Pregnancy

More Research on Cannabis and Pregnancy

Effects of cannabis tetrahydrocannabinol on endocannabinoid homeostasis in human placenta

In Summary

 Researchers recently revealed a possible mechanism for the effect of cannabis on pregnancy outcomes via the endocannabinoid system. The placenta contains endocannabinoid receptors and becomes part of the endocannabinoid system of the mother and fetus during pregnancy. The data found in this article provides evidence that ∆-9-tetrahydrocannabinol (THC) impairs the placental endocannabinoid system by disrupting the production and degradation of endogenous cannabinoids. The altered endocannabinoid levels disrupt the trophoblast that comprises a large portion of the placenta, decreasing the number of nutritional compounds that are delivered to the fetus. Further research is necessary to validate the effect of the disrupted placental endocannabinoid system. 

This research is a great addition to the current medical research concerning cannabis use and pregnancy but more is still needed. The featured article only focused on the effect of THC on the placenta and resulting birth outcomes but there is so much still to learn. THC is only one of the many medically beneficial cannabinoids present within cannabis products, not to mention terpenes and flavonoids which have also been revealed to possess medicinal properties. As more young women consume medical cannabis for various reasons and then become pregnant, it is imperative that all of the possible effects of cannabis on pregnancy outcomes and overall gestation be revealed. Obstetricians need to know if cannabinoids have little to no effect on pregnancy and are safe for women to continue taking or if alternative therapies need to be decided. 

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Benjamin Caplan, MDMore Research on Cannabis and Pregnancy
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Correlation Between Preterm Birth and Prenatal Cannabis use Backed by Minimal Evidence

Association Between Self-Reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes

In Summary

A 2018 Canadian study reports increased incidence of preterm birth and low birth weight among children prenatally exposed to cannabis. The legalization and subsequent increase in use of cannabis calls for further studies investigating the effects of maternal cannabis use on infants; however, covariates make it difficult to make definitive conclusions. Individuals who use cannabis during pregnancy are also more likely to be younger, low-income, and receive inadequate medical attention during pregnancy, all factors which can impact birth weight and gestational length. Although evidence may point to cannabis use during pregnancy influencing preterm birth and birth weight, many other factors can impact these outcomes.

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Benjamin Caplan, MDCorrelation Between Preterm Birth and Prenatal Cannabis use Backed by Minimal Evidence
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The Effect of Cannabis Use During Preconception and Pregnancy Outcomes

In Summary

 A recent study has revealed that women who used cannabis during preconception had lower fecundability but cannabis had no effect on pregnancy outcomes. Researchers screened women attempting to get pregnant for previous cannabis use through urine testing and self-reporting. Women who tested or reported positive for cannabis use were less likely to conceive during the primary menstrual cycle when attempting to get pregnant but the use of cannabis had no effect on the rate of live births or loss of pregnancy. The authors call for further research as some women may not report cannabis use due to stigma despite the importance of gathering data for possible effects of cannabis use on conception. 

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Benjamin Caplan, MDThe Effect of Cannabis Use During Preconception and Pregnancy Outcomes
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The Relationship of Flavonoid Intake During Pregnancy With Excess Body Weight and Gestational Diabetes Mellitus

 Consuming Food Rich in Flavonoids Can Reduce Excess Body Weight During Pregnancy

In Summary

A recent study has found that women who consume food rich in flavonoids during pregnancy (found in fruits, vegetation, and also in cannabis, tend to have less excess body weight. European studies have also reported that flavonoid-rich diets during pregnancy can reduce the risk of gestational Diabetes Mellitus (GDM) but their studies recorded women consuming even higher amounts of flavonoids that the women in the American study. A meta-analysis of American and European studies confirms that pregnant women who maintain a flavonoid-rich diet have an easier time managing the excess weight associated with pregnancy. 

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Benjamin Caplan, MDThe Relationship of Flavonoid Intake During Pregnancy With Excess Body Weight and Gestational Diabetes Mellitus
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Pre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner

Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences

Summary Info:

Prenatal maternal cannabis and tobacco use is predictive of behavioral problems among toddlers. Resulting differences from control groups include anxiety, depression, and attention problems. Female children of mom’s consuming substances, in particular, seem to be more susceptible to problems relating to internalization, attention, and sleep. Additionally, the behavioral problems induced by prenatal cannabis and tobacco consumption often lead to further maternal substance consumption, which frequently exacerbates existing behavioral problems. 

