Increasing Rates of Marijuana Use During Pregnancy
To date, there are no marijuana-derived medications that are FDA-approved for treating conditions associated with pregnancy, including nausea. However, marijuana is the illicit drug most commonly used by pregnant women, with rates doubling since 2002.1
- Pregnant women report marijuana use predominantly to self-treat depression, anxiety, stress, pain, nausea, and vomiting;2,3 it is most commonly used during the first trimester1,4 and by women with severe nausea.5,6
- About 7 percent of pregnant women self-report marijuana use–with rates as high as 10 percent among women ages 18-25. Rates based on urine toxicology are even higher, with 19 percent of pregnant women ages 18-25 screening positive for marijuana use.7
The Endocannabinoid System
Marijuana contains hundreds of chemicals including Δ-9-tetrahydrocannabinol (THC) and other cannabinoids. THC, the main psychoactive component of marijuana and the one that makes people high, is linked to most of the effects people commonly associate with marijuana.
- THC works by interacting with a signaling system found throughout the brain and other areas of the body known as the endocannabinoid (ECB) system.
- The ECB system is involved in regulating pain, nausea, and appetite, among others. It also plays a key role in pregnancy (implantation and placenta maintenance) and in prenatal brain development.
- Because THC disrupts the normal functioning of the ECB system, it may have lasting effects on prenatal development.
Recommendations for Health Care Providers 21,36
- Screen for substance use. Women should be screened for substance use before and throughout pregnancy.
- Encourage pregnant women who use marijuana to discontinue its use. Refer them to appropriate resources to help with cessation, if necessary.
- Pregnant women who are using marijuana to treat nausea and vomiting or for another medical condition during pregnancy should be counseled about the lack of safety data and efficacy data in pregnant women and the possible adverse effects of THC on the developing fetus. Refer them to their OB/GYN for alternative treatments that have pregnancy-specific safety data.
- Recommend that women avoid using marijuana while lactating. Marijuana is passed to the child in breast milk and may have adverse effects on early neurodevelopment.
- Provide counseling, but do not withdraw lactation or other medical support.
The health effects of marijuana exposure during pregnancy and breastfeeding are not certain. In studies with people, it can be challenging to disentangle the multiple risk and protective factors that affect fetal and newborn outcomes. Exposure to other drugs (see “Role of Poly-Drug Use,” below) and factors such as nutrition, prenatal care, family support, and stress among others can be important influences on the health of the baby. Moreover, many studies rely on self-reported measures of marijuana consumption, which frequently underestimate use.
Additional research is needed on the health effects associated with marijuana exposure during pregnancy and breastfeeding, particularly studies examining the effects of the marijuana products used by women today, the patterns by which they are used, and their co-use with other substances. However, what we do know already urges caution, since the endocannabinoid system guides neural development, and cannabinoids consumed during pregnancy can get into the fetal brain.8-10 Current research on marijuana indicates that:
- THC crosses the placenta, enters the fetal brain, and is transferred to newborns through breastmilk.11,12
- In animals, moderate concentrations of THC, when administered to mothers while pregnant or nursing, may have long-lasting effects on offspring, including increasing stress responsivity, abnormal patterns of social interaction, and later preference for other substances.13,14
- Prenatal marijuana exposure is associated with lower birth weight.15
- Marijuana use during pregnancy is linked to a higher likelihood of an infant’s being placed in neonatal intensive care,16 increased startle and tremors, altered sleep patterns, and preterm birth.17-20 Further research is needed to determine if these associations persist when confounding factors are considered.21-23
- Prenatal marijuana exposure is associated with neurocognitive vulnerabilities in children and adolescents,19 including decreased executive function (problem solving, sustained attention and short-term memory);24-26 behavioral problems (impulsivity and hyperactivity);27 lower academic achievement;28,29 and higher levels of self-reported depressive symptoms.30
Additional research is critical to fully understand how marijuana use during pregnancy and breastfeeding affects the mother, developing fetus, and child.
Role of Poly-drug Use
Disentangling the developmental effects of prenatal marijuana exposure from exposure to other substances is difficult because many women who use marijuana during pregnancy are also using other substances (tobacco, alcohol, and other drugs).21,23,24 Prenatal poly-substance exposure has been found by numerous studies to cause harmful effects in infants.
- Use of tobacco and marijuana by pregnant women is associated with lower birth weight, small size for gestational age, small head circumference, and other birth defects in their infants.16,31
- Children of women who chronically use multiple drugs are more likely to suffer from a substance use disorder by early adulthood compared to children of women who do not use multiple drugs.32
Perception of Safety
Pregnant women are more likely to cease using marijuana if they perceive it to be harmful, but multiple factors such as state legalization, social acceptability, and misconceptions about health risks are increasing the perception that marijuana is safe.21,33,34
- Women report a need for resources and communication with healthcare providers about the risks of prenatal marijuana use. When women do not receive resources or advice from health care providers, they may interpret this as an indication that marijuana is safe.34
- in a study of Colorado marijuana dispensaries, 70 percent of dispensaries recommended marijuana products to treat nausea in the first trimester. Only 1 in 3 dispensaries encouraged discussion with a healthcare provider without first being asked by the caller.35
If you or someone you care about is pregnant and using a drug such as marijuana or has a substance use disorder:
- Ask your healthcare provider about the risks and treatment options.
- Find treatment services in your area through SAMHSA's treatment locator and HRSA's Find a Health Center.
