What is Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)?
Drug use has become a serious issue in the United States, affecting a wide range of age groups, including the young and pregnant women. A 2019 report indicates that marijuana, also known as cannabis, is one of the most frequently used drugs. Its usage has consistently risen between 2016 and 2019. In fact, it ranks as the second most commonly used drug among pregnant women.
What Causes Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)?
Delta-9-tetrahydrocannabinol, often simply called THC, is the primary chemical in marijuana that affects your mind. The fact that THC is easily dissolved in fat means that it quickly travels to the brain and stored fat when consumed. THC can also pass through the placenta, so high levels of exposure can affect a developing fetus. Additionally, THC can be found in breast milk, meaning even newborns can be exposed.
Interestingly, THC’s chemical structure is similar to the natural chemicals in our body that affect areas of the brain involving happiness and memory. Cannabinoids, including THC, have their impact on the brain via a receptor called CB1. This receptor is very important for the normal development of a fetus’s brain. Animal studies have shown that when a fetus is exposed to THC, it can disrupt normal brain development. Moreover, consuming marijuana through smoking exposes the lungs to a lot of carbon monoxide, leading to higher levels of carboxyhemoglobin in the blood, much more than what’s caused by smoking tobacco.
Two of the most studied cannabinoids are tetrahydrocannabinolic acid and cannabidiolic acid. These get transformed into their active forms, THC and cannabidiol (CBD), inside our body. THC and CBD interact with CB1 and CB2, which are both types of protein receptors. The activation of CB1 receptors by these substances reduces signaling among nerve cells. THC, specifically, increases the release of certain brain chemicals in different brain regions. Meanwhile, CBD acts in the opposite manner at CB1 receptors.
Current research is still limited on the different strengths of cannabis products available today or ways of administration other than smoking.
Risk Factors and Frequency for Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
Between 2% and 5% of pregnant women have reported using marijuana during their pregnancies. This number can rise up to 28% in areas with lower incomes. A study in Vermont found that 9.4% of the women surveyed were using marijuana while pregnant. It’s also been found that more than half of women using marijuana before pregnancy continue to use it while pregnant. The highest percentage of usage was found among women aged 20 to 24. Interestingly, 65% of pregnant women who use marijuana and 17% of those who do not use it believe that it does not pose any health risks.
The use of marijuana during pregnancy is on the rise due to easier access as a result of legalization, presumed safety, and possible effectiveness against pregnancy-related nausea. However, the use of marijuana during pregnancy is often linked with high rates of other substance use disorders, potentially exposing the mother and fetus to multiple risks.
Signs and Symptoms of Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
Prenatal visits are an excellent time to check for potential drug use. If a pregnant woman is found to be using marijuana, it’s essential to consider other possible substance abuse, mental health disorders like anxiety and depression, and any stressors from their environment or social life.
Depending on the stage of drug abuse, different clinical symptoms can be seen in the patient. During the initial intoxication phase, the person may experience heightened happiness, nervousness, dry mouth, and a rapid heartbeat. In contrast, signs of withdrawal might include feelings of depression, loss of appetite, restlessness, irritability, and sleep issues.
In newborns, exposure to marijuana in the womb does not result in abnormal physical features. However, these babies are often born with low body weight, and if exposed to tobacco in addition to marijuana in the womb, they might have a smaller head size. Although marijuana exposure doesn’t cause withdrawal symptoms in newborns, they’re at a high risk of being impacted by other drugs like nicotine or opioids causing withdrawal symptoms. Signs of this might include unusual responses to visual stimuli, a high-pitched cry, and increased trembling.
Testing for Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
Major medical organizations such as the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the American Society for Addiction Medicine advise that all pregnant women be checked for drug use, including marijuana. This check, or screening, can be done using a confirmed questionnaire. If a woman is found to be using drugs, then she should be given further counseling and support to help her get treatment.
Laboratory tests and women’s own reports are used to find out if they have been using marijuana. Out of all the laboratory tests, urine testing is the most common one. It can show if a woman has been using marijuana recently or for a long time. Other testing methods, like those that analyze umbilical cord blood or a baby’s first stool, can detect the presence of THC (the active compound in marijuana) starting from the second half of the pregnancy.
It is important to note that drug testing can have legal consequences. As a result, it is critical for doctors to get a patient’s consent before any tests are done. Depending on the state laws, health care providers may have to report any cases where a newborn has been exposed to illegal drugs, such as marijuana, to child protective services. This action is in response to potential child abuse and neglect. Therefore, healthcare providers need to be aware of the legal requirements they need to meet in their particular states.
Exposing a newborn to marijuana can have severe long-term effects, which further underscores the importance of this issue.
Treatment Options for Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
The U.S Food and Drug Administration (FDA) hasn’t approved any drugs for treating marijuana use. If a pregnant woman is found to be using marijuana, she should be directed to receive psychological counseling, detoxification, and mental health services. The ultimate goal is to stop all drug use. Babies who have been exposed to marijuana need to be checked for exposure to other drugs and treated accordingly.
