The Great Ganja Debate
Karen was so sick during her first pregnancy, she felt like she might die.
Practically from conception, Karen was throwing up morning, noon and night. She lost weight, became severely dehydrated and was repulsed by the sight and smell of food. Acupressure, diet changes and even the psychologist her doctor recommended didn't help. Karen was nervous about taking medications her doctor prescribed after reading about the potentially harmful effects to her and her baby.
Then a straight-laced friend made a surprising suggestion: "Have you tried pot?"
"I was shocked," said Karen, a communications executive who lives in Seattle and now has two children.
The year was 2006. Marijuana was an illicit drug, and Karen didn't even know how to get it. Besides, the expectant mother assumed that marijuana was just as dangerous to her fetus as alcohol.
Now that marijuana use is legal in Washington, some moms and childbirth professionals are hoping there can be an open discussion about its use to treat common pregnancy issues, including chronic vomiting, sleeplessness, anxiety, labor pain and postpartum stress. Currently, most health care providers recommend that pregnant and nursing women abstain from marijuana use. However, scientific research on the drug's long-term effects on children is incomplete and sometimes conflicting.
Karen and other women are eager for medical experts and scientists to clear up the confusion around cannabis.
"Regular women, not just ‘potheads' are using it," said Karen, who asked that her last name not be published due to the stigma still attached to cannabis use, whether medicinal or not. "We have to talk about it."
Several weeks after her friend posed the question, Karen was still vomiting violently whenever she stood up. She was desperate.
The next day the friend arrived with a dish of "green" brownies and whatever research she could glean from the internet about marijuana and pregnancy. Much of the science was inconclusive and the majority of the studies focused on heavy pot users, not women who had the occasional joint or brownie to relieve common pregnancy complaints. A search today yields the same confusing information.
That has left some women with a difficult decision. Do you take conventional pharmaceuticals with potential side effects including developmental problems, such as cleft palates, uncontrollable twitching and lip smacking, or do you try marijuana and the seemingly more ambiguous risks that it poses? Karen went with the weed.
"I just didn't see a catastrophe in taking it," she said, "especially in small amounts."
Does It Really Work?
Eating cannabis didn't completely cure Karen's severe morning sickness, which is also called hyperemesis gravidarum. But just as it has for nauseous cancer patients, pot did make her symptoms manageable. Equally important, the small daily dose of marijuana – less than the amount found in the typical one gram joint – stoked her appetite, and Karen began gaining weight. While smoked marijuana's effects are felt more quickly, ingested pot tends to act longer and stronger, according to research from the University of Washington.
Studies supporting the claim that marijuana helps to ease severe morning sickness are hard to come by, since the substance remains illegal nationally and in most states. However, international research suggests that marijuana could be a powerful, natural remedy for this relatively common and sometimes dangerous problem.
In 2006, Canadian scientists published a study concluding that 92 percent of pregnant women who used cannabis to quell extreme nausea and pain rated it as "effective" or "extremely effective."
"Our findings support the need for further investigations into cannabis therapy for severe nausea and vomiting during pregnancy," study authors concluded in the journal Complementary Therapies in Clinical Practice.
Even with some research on her side, Karen was uncomfortable disclosing what she'd done. "I didn't tell anyone, not even my husband," she said.
Is It Safe? The Conflicting Research
It's hard to know how many pregnant women in the U.S. use pot. A 2003 report in BJOG: An International Journal of Obstetrics & Gynaecology found that of 12,000 women studied, 5 percent had used the drug before or during pregnancy. Research conducted during the 1980s found that as many as 11 percent of pregnant American women used marijuana.
But the experts are divided on the effects of marijuana on fetal and child development.
Most obstetricians and pediatricians oppose pot use for pregnant and nursing mothers. They say that there is research showing that it can cause health problems in babies, make someone more prone to weed addiction in the future, and that there is insufficient quality control for marijuana.
