On November 16, the American Medical Association (AMA) announced that it would promote regulations requiring a warning to be written on medical and recreational marijuana products and posted wherever they are sold. A proposed warning label is: Marijuana use during pregnancy and breastfeeding poses potential harms. The decision was made based on studies that suggested that marijuana use may be associated with low birth weight, premature birth, and behavior problems in young children. Opponents of such warning labels counter that evidence of harm is weak; however, while proponents agree that more research is needed, they note that erring on the side of caution makes sense.
The AMA notes that some studies have linked marijuana use in pregnancy with childhood attention problems and lower scores on problem-solving measures. Tetrahydrocannabinol (THC), the main active ingredient in marijuana, has been found in the milk of women who use it while breastfeeding, and some studies suggest that the drug can affect the quality and quantity of breast milk.
There are similar warnings for alcohol and tobacco, “so why not do the same thing with marijuana since it is the most commonly used illicit drug during pregnancy,” noted Diana Ramos, MD, a Los Angeles physician with the American Congress of Obstetricians and Gynecologists (ACOG), which proposed the warnings at an AMA policy-making meeting in Atlanta. At present, much more scientific evidence exists regarding harm from alcohol and tobacco than from marijuana; however, marijuana has not been proven safe to use during pregnancy or breastfeeding.
In an opinion issued last June, ACOG noted that approximately half of female marijuana users continue to use during pregnancy, evidence suggests that the drug may have a negative impact on fetal neurodevelopment. This is why is calling for obstetrician /gynecologists to urge their patients who are pregnant or contemplating pregnancy to discontinue marijuana use.
ACOG notes that marijuana is the most commonly used illicit drug during pregnancy. The self-reported usage of marijuana use during pregnancy ranges from 2% to 5%; however, usage increases to 15% to 28% among young, urban, socioeconomically disadvantaged women. In addition, as a growing number of states legalize marijuana for medical and recreational purposes, there are concerns among healthcare professionals that its use by pregnant women could potentially increase.
In recommending that obstetrician-gynecologists counsel pregnant women regarding marijuana use cessation, the new committee opinion notes that studies suggest marijuana is dangerous to the fetus’s development in a variety of ways. Studies have reported that children who were exposed to marijuana in utero had lower scores on tests of visual problem solving, visual-motor coordination, and visual analysis than children who were not exposed to marijuana in utero. Furthermore, prenatal marijuana exposure is associated with decreased attention span and behavioral problems. It also is an independent predictor of marijuana use by age 14. Other studies show that marijuana use may increase the likelihood of stillbirth, smaller birth lengths, and head circumferences.
The new recommendations also address marijuana use during breastfeeding, acknowledging that although there are insufficient data to evaluate the effects of marijuana use on infants during breastfeeding, marijuana use during this time is discouraged. Obstetrician-gynecologists are discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during preconception, pregnancy, and breastfeeding. The ACOG opinion notes that marijuana is neither regulated nor evaluated as a medicine by the Food and Drug Administration (FDA) and there are no approved indications, contraindications, safety precautions, formulations, dosage, or recommendations regarding its use during this time.