Exposure to marijuana and tobacco usually doesn’t need any medical treatment. But, if at the same time the baby has been exposed to drugs like opioids, the baby may need to stay in the hospital for a longer period of time and may need treatment for opioid withdrawal symptoms.
Since THC, a component of marijuana, can have long-term effects, it’s important that these children are closely watched to make sure they are reaching normal growth and development milestones. If any issues are noticed, they should be referred to early intervention services.
What else can Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy) be?
The symptoms of drug use and addiction can often appear to be like other mental health conditions, such as anxiety, panic attacks, and depression. In addition, the signs and symptoms that someone is using marijuana can be similar to the signs of usage of other drugs like speed and sedatives. This makes it hard to figure out if someone is using drugs without a detailed background check on their health and mental health, as well as tests for the presence of drugs in their system.
What to expect with Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
Expectant mothers who use marijuana are more likely to be underweight and have lower educational and socioeconomic status, with a tendency to use other substances like alcohol. There are suggestions that marijuana use can lead to depression and anxiety. These women run a higher risk of anemia and premature birth. Marijuana use can alter placental functions, but interestingly, it hasn’t been linked with other pregnancy-related issues like gestational diabetes and hypertension, or concerns with bleeding before or after childbirth.
Like tobacco, marijuana smoke contains harmful toxins, which are potentially damaging to the respiratory system and could cause cancer. Marijuana and tobacco used together could increase the risk of the mother developing asthma and high blood pressure during pregnancy.
While breastfeeding is generally beneficial for the mother-infant relationship, it can potentially expose the infant to harmful drugs if the mother is a drug user. Breast milk has been found to contain moderate amounts of THC – a compound found in marijuana. The infant can show signs of sedation, poor sucking reflex, and delayed growth due to their ingestion of THC in the milk. Yet, discerning whether these effects are a result of exposure during pregnancy or through breast milk can be challenging, particularly when there’s tobacco use in the mix as well.
Given the central role of the early months in an infant’s brain development, THC exposure could potentially disrupt this important phase. So, despite the lack of definitive evidence, organizations like ACOG, AAP and the Academy of Breastfeeding Medicine advise against marijuana use during breastfeeding. They believe that while these mothers should be encouraged to breastfeed, they should be strongly advised to refrain from marijuana use.
Children exposed to marijuana present with gaps in problem-solving skills and memory, showing increased symptoms of depression and anxiety, and decreased attention span. As they reach adolescence, these children have a higher risk of engaging in delinquent behavior and are more likely to start using marijuana at an early age.
Possible Complications When Diagnosed with Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
The effects of THC, the psychoactive substance in marijuana, on pregnancy and child development have been widely examined. For the risk of stillbirth or abortion, studies have been inconclusive, with some suggesting a correlation related to THC use and others not finding any significant link.
THC exposure in the womb has been linked to decreased birth weight, potentially due to hindrances in fetal growth. Notably, the decrease is not seen in birth length or head circumference. The diminished birth weight can be linked to issues such as increased carbon monoxide levels in the blood. It has also been noted that the combined use of marijuana and tobacco may further reduce birth weight and head circumference.
With regard to congenital malformations, studies are scarce and fragmented. Some evidence implies maternal marijuana use may increase the risk of certain congenital disabilities, but again, not all studies support this notion.
In terms of neonatal outcomes, some studies found that mothers consuming THC might lead to a shortened gestational period, an increased chance of neonate hospitalization, and a higher likelihood of admission to the neonatal intensive care unit (NICU). However, such a correlation is not universally agreed upon among all studies.
It’s crucial to note that exposure to THC could have an effect on a child’s overall development. The effects can start to become noticeable as early as four years old. They typically manifest as:
- Reduced scores on verbal reasoning and memory tasks
- Poor language comprehension
- Impaired visual and perceptual functions
- Reduced impulse control and problem-solving skills
- Shorter attention spans
- Weakened analytical skills
- Lower overall achievement, including in reading, spelling and math
It’s important to remember that these effects have been shown to be dose-dependent, meaning the more THC the mother has consumed during her pregnancy, the greater the effects could be seen in the child’s development.
Preventing Marijuana and Maternal, Perinatal, and Neonatal Outcomes (Marijuana and Pregnancy)
Marijuana or cannabis is often used illegally by people of all ages, including women who are pregnant or could become pregnant. Quite a few women who use marijuana continue to use it while they’re pregnant.
It’s suggested that all pregnant women get checked for use of illegal drugs, including marijuana. They should also be informed about the possible effects of THC, a component of marijuana, on the mother’s, the baby’s and the newborn’s health. If necessary, they should be sent for treatment for substance use problems.
Using marijuana can lead to harmful outcomes for the mother and the baby. As such, two groups, the ACOG and AAP, strongly advise against using marijuana when pregnant or breastfeeding.
As marijuana is becoming more readily available and used, it’s crucial to conduct high-quality, ethical research studies to understand its effects on mothers and children.
