Lauren M. Jansson, MD1Chloe J. Jordan, PhD2Martha L. Velez, MD1

JAMA. Published online July 16, 2018. doi:10.1001/jama.2018.8401 

Increasing public attention has recently been paid to the opioid epidemic and attendant effects on prenatally exposed infants and children. 1Current literature has emerged proposing marijuana as a safe alternative to opioids in addressing pain 2 and cannabis legalization as a way to decrease opioid fatalities. 3 As a result, perceptions of cannabis safety have increased, and the prevalence of marijuana use among pregnant women has expanded; past-month cannabis use among pregnant US women increased from 2.4% to 3.9% between 2002 and 2014. 4 Further, cannabis potency has been substantially increasing over the past 4 decades in the United States, and will likely continue to do so as extraction procedures of active components improve.

Although cannabis does have known medical utility for some conditions, its associated acute and long-term psychoactive effects on brain function are also known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated …The exogenous supply of cannabinoids resulting from THC exposure can adversely affect fetal growth as well as structural and functional neurodevelopment. 6

Prenatal THC exposure has been documented to adversely affect infant neurobehavior and child development up through the teen years,5and postnatal exposures may compound prenatally acquired deficits. Neurobehavioral effects associated with prenatal THC exposure range from dysregulated arousal and motor difficulties at birth to disturbed sleep, memory impairment, aggression, and other developmental and behavioral concerns in childhood. 5

Despite these risks, it appears that clinicians are not addressing cannabis use during pregnancy or lactation; in one study of 74 lactation professionals, 85% encouraged breastfeeding among marijuana-using mothers. 7 Most national breastfeeding guidelines (eg, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists) have remained steadfast in recommending against cannabis use during lactation….

The medical community should advise pregnant women to avoid perinatal THC exposure and intervene for women needing treatment, for children at risk for neurobiological and developmental problems, or for dyads at risk for negative outcomes associated with an untreated substance use disorder. Advice from medical professionals should be consistent: pregnant and lactating women should be advised to avoid cannabis use, and women (and men) caring for developing children also should be advised to maintain abstinence. Treatment programs for women with CUD should be available and accessible, and gender and culturally specific, particularly during pregnancy and postpartum periods. Converging, systematic research is necessary at both the preclinical and clinical levels to address insufficient evidence regarding maternal cannabis use 9 and to fully understand the short- and long-term effects of perinatal THC exposure, the effects of maternal cannabis use on fetal outcomes, and the consequences of polysubstance use in treatment and intervention efforts.

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