- Visit NIDA's webpages for more information: Marijuana Research Report and Substance Use While Pregnant and Breastfeeding.
- Quality. Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. 2018.
- Brown QL, Sarvet AL, Shmulewitz D, Martins SS, Wall MM, Hasin DS. Trends in Marijuana Use Among Pregnant and Nonpregnant Reproductive-Aged Women, 2002-2014. JAMA. 2017;317(2):207-209.
- Mark K, Gryczynski J, Axenfeld E, Schwartz RP, Terplan M. Pregnant Women's Current and Intended Cannabis Use in Relation to Their Views Toward Legalization and Knowledge of Potential Harm. J Addict Med. 2017;11(3):211-216.
- Volkow ND, Han B, Compton WM, Blanco C. Marijuana Use During Stages of Pregnancy in the United States. Annals of internal medicine. 2017;166(10):763-764.
- Young-Wolff KC, Sarovar V, Tucker L, et al. Association of nausea and vomiting in pregnancy with prenatal marijuana use. JAMA Internal Medicine. 2018.
- Roberson EK, Patrick WK, Hurwitz EL. Marijuana use and maternal experiences of severe nausea during pregnancy in Hawai'i. Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health. 2014;73(9):283-287.
- Young-Wolff KC, Tucker LY, Alexeeff S, et al. Trends in Self-reported and Biochemically Tested Marijuana Use Among Pregnant Females in California From 2009-2016. JAMA. 2017;318(24):2490-2491.
- Stickrath E. Marijuana Use in Pregnancy: An Updated Look at Marijuana Use and Its Impact on Pregnancy. Clinical obstetrics and gynecology. 2019;62(1):185-190.
- Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. American journal of obstetrics and gynecology. 2015;213(6):761-778.
- Weiss SRB, Howlett KD, Baler RD. Building smart cannabis policy from the science up. Int J Drug Policy. 2017;42:39-49.
- Kim J, de Castro A, Lendoiro E, Cruz-Landeira A, Lopez-Rivadulla M, Concheiro M. Detection of in utero cannabis exposure by umbilical cord analysis. Drug testing and analysis. 2018;10(4):636-643.
- Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk. Pediatrics. 2018;142(3).
- Schneider M. Cannabis use in pregnancy and early life and its consequences: animal models. European archives of psychiatry and clinical neuroscience. 2009;259(7):383-393.
- Szutorisz H, Hurd YL. High times for cannabis: Epigenetic imprint and its legacy on brain and behavior. Neuroscience and biobehavioral reviews. 2018;85:93-101.
- National Academies of Sciences E, Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017.
- Gunn JKL, Rosales CB, Center KE, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6(4).
- Fried PA, Makin JE. Neonatal behavioural correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population. Neurotoxicol Teratol. 1987;9(1):1-7.
- Fried PA, Watkinson B, Dillon RF, Dulberg CS. Neonatal neurological status in a low-risk population after prenatal exposure to cigarettes, marijuana, and alcohol. Journal of developmental and behavioral pediatrics : JDBP. 1987;8(6):318-326.
- McLemore GL, Richardson KA. Data from three prospective longitudinal human cohorts of prenatal marijuana exposure and offspring outcomes from the fetal period through young adulthood. Data in brief. 2016;9:753-757.
- Corsi DJ, Walsh L, Weiss D, et al. Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes. JAMA. 2019.
- Ryan SA, Ammerman SD, O'Connor ME. Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes. Pediatrics. 2018;142(3).
- Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG. Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016;128(4):713-723.
- Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabis Use During the Perinatal Period in a State With Legalized Recreational and Medical Marijuana: The Association Between Maternal Characteristics, Breastfeeding Patterns, and Neonatal Outcomes. J Pediatr. 2018;197:90-96.
- Richardson GA, Ryan C, Willford J, Day NL, Goldschmidt L. Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years. Neurotoxicol Teratol. 2002;24(3):309-320.
- Fried PA, Watkinson B. 36- and 48-month neurobehavioral follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol. Journal of developmental and behavioral pediatrics : JDBP. 1990;11(2):49-58.
- Wu CS, Jew CP, Lu HC. Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. Future neurology. 2011;6(4):459-480.
- Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000;22(3):325-336.
- Goldschmidt L. School achievement in 14-year-old youths prenatally exposed to marijuana. 2012;34(1):161-167.
- Fried PA, Watkinson B. Differential effects on facets of attention in adolescents prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol. 2001;23(5):421-430.
- Gray KA, Day NL, Leech S, Richardson GA. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Neurotoxicol Teratol. 2005;27(3):439-448.
- Coleman-Cowger VH, Oga EA, Peters EN, Mark K. Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicol Teratol. 2018;68:84-90.
- De Genna NM, Goldschmidt L, Richardson GA, Cornelius MD, Day NL. Trajectories of pre- and postnatal co-use of cannabis and tobacco predict co-use and drug use disorders in adult offspring. Neurotoxicol Teratol. 2018;70:10-17.
- Cook JL, Green CR, de la Ronde S, et al. Screening and Management of Substance Use in Pregnancy: A Review. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2017;39(10):897-905.
- Bayrampour H, Zahradnik M, Lisonkova S, Janssen P. Women's perspectives about cannabis use during pregnancy and the postpartum period: An integrative review. Preventive medicine. 2019;119:17-23.
- Dickson B, Mansfield C, Guiahi M, et al. Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use. Obstet Gynecol. 2018;131(6):1031-1038.
- Marijuana use during pregnancy and lactation. Committee Opinion No. 722. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e205–9.