies.

In July of 2015, the American College of Obstetricians and Gynecologists put out a Committee Opinion on Marijuana use during pregnancy and lactation. Not surprisingly, they discouraged the use of cannabis during pregnancy. However, they made the following statement:”It is difficult to be certain about the specific effects of marijuana on pregnancy and the developing fetus, in part because those who use it often use other drugs as well, including tobacco, alcohol, or illicit drugs, and in part because of other potential confounding exposures…Adverse socioeconomic conditions, such as poverty and malnutrition, may contribute to outcomes otherwise attributed to marijuana. For example, one population-based study reported that pregnant marijuana users were more often underweight and had lower levels of education, had a lower household income, and were less likely to use folic acid supplementation than nonusers.”

The studies showing that tobacco and alcohol have negative effects on the fetus are unequivocal. That is not the case with cannabis. However, what has been proven without a shadow of a doubt, is that cannabis can provide certain palliative effects. And this is where it can play a positive role in pregnancy. Pregnancy is experienced differently from mother to mother — some appear to breeze through it (relatively speaking) while for others it’s more of a struggle. In a small percentage of cases, women experience hyperemesis gravidarum which leads to severe nausea and vomiting resulting in weight loss and dehydration, and can endanger the lives of the mother and fetus. Although a certain amount of stress is to be expected during pregnancy, excessive stress has been proven to have negative consequences for the fetus. Simple logic dictates that the worse a pregnant mother feels throughout her pregnancy the worse it is for her fetus and vice versa. The most common sources of discomfort for a pregnant women are: nausea, vomiting, backaches, constipation and lack of sleep. It turns out that, with the exception of constipation, cannabis has an excellent track record of alleviating these other symptoms. So it makes sense for pregnant women who are struggling with these issues, to use cannabis to alleviate these symptoms and the stress they cause. This is backed up by survey conducted on pregnant women in Canada: ”While 59 (77%) of the respondents who had been pregnant had experienced nausea and/or vomiting of pregnancy, 40 (68%) had used cannabis to treat the condition, and of these respondents, 37 (over 92%) rated cannabis as ‘extremely effective’ or ‘effective.’”

Morning sickness is bad, hyperemesis gravidarum is hell. Dr Wei-Ni Lin Curry experienced hyperemesis gravidarum and was able to overcome it by using cannabis. She was lucky, since many women who experience HG end up undergoing unwanted abortions to save their lives. She published an excellent article called:” Hyperemesis Gravidarum and Clinical Cannabis: To Eat or Not to Eat”. In the article, she describes her own experience, as well as the experiences of other women suffering from HG. What is perplexing is that currently in the US, women who are suffering from severe nausea and vomiting are prescribed antiemetic off label drugs like zofran, phenergan and compazine. These drugs have numerous potential side effects which can lead to great discomfort. But what is truly shocking, is that these drugs are rated as Category C by the FDA Pregnancy Categories (NOTE — The FDA changed its labeling system in June 2015). Per the FDA, Category C drugs are described as: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks”. Unfortunately, women are finding out the hard way as zofran has been potentially linked to birth defects. In the case of phenergan, the HER Foundation found that:”…the 3 most commonly prescribed antiemetics (phenergan, compazine, and tigan) are more strongly correlated with second trimester fetal demise than with having any positive therapeutic effect…” Included is a link to the latest study on HG and cannabis.

In the Committee Opinion put out by the American College of Obstetricians and Gynecologists they make the following statement: “Because marijuana is neither regulated nor evaluated by the U.S. Food and Drug Administration, there are no approved indications, contraindications, safety precautions, or recommendations regarding its use during pregnancy and lactation. Likewise, there are no standardized formulations, dosages, or delivery systems. Smoking, the most common route of administration of THC, cannot be medically condoned during pregnancy and lactation.” It has already been widely documented how doctors and scientists in the US face nearly insurmountable obstacles in trying to study the medical properties of cannabis. This is the reason why FDA regulation or evaluation for cannabis does not exist. However, what ACOG and the vast majority of doctors in the US are not aware of, is the fact that the medical cannabis movement has evolved substantially since 1996 when California first legalized medical cannabis. New discoveries and innovations have emerged since then, many of which address the second sentence of ACOG’s statement regarding: standardized formulas, dosages and delivery systems.

First, testing for pesticides and molds which was non existent in the past, is becoming a regulatory reality in states where it’s legal. Secondly, specific strains are being developed to address certain medical conditions. Some of these strains are high in CBD content. Unlike THC, CBD is not psychoactive and has been proven to mitigate the psychoactive effects of THC. So the notion that the only type of cannabis that exists is one that gets you high is simply not true. Lastly, these medicinal qualities can be replicated from plant to plant by using cloning techniques and even more advanced techniques like tissue culturing, whether you are a dispensary, or a NASDAQ listed company like GW Pharmaceuticals. This will insure that each plant bred for a specific purpose will in essence offer a standardized formula. So what do you get when you weigh out the same amount of a cloned strain using a high quality vaporizer? A standardized formula that can be consumed in a measured dosage using a medical grade device. As a matter of fact, vaporizing cannabis in Israeli hospitals, including children’s hospitals, has been a reality for a number of years.

Although medical cannabis can be consumed in an edible form, it’s not recommended that pregnant women use this form of consumption for three reasons. First, if the woman is suffering from nausea and the inability to keep food down, she probably will have a hard time keeping the edible cannabis down. Secondly, the ability to self dose (titrate) is more difficult due to the long time lag between digesting and feeling the effects. Lastly, when cannabis is digested it goes through what is called “first-pass metabolism” which means the THC is converted to 11-Hydroxy-THC (commonly known as THC11) which is 4–5 times more psychoactive. This is why the best way for pregnant women to use cannabis is through a vaporizer. The following are some tips for women who are going to vaporize cannabis while pregnant.

• Only buy cannabis from dispensaries that test their cannabis for unwanted substances.
• If possible, request strains that have less than 20% THC and also have CBD.
• Only use cannabis flowers (buds) and not cannabis concentrates like oil or shatter.
• Only use high quality vaporizers with accurate temperature gauges.
• Never heat the vaporizer above 380 Fahrenheit (198 Celsius).
• If you want to keep consumption to a minimum, use it at night to get the added benefit of cannabis as a sleep aid.

Anyone looking at the overall studies of pregnancy and cannabis in an objective manner will conclude that many of these studies were flawed, as pointed out by ACOG. If these flawed studies continue to be used as part of the overall assessment, how are we ever going to arrive at an accurate answer? Given the fact that numerous states have legalized cannabis for recreational use, it would make sense to conduct a well structured study — using vaporizers as the method of delivery — to finally bring clarity to this issue. Doctors are willing to prescribe off label drugs like zofran and phenergan because, to quote the FDA:”the potential benefits may warrant use of the drug in pregnant women despite the risks”. The potential benefits of cannabis are far greater than what existing off label drugs can do for morning sickness and hyperemesis gravidarum. At this point, given the number of cannabis studies that show no negative outcomes for either the mother or the fetus, the potential benefits of undertaking this study in a state where recreational cannabis is legal makes medical sense.