Should Mom Avoid The Cannabinoid?

Cannabis intended for medicinal use is available in over half of the United States and is used by many men and women for a myriad of conditions. But as medical cannabis usage continues to become an increasingly acceptable mainstream activity, many questions are in need of answers.

Cannabis Use by Pregnant Females 2009-2016

Both recreational and medicinal cannabis use among adults is increasing with the spread of legalization, and there is an increased interest in determining whether or not is safe to use during a pregnancy or while breastfeeding. Many patients use marijuana for its effective anti-nausea properties, including a portion of the 79-80% of pregnant women who experience nausea and vomiting of pregnancy (NVP), also known as morning sickness.

According to research published in the Journal of American Medical Association in 2017, 14.6% of pregnant adolescents reported past-month cannabis use. The research letter states that the actual number is likely higher as they relied on self-reporting surveys that “underestimate use due to social desirability bias and underreporting.”

What causes NVP is currently unknown, though some believe that it may be related to hormone changes in a mother’s body, and may function as a defense mechanism against toxins. A mother’s immune system is suppressed during pregnancy and vulnerability to toxins peaks for both her and her child at around three months. This time frame correlates to when a mother is most susceptible to NVP.

Milder and moderate cases will not generally result in injury to the baby, but sporadic bouts of nausea and vomiting during a portion of the pregnancy can significantly diminish the mother’s quality of life.

And though there are a number of readily-available antiemetics to combat the nausea, some of them may be less effective or come with side-effects like Zofran (Ondansetron), which some are concerned is linked to cleft palate.

Vitamin B6, ginger, aromatheraphy, hypnosis, acupuncture, and acupressure are other remedies commonly used to aid in alleviating symptoms of nausea.

But the cannabinoids produced by the cannabis plant are effective at suppressing nausea and exhibit an uncommon safety profile with regards to consumption. They’re safe enough that in order for a human to achieve a potentially fatal overdose, one would have to consume many times the normal dose.

An LD50 is a rating that indicates at what dosage 50% of users are likely to die from a substance.

According to a ruling by Judge Francis Young in 1988, the LD50 rating of cannabis is around 1:20,000 to 1:40,000. That means that for a dosage to become fatal to the user, it would have to be 20,000 to 40,000 times more marijuana than they would normally consume in one sitting.

But even with the high level of safety for the mother, there are still questions about the health of the baby as physiology differs greatly between an adult and a child.

The human endocannabinoid system is involved in processing memory, mood, appetite, and pain sensation. Cannabinoid receptors (CB1, CB2) can be found in the human embryo only fourteen weeks after conception and receptor growth begins to accelerate rapidly in the twentieth week of growth.

CB1 receptors are found in the brain, lungs, liver, and kidneys and CB2 receptors are found in the immune system and in the hematopoietic cells where blood is produced.

Endocannabinoid system

Due to cannabis’ illegal status in the United States, research on its use during pregnancy and breastfeeding is limited. The National Institute on Drug Abuse (NIDA) says that there is no human research linking cannabis use to the possibility of a miscarriage, but claims that animal studies suggest that the risk is elevated if the mother uses cannabis early in the pregnancy.

The NIDA website states that cannabis use by mothers has been associated with developmental and hyperactivity disorders in children, but say that there is mixed evidence regarding low birth weight or premature birth.

The site also claims that women who use cannabis during pregnancy are 2.3 times more likely to have a stillbirth. Though even the authors from that particular study that NIDA cites say that they “could not entirely separate the effects of smoking tobacco from those of smoking marijuana.”

But while NIDA and others urge expectant mothers to abstain from cannabis during their pregnancy and while breastfeeding, it is an option that an increasing number of women are reportedly choosing.

26-year-old Teen Mom 2 star Jenelle Evans recently admitted to smoking cannabis during the third trimester of her pregnancy to relieve esophageal spasms which caused her to vomit frequently. According to an interview with Vince Russo, she tested positive for THC after the birth, but her newborn daughter did not.

In an article posted in September 2017, Lemon Knowles detailed her experience with using cannabis during her pregnancy. Presented with limited information from the internet, and a generally discouraging tone from American health associations, she came across a Jamaican study involving fifty-nine children from birth to five years of age whose mothers used cannabis.

According to the study, there were no significant differences in development testing outcomes, except at thirty days of age when the babies of cannabis-using mothers scored higher on autonomic stability and reflexes.

Knowles reports using cannabis to help control NVP, regain her appetite, and treat pregnancy-related stress and anxiety. After giving birth, she also smoked marijuana during the six month period that she breastfed her baby. Knowles reports that at one-year-old, her child hasn’t been sick once and is happy and healthy.

In an update released on their website in October 2017, the American College of Obstetricians and Gynecologists state that cannabis is the most commonly used illicit drug during pregnancy.

But in addition to the plant-based phytocannabinoids that some pregnant women choose to consume, endocannabinoids are already produced within their body and are found in breast milk.

Studies suggest that endocannabinoids play a crucial role during pre- and postnatal stages of development.

According to the European Journal of Pharmacology, “endocannabinoids have been detected in maternal milk and activation of CB1 receptors to be critical for milk sucking…apparently activating oral-motor musculature.”

When THC is processed in the human body, it mimics the effects of anandamide (N-arachidonoyl ethanolamine), an endocannabinoid which plays a role in the implantation of the early stage embryo into the womb’s blastocyst. Also found in chocolate, anandamide has been found to inhibit the proliferation of human breast cancer cells as well.

According to the Journal, THC and anandamide may be somewhat interchangeable as it states, “Prenatal exposure to the active constituent of marihuana (Δ9-tetrahydrocannabinol) or to anandamide affects prefrontal cortical functions, memory and motor and addictive behaviors, suggesting a role for the endocannabinoid CB1 receptor system in the brain structures which control these functions.”

But should a mother choose to use cannabis, the authors state the effects appear to be different for the mother than they are for the child.

They write that “Further observations suggest that children may be less prone to psychoactive side effects of Δ9-tetrahydrocannabinol or endocannabinoids than adults. The medical implications of these novel developments are far reaching and suggest a promising future for cannabinoids in pediatric medicine for conditions including ‘non-organic failure-to-thrive’ and cystic fibrosis.”

So depending on the source of information, there are differing opinions and varying evidence regarding cannabis use by an expectant mother and whether or not it is safe for her and her child.

For those concerned about the smoking aspect, there are many other forms in which cannabis can be administered including oils, edibles, tinctures, and topicals.

Anecdotal evidence and limited studies indicate that cannabis use by the mother does not interfere with a child’s development, and may even be beneficial for them, as noted in the Jamaican study.

But data from mainstream sources like NIDA and others tend to disagree with that information at this point, though it is likely at some level due to the ever-present bias of federal cannabis prohibition hanging overhead.

Ultimately, the responsibility for a child’s safety rests solely with the parents, with education being the key to making an informed decision and determining if cannabis use during pregnancy is right for them.