Pot and pregnancy: Are CBD warnings strong enough?

The recent increase in legalized recreational marijuana sales demonstrates the critical need to come with a strong warning for pregnant and breastfeeding women. 

According to the Centers for Disease Control and Prevention,  one in 25 women uses marijuana while pregnant.  Seventy percent of women who use marijuana during pregnancy don’t believe there is any harm in doing so. Women who use marijuana during pregnancy report doing so in order to reduce the effects of morning sickness and anxiety or for social reasons.

As nurses with years of experience caring for women, mothers, and babies, we know the value of prevention in fostering positive pregnancy outcomes. It is not an easy task to care for a baby in the Neonatal Intensive Care Unit and have a family already riddled with guilt and anguish, wondering what they could have potentially done differently to have a more positive birth outcome. 

Mothers, as well as health care providers, need to ensure all mothers experience a safe pregnancy and positive outcomes for themselves and their children. 

The United States continues to experience the worst pregnancy-related outcomes compared to other developed nations.  For decades, leading experts have strongly warned about the effects of cigarette smoking and second-hand smoke exposure on adverse pregnancy outcomes. 

According to the Centers for Disease Control, smoking during pregnancy increases the risk of preterm birth, low birth weight, and stillbirth along with other adverse consequences after delivery, such as sudden infant death syndrome. Experts say that smoking prevention offers one of the greatest protections against these and other adverse pregnancy outcomes.  

Researchers at the University of Western Ontario reported that regular exposure to THC, the potently psychoactive ingredient in marijuana that produces the “high effect,” was associated with more than a 20 percent decrease on a fetus’ brain and liver development, and an 8 percent reduction in birth weight when used regularly during pregnancy. The study also shows that THC negatively impacts placental and fetal growth. 

Hemp plants contain extremely low levels of THC. Both marijuana and hemp plants can be used to derive cannabidiol (CBD). CBD, unlike marijuana, does not produce a high effect, and its recent use has been reported in a number of products like food, cosmetic and supplements. 

The Federal Drug Administration (FDA) has only approved the use of one CBD prescription drug for use to treat a rare seizure disorder in children.  CBD oil has also been reported to reduce nausea, and pain, improve sleep and to elevate mood.  CBD in all its forms (oils, lotions, capsules and foods) has yet to be proven safe for use in any amount. Pregnant women who use marijuana or CBD products may be doing so because they believe that it is more natural than using chemically compounded medications for treating morning sickness and nausea. However, “natural” is not synonymous with safe, nor does it negate the side effects, consequences or untoward effects on health outcomes. 

Colorado and California are among the first states requiring warning labels on medical and recreational marijuana products for pregnant and breastfeeding women. In addition to the warning labels, Michigan is also proposing that informational pamphlets be provided with the number to the Poison Control Hotline for edibles like gummies and other products in case they are accidentally ingested. 

In order to protect the health and well-being of babies and mothers everywhere, a strong national educational campaign needs to outline the adverse effects of all forms of marijuana and cannabinoid containing products. 

Health care providers need to be explicit in screenings of pregnant and breastfeeding women about the use of cannabinoid containing substance use in all of its forms, similar to what is done regarding alcohol, smoking, and other drugs.  

If they identify marijuana or CBD use, they can provide cessation information along with recommendations for FDA-approved cessation support measures.  International Board Certified Lactation Consultants need to establish strong partnerships with providers for ongoing screening and education during lactation.  

The increased social acceptability of and accessibility to marijuana and marijuana-related products calls for greater public awareness, especially for women of childbearing age and all pregnant women. 

The Surgeon General has issued a clarion call for stronger awareness, emphasizing that no amount of marijuana or cannabinoid containing substances are safe during pregnancy or while breastfeeding. 

Efforts to reverse the high rates of maternal and infant mortality among women would be incomplete without a stronger emphasis on the known and unknown effects of all cannabis-containing substances, including recreational marijuana. Safeguarding the health of mothers and babies is one of the most significant indicators of a nation’s health and, certainly, something that all mothers and babies deserve.   

Christie Lawrence, R.N. is an assistant professor in the College of Nursing, Department of women, Children and Family Nursing, at Rush University. Janice Phillips, R.N., Ph.D., is an Associate Professor at Rush University College of Nursing, the Director of Nursing Research and Health Equity at the Rush University Medical Center.