Highlights of study of mother's prenatal and postnatal consumption of  cannabis
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with children
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with toddlers

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Benjamin Caplan, MDPre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner
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Dr Caplan’s response to Surgeon General advisory statement

Last week’s statement by the US Surgeon General

https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-marijuana-use-and-developing-brain/index.html

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Benjamin Caplan, MDDr Caplan’s response to Surgeon General advisory statement
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More Research Needed to Determine Impacts of Cannabis Use During Pregnancy

Cannabis Use in Pregnancy

With rates of cannabis use during pregnancy more than doubling between 2002 and 2017, a need for more studies, over longer periods of time, which investigate prenatal cannabis use has emerged. Existing data ranges from reporting an increased risk for preterm birth and low birth weight to cannabis reducing the risk of preeclampsia and gestational diabetes during pregnancy. Concerns are historically informed by preliminary alcohol and cocaine studies that falsely suggested no gestational harm, despite the eventual recognition that these substances ultimately carry significant risk. Pregnant women should exercise caution in their cannabis use until more definitive conclusions are found, regarding maternal cannabis use.

The decision of where, if anywhere, cannabis fits in relationship to pregnancy is populated with more questions than answers. There are a handful of good quality, long-term studies, to date, that show a pattern that informs some degree of generalization: by and large, the less frequently consumed, and the later during the pregnancy the consumption, the less potential risk. But, for the sake of any pregnant woman and her baby, this type of decision should always be made in direct consultation with the obstetrician supporting the pregnancy.

Additional Point: A lack of high-quality studies relating to cannabis use and gestational risk has resulted in conflicting evidence surrounding prenatal cannabis use. However, historical context involving prenatal alcohol and cocaine use studies informs the need to exercise caution before definitive conclusions are made

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Benjamin Caplan, MDMore Research Needed to Determine Impacts of Cannabis Use During Pregnancy
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Current Numbers for Cannabis Use Among Pregnant Women in the United State

Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States 

An observational study has revealed that the prevalence and frequency of cannabis use in pregnant women have increased over the past two decades.

No trends were seen although except a slight decrease in fetal growth in women who frequently used during the first two trimesters. The data concerning fetal growth, such as length and weight, were not statistically significant and would require further studies to appropriately indicate a correlation between cannabis use and decreased fetal growth.

The authors acknowledge that cannabis use may suffer from recall bias as women may underestimate the amount of cannabis they consumed or purposely withheld some information due to stigma, although some of the surveyed women were using recommended medical cannabis.  

This article highlights the large issue surrounding women consuming cannabis while expecting. Cannabinoids are able to cross the placenta and therefore affect the fetus during development. The American College of Obstetrics and Gynecologists recommend the cessation of any cannabis consumption while pregnant although there has been limited data discussing the actual effects on fetal development. A previously featured article on this blog stated that cannabis use had no effect on birth outcomes but also noted uncertainty in the possible effect on fetal growth. Considering this uncertainty, physicians should push for more research so that women who take medical cannabis can accurately discern whether or not to cease consumption while pregnant. 

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Benjamin Caplan, MDCurrent Numbers for Cannabis Use Among Pregnant Women in the United State
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Pregnant women are using more cannabis over time

Statistics show that in the past 15 years, the number of pregnant women using marijuana, especially in their first trimester, has risen greatly. These numbers may be slightly skewed, but they show the importance of more research being done on the effect of cannabis on pregnant women. https://cnn.it/2WWQV1e

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This paper is also stored here:     http://bit.ly/2IwLxcp    inside the CED Foundation Archive

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Benjamin Caplan, MDPregnant women are using more cannabis over time
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New Study Finds Cannabis May Be “Unsafe” For Pregnant Women

https://www.wbur.org/commonhealth/2019/06/18/cannabis-unsafe-pregnant-women

In a study of 661, 617 pregnant women, researchers found that cannabis use was significantly associated with an increased risk of preterm birth. But these findings may be limited due to other risk factors like tobacco, alcohol, and opioid use. 

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This paper is also stored here:    http://bit.ly/2L0vTaY     inside the CED Foundation Archive

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Benjamin Caplan, MDNew Study Finds Cannabis May Be “Unsafe” For Pregnant Women
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