Mothers on marijuana

Ask Cara Crabb-Burnham, and she’ll tell you that marijuana was the only thing that helped keep her seizure disorder under control during her first pregnancy. The Massachusetts resident regularly consumed a pure concentration of the drug through a dab pen, or vaporizer.

“I needed really high doses at that time,” Crabb-Burnham, age 39, told me in an interview. “I used throughout my entire pregnancy.”

Pot also featured prominently throughout her 14 hours of labor at home with her second child. She recalls her husband loading the cannabis flower into the glass bowl at the end of her pipe. And her labor-induced screams of pain as he lit the contraption and shoved it in her mouth. (“Marijuana is not a good substitute for an epidural,” she said.)

As more states legalize medical and recreational marijuana, more women are turning to it to ease pregnancy symptoms. Yet mounting evidence points to the drug’s potential neurodevelopmental harm to unborn children. While advocates for prenatal use argue the available evidence is inconclusive, the larger medical community agrees: Where a child’s health is at stake, pregnant mothers should minimize risks.

So far, 24 states and the District of Columbia have fully legalized marijuana. A nationally representative survey found self-reported cannabis use among pregnant women grew from 3.4% in the 2002-2003 period to 7% in 2016-2017. Women with severe nausea and vomiting are four times as likely to consume cannabis as women without these symptoms, a 2018 study of 220,000 pregnancies in California found.

Benjamin Caplan is a board-certified family doctor who has seen the uptick firsthand. Caplan runs a Massachusetts-based virtual clinic that recommends cannabis products to treat medical conditions. His clinic sees about 18,000 patients every year, and, of those, between 200 and 300 are pregnant or trying to get pregnant, he said.

Some of Caplan’s patients distrust modern medicine or are experiencing morning sickness and haven’t found relief through traditional medications. He recommends products containing THC, the psychoactive component found in cannabis, as well as CBD, another marijuana product that does not typically cause the user to get high. “My routine is usually to try products that are going to be most useful and discover what’s helpful for mom, and then make a routine that’s personalized,” he said.

Yet Caplan’s recommendations directly contradict the American College of Obstetricians and Gynecologists, which discourages marijuana use while pregnant or breastfeeding. Then-U.S. Surgeon General Jerome Adams issued a warning in 2019 urging pregnant women to avoid the drug, since studies link in utero cannabis exposure to low birth weight, preterm birth, and disorders of pregnancy like preeclampsia. Both THC and CBD cross the placenta and are found in breast milk.

Carrie Bearden would like pregnant pot users to just stop. A professor and researcher at UCLA’s Brain Research Institute, Bearden said the young people who frequent her clinic with signs of schizophrenia and other mental problems often use marijuana to calm their anxiety. But she believes the drug is exacerbating their symptoms. Her observations align with a growing body of research linking high-potency cannabis use to severe mental illness.

Bearden wants more mothers to understand this link. A 2020 study of 11,000 U.S. children showed that those exposed to cannabis in utero were more prone to psychotic-like behaviors during middle childhood. The researchers, affiliated with the Washington University in St. Louis, also linked prenatal cannabis use with attention, social, and behavioral problems in early adolescence.

“I think a lot of women are using it because they are not really aware of [the risks],” said UCLA’s Bearden. “A lot of this information is not really that accessible, or it’s really just coming out now.”

Bearden said cannabis use affects the body’s endocannabinoid system, a network of receptors that help regulate our immune response, emotions, sleep, and other functions. “Cannabis in pregnancy is going to affect those receptors in your developing child,” she said. “And those effects do appear to be pretty long term.”

In addition to ACOG, the American Academy of Pediatrics and Mayo Clinic also recommend against marijuana use during pregnancy.

So does James Avery, a doctor and the author of Marijuana: An Honest Look at the World’s Most Misunderstood Weed. He noted the cannabis plant is composed of more than 100 unique compounds that are still poorly understood.

But caution isn’t typically a component of the marijuana industry. A 2018 survey involving a mystery caller revealed that out of 400 Colorado dispensaries, almost 70% recommended cannabis products for morning sickness. Only 32% encouraged the mystery caller, without prompting, to discuss marijuana use with a healthcare provider.

Caplan, the pro-cannabis doctor, acknowledged marijuana comes with risks. But he argued they’re “modest” and “mostly unconfirmed.” Traditional medications for morning sickness also come with risk, he said, characterizing marijuana as a “natural” alternative and the “safest possible choice.”

Cannabis advocate Cara Crabb-Burnham also dismissed the available evidence about the drug’s risks as unproved correlations. “It just needs to be a woman’s choice,” she argued. “If there’s no direct evidence that immediately supports a known harm, maybe we should just leave people alone.”

Caplan said he does encourage expectant mothers to take precautions. Lower doses as opposed to high doses. Oil-based tinctures instead of dispensary products full of sugar and additives. He discourages smoking cannabis since it changes the properties of the plant.

Ethical concerns prevent randomized controlled trials of prenatal cannabis use, so available studies draw on previously collected data and can only determine association, not causation. Still, research points to a noticeable link to adverse pregnancy outcomes and childhood neurological problems even after controlling for confounding variables, such as socioeconomic status.

Misty Richards, a reproductive psychiatrist and assistant clinical professor at UCLA, said marijuana use has even edged out alcohol use among her pregnant patients. The drug’s risks shouldn’t be ignored, she noted.

“It’s potent. It packs a punch,” she said. “And it impacts this endocannabinoid system, which is just developing in little babies.”