Pot in Pregnancy? Usage is Rising. Should We Be Alarmed?

Earlier this week a new study was published online by Dr. Corsi and colleagues, at the Journal of the American Medical Association.  In this retrospective cohort study that included 661, 617 pregnancies and 9,427 reported cannabis users, the rate of preterm birth among reported cannabis users was 12% vs 6% in nonusers, a statistically significant difference.  Should we be alarmed?

The truth is that cannabis is here to stay.  Legalized, in some form in almost 30 states and counting, the horse is out of the barn.  In addition, one of the first and most prominent “legal” uses of medicinal marijuana was for lack of appetite and nausea in cancer and chemotherapy patients.  What do women early in their pregnancy also have? Yes, nausea and lack of appetite. Understandably, with the growth of legalization and “holistic medicine”, marijuana use has increased and has become a therapy touted, in some circles, for use in pregnancy.  Proponents argue that it is “natural”, “safe” and can help combat the common discomforts in pregnancy. As an Ob/Gyn with a fellowship in Integrative Medicine, I must admit, it is hard to deny these claims. It’s also hard to deny that a few glasses of wine or beer might not provide the same “discomfort” relief….but most women understand it is a bad idea to drink during pregnancy (wine is “natural” too, afterall).

The other unfortunate truth is that we will have a very difficult time ever proving or disproving marijuana’s safety in pregnancy because it is unethical to “experiment” on women and unborn babies.  In today’s medico-legal climate, there is no one who would be able to get institutional clearance for a study comparing the outcomes, nor are there many women willing to volunteer for a study where the known possible outcomes of randomization to a study arm could result in malformations, low birthweight, learning disorders, psychosis in the adolescent, or other outcomes not yet associated with marijuana use.  At present, there is simply very little information out there on the safety of marijuana use in pregnancy and almost all the information is based on self-reporting of use (a highly inaccurate data collection method). There have only been a handful of papers even looking at the issue and, frankly, they have had conflicting outcomes of clinical significance.

Due to these issues, it is my belief that pregnant women and women who desire to become pregnant abstain from any form of marijuana use, including CBD products (which are not regulated and can contain up to 3% THC in OTC preparations).  This is not because I do not believe in the medicinal properties of cannabis, but because as a physician who has spent the better part of her life learning about and caring for women and babies, I can not tell you it is NOT dangerous for you during pregnancy.  

As more states legalize marijuana, I suspect the numbers of women who use in pregnancy will increase accordingly and more papers will be written looking at the safety and efficacy profile of cannabis in pregnancy.  KM Kuczkowski wrote in 2004, in the Annals of the Academy of Medicine Singapore  “Because the pharmacological actions of marijuana are complex and include a unique blend of effects, the clinical picture could be very unpredictable, the diagnosis often difficult, and the management at times controversial.”.  

The real question is whether you want to risk your baby to an “unpredictable” outcome?

Karyn Tapley MD

Dr. Karyn L Tapley, MD is a residency-trained Ob/Gyn with a fellowship in Integrative Medicine. She was born in Ft. Myers, Florida into a military family and spent the first few years of life living with her parents in Okinawa, Japan. After returning to the states, her father was recruited by Texas Instruments and the family moved to Houston where she spent most of her young life. She moved back to Florida in her early 20s and obtained a BS in Marine Biology from the University of West Florida, before moving on to the University of Florida for medical school. She obtained her residency at Christiana Health System in Delaware. This large, community hospital was situated on the I-95 corridor between Philadelphia and Washington, DC, providing ample educational opportunities with over 8000 deliveries a year and only 16 residents. After successfully completely residency, Dr. Tapley moved across the country to be closer to her husband who had been deployed to the West Coast. She joined a Gyn-only practice with Aesthetics in Oregon and was able to add an extensive cosmetic-surgery education to her skillset. From there, she transitioned to traditional Ob/Gyn care, as an employed physician, in northern Washington state so that she could be closer to her husband who was stationed there. Frustrated with the typical bureaucracy & politics of hospital-based care, she turned to rural Locum Tenens (“traveling doctor”) for a change of pace and to have some control over her life. For over 3 years, she traveled with her husband, now retired from the Navy, her 2 large dogs, and an Amazon parrot named “Cowboy” in a small, vintage travel trailer, caring for women and babies in rural towns from Bar Harbor, ME to Astoria, OR. Eventually, they were ready to return home and she opened her own women’s health clinic and medical spa in northern Washington state. It was during this time she obtained her fellowship in Integrative Medicine from the world-renowned Dr. Andrew Weil Center for Integrative Medicine at the University of Arizona in Tucson. Her non-clinical interests include real estate investing and financial planning for female physicians and other high-income female professionals. She has completed her real estate license training and is currently completing her master’s-level Certified Financial Planning course to sit for the CFP exam. She will be a guest speaker at a major non-clinical career conference in October, speaking on Locums opportunities. For fun, she races cars. 

  3 comments for “Pot in Pregnancy? Usage is Rising. Should We Be Alarmed?

  1. Thomas David Guastavino
    June 24, 2019 at 3:18 pm

    As Albert Einstein saiid, there are only two constants in the universe, the speed of light and human stupidity.

  2. Russ
    June 24, 2019 at 2:01 pm

    You realize that U of W is starting a Moms and marijuana study despite the ethical concerns you mention. The researchers aren’t supplying the weed, but they aren’t discouraging it either.

    • Karyn Tapley MD
      June 24, 2019 at 3:21 pm

      It doesn’t sound like it will be a randomized, controlled trial…so like all before it, it will only give us retrospective, patient-supplied feedback, not true controlled clinical outcomes. There is nothing unethical about following patients who choose to subject themselves to potential harm (or not), and as you noted, the researchers are not supplying the marijuana.

Comments are closed.