"There is no medical condition that a mother could have that would outweigh the risk to the unborn child. For any malady marijuana could possibly have an impact on, there is a regulated FDA approved medication with known risks and benefits that can be used instead," said Seattle Children's Hospital's Dr. Leslie Walker, a UW professor of Pediatrics.
Walker says that she has seen evidence that mothers who smoke marijuana have babies with brains smaller than normal – although other research shows the opposite, that heads – and brains – may be bigger in babies exposed in utero.
Either way, Walker says, "We know it stunts some of the critical growth of a newborn. The fact (that) marijuana is legal does not change its addictive properties nor change its dangers to the unborn child."
The Washington Department of Health has yet to weigh in on marijuana use by pregnant women, now that the drug is legal here.
"We have done no independent research on this issue, and have no real expertise regarding marijuana and its health impacts," said spokesman Timothy Church. Eventually, the department will offer public education and information about pot consumption in pregnancy. Ironically, that advice is dependent on the taxes collected on marijuana sales.
At the national level, the Centers for Disease Control and Prevention has this advice for expectant or nursing moms: Don't do it. Marijuana, according to the CDC, can cause birth defects or "be passed through breast milk to her baby and can affect the baby's growth and development."
Some long-term studies support this position. The Ottawa Prenatal Prospective Study began tracking mothers in 1978, and in 1982 the Maternal Health Practices and Child Development Study was launched in Pittsburgh. Both have found that the head circumference of infants whose mothers used cannabis during pregnancy were larger than those whose mothers refrained. Head measurement is used as an indication of normal fetal brain development. By age 4, the marijuana-exposed children showed increased behavior problems and indications of poor organization or "executive functioning."
But those who support marijuana use in pregnancy point to other published research showing that moderate pot use poses little or no threat to baby or mother.
Exposure to cannabis in utero makes no difference to newborns or older children in terms of growth and development, says Dr. Melanie Dreher, a frequently cited researcher and Dean of Nursing at Rush Medical Center in Chicago.
Nearly 20 years ago, Dreher published a landmark study titled "Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study" in the journal Pediatrics. It compared the children of pregnant women who were heavy cannabis users in Jamaica to kids of mothers from an otherwise similar demographic who were non-users. She and her colleagues used rigorous, well-regarded assessment tools in their analysis in order to capture possible subtle effects when comparing the two groups of children.
They found no differences in key developmental measurements with one exception: the babies exposed to cannabis scored significantly higher on these tests at one month old. By age 5, Dreher detected nothing that linked kids' development with their exposure during pregnancy.
One Puff or Two?
There is general consensus on both sides that overuse or abuse of any drug, whether it's alcohol, weed, pain killers or vitamins, is unhealthy for a pregnant woman and her fetus. But no one yet knows if there's a safe dose for mothers medicating with marijuana. Those studies are yet to be done – and may still be a ways off, given that cannabis remains illegal in most places and human testing, especially on pregnant or nursing women, is ethically problematic.
So mothers are using their own best judgments to decide how much pot is OK. Five King County mothers and numerous other women commenting on health-related websites said that smoking a single joint or ingesting a small amount of the drug helped reduce nausea or deal with prolonged early labor. When asked how they knew how much to take, each of the five moms – all of whom declined to have their name published – said some version of the same thing: "I guessed."
In the absence of advice from the medical community, moms have turned to other resources. One of the best guides on medical marijuana use is " Medicinal Cannabis: Rational Guidelines for Dosing" by UW researcher Dr. Gregory Carter. But the guide is largely based on sufferers of cancer and other disease, not pregnancy.
The huge variability in the amount and types of cannabinoids present in marijuana and patient tolerance for the drug, "make it imperative that the dosing be highly individualized," Carter wrote.
That is why local childbirth professionals stress that moms considering using marijuana in pregnancy should not keep that information from their health care provider.
"As with other drugs, prescription or otherwise, it