Accurate data on cannabis use while pregnant ‘essential’ to improve health of women, kids

Cannabis use during pregnancy may predispose children to stress susceptibility and anxiety, according to a study published in Proceedings of the National Academy of Science.

But instead of asking doctors for information about whether cannabis is safe to use during pregnancy, many mothers are turning to the clerks at their local dispensaries instead, according to another report in The American Journal of Drug and Alcohol Abuse.

Anxious children

Increased legalization has softened public opinion about the health risks associated with cannabis use, according to the researchers of the first study, and cannabis has become one of the most frequently abused recreational drugs during pregnancy. However, the researchers added, the impact of maternal use on fetal and childhood development is not clear.

“We know that cannabinoid signaling plays a role in modulating stress, which is why some people use cannabis to reduce anxiety and relax,” author Yoko Nomura, PhD, professor of psychology at CUNY Graduate Center and Queens College, said in a press release.

Yoko Nomura

“But our study shows that in utero exposure to cannabis has the opposite effect on children, causing them to have increased levels of anxiety, aggression and hyperactivity compared to other children who were not exposed to cannabis during pregnancy,” Nomura said.

The researchers examined placental gene expression and early childhood behavior and physiology in a long-term study of 322 mother-child pairs drawn from an ongoing study of stress in pregnancy based in New York City that began in 2009.

When the children were approximately aged 6 years, the researchers measured their hormone levels via hair samples and heart function during a stress-inducing condition via electrocardiogram recordings. Also, the researchers surveyed the parents to assess behavior and emotional functioning.

The children of mothers who used cannabis during pregnancy showed higher anxiety, aggression, hyperactivity and cortisol levels compared with children of mothers who did not use cannabis. The researchers also said they found an association between maternal cannabis use and a reduction in the high-frequency component of heart rate variability — or the change in time interval between heartbeats — which normally reflects increased stress sensitivity.

Furthermore, by sequencing the RNA of placental tissue collected at birth in a subset of participants, the researchers associated maternal cannabis use with lower expression of immune-activating genes, including pro-inflammatory cytokines, which help protect the body against pathogens. The cannabis-related suppression of several placental immune-gene networks predicted higher anxiety in the children.

“Pregnant women are being bombarded with misinformation that cannabis is of no risk, while the reality is that cannabis is more potent today than it was even a few years ago,” author Yasmin L. Hurd, PhD, Ward-Coleman Chair of Translational Neuroscience and director of the Addiction Institute at Mount Sinai, said in a hospital press release.

Yasmin L. Hurd

“Our findings indicate that using it during pregnancy can have long-term impact on children,” Hurd said.

The researchers said their findings underscore the need for nonbiased education and outreach to the public and to particularly vulnerable populations of pregnant women about the potential impact of cannabis use.

“Disseminating this data and accurate information is essential to improving the health of women and their children,” Hurd said.

Listening to their ‘budtender’

Many women who are pregnant or breastfeeding get information on cannabis use from retail cannabis workers, or “budtenders,” instead of from health care providers, researchers at Washington State University Health Sciences said.

According to researchers who conducted the second study, past-month cannabis use among pregnant women has nearly doubled to 7% while daily or near-daily use has tripled to 3.4% from 2002 to 2017.

However, education for health care providers and for budtenders has not kept pace with this increase in demand, and both groups said they want more information about interacting with pregnant and nursing women about cannabis use.

“We need to use all approaches and all people in the patient’s life to help them,” author Celestina Barbosa-Leiker, PhD, vice chancellor for research at Washington State University Health Sciences, said in a university press release.

“There is such limited research with budtenders, but they need to be part of this conversation because they are seen as trusted sources by their customers and our patients. We need to engage with them because that’s where the information is being disseminated,” Barbosa-Leiker said.

The researchers interviewed 10 health care professionals (primarily nurses; 100% women) and 10 budtenders (70% women) in Washington about their opinions and perceptions on perinatal cannabis use. Washington legalized recreational marijuana use in 2013.

In addition to a desire for more education and training, health care providers and budtenders agreed that pregnant and breastfeeding women primarily use cannabis to relieve nausea, anxiety, pain and stress instead of for recreation.

The health care providers had a negative opinion of the effects of cannabis use on those patients. The providers said they try to be nonjudgmental when they talk to their perinatal patients, but they also follow national guidelines in advising patients to refrain from cannabis use during pregnancy and breastfeeding.

The budtenders had a much more positive view of cannabis use during pregnancy and breastfeeding, the researchers said, seeing marijuana as a natural substance that is safer than perinatal alcohol or cigarette use.

Also, the budtenders said they tended to focus on harm reduction and recommend products with lower levels of THC for pregnant and breastfeeding customers. The health care providers did not see cannabis use on a spectrum, but rather as a choice between not using cannabis and very heavy use.

Patients who feel stigmatized by health care providers or whose provider does not have information or guidance about cannabis use might turn to a budtender for advice, Barbosa-Leiker said.

Barbosa-Leiker also said that she sympathizes with the budtenders because pregnant and breastfeeding women are turning to them for advice. Budtenders have to rely on “stoner science” of largely unverified claims or Google searches to help those customers, one of the budtender respondents said.

Budtenders additionally need training about cannabis products and asked for training about how they can best serve perinatal customers, the researchers said.

According to the researchers, the best scenario would be for women who use cannabis to feel as comfortable talking to their health care provider about their choice as they do to their budtender. That will require training in how to ask the right questions the right way, the researchers added.

“With that additional training, I think those conversations can happen in a more nonjudgmental way, in a harm-reduction way, and hopefully trust will be built,” Barbosa-Leiker said.

References:

• Rompala G, et al. Proc Natl Acad Sci U S A. 2021;doi:10.1073/pnas.2106115118.
• Budtenders, healthcare providers seek more training as cannabis use rises. https://news.wsu.edu/press-release/2021/11/15/budtenders-healthcare-providers-seek-more-training-as-cannabis-use-rises-sharply-in-perinatal-women/. Published Nov. 15, 2021. Accessed November 16, 2021.
• Barbosa-Leiker C, et al. Am J Drug Alcohol Abuse. 2021;doi:10.1080/00952990.2021.1988091.