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 While cannabis and other drugs are not tested in pregnant women to
avoid any unintended harms to mothers and babies, animal research to
date has linked marijuana use during pregnancy to an increased risk
of underweight and premature infants as well as neurological
defects.
The American College of Obstetricians and Gynecologists discourages
doctors from prescribing or suggesting the use of marijuana for
medicinal purposes while women are trying to conceive, pregnant, or
nursing their babies.
"Given the concern for fetal harm with maternal cannabis use, women
should utilize nausea medications prescribed by a physician for
treatment of nausea and vomiting in pregnancy, and should not use
cannabis for this," said senior study author Dr. Torri Metz of the
University of Colorado School of Medicine in Aurora.
"First line medical therapy for treatment of nausea and vomiting in
pregnancy is vitamin B6 and doxylamine," Metz said by email. "This
combination has been studied extensively and there is not concern
for fetal harm, and there are numerous other agents that can also be
prescribed if the first line therapy fails."
As more U.S. states legalize marijuana, concern is mounting in the
medical community that many people including pregnant women may
mistakenly assume that using the drug is risk-free, researchers note
in Obstetrics & Gynecology.
For the current study, researchers posing as pregnant women with
morning sickness called 400 randomly selected cannabis dispensaries
in Colorado, one of about 30 U.S. states that have legalized some
form of marijuana sales. Overall, 69 percent of the dispensaries
recommended cannabis to help pregnant women relieve this nausea, the
study found.
Medical marijuana dispensaries were even more likely than other
cannabis retailers to recommend the drug to pregnant women: 83
percent of medical dispensaries did this, compared to slightly more
than 60 percent of other dispensaries.
Most of the people women spoke to at the dispensaries recommended
cannabis for use in pregnancy based on their personal opinion, and
36 percent stated that the drug is safe in pregnancy.
While 82 percent of the dispensaries ultimately advised women to
speak to a healthcare provider, only 32 percent made this
recommendation without prompting.
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One limitation of the study is that it's possible mystery callers
might get different advice by phone than pregnant women might get in
person at dispensaries, the study team acknowledges.
Still, the results are concerning because medical marijuana laws
prohibit dispensing cannabis to pregnant women, said Dr. Nora Volkow,
director of the National Institute on Drug Abuse in Bethesda,
Maryland.
"One issue is that dispensaries may not have the proper training,
and how women got the prescriptions is another issue because this
should not be prescribed for pregnant women," Volkow, who wasn't
involved in the study, said in a telephone interview.
Another problem is that scientists don't know how different types
and amounts of cannabis use might impact pregnant women and their
babies," said Kelly Young-Wolff, a researcher at Kaiser Permanente
Northern California in Oakland who wasn't involved in the study.
"The health effects of cannabis use in pregnancy may differ
depending on mode of administration (e.g., vaping versus smoking),
cannabis potency, trimester of cannabis exposure, and concurrent use
of other substances, factors that we are just beginning to include
in research on the health effects of cannabis use in pregnancy,"
Young-Wolff said by email.
While cannabis can indeed ease nausea, most of the research in this
area has focused on cancer patients who have nausea as a side effect
of chemotherapy, said Marcel Bonn-Miller of the Perelman School of
Medicine at the University of Pennsylvania in Philadelphia.
"I would not advise pregnant women to use cannabis for nausea,
especially because we already have a number of good treatment
options," Bonn-Miller, who wasn't involved in the study, said by
email. "There are just too many risks and unknowns at this stage."
SOURCE: https://bit.ly/2ruCa42 Obstetrics & Gynecology, online May
9, 2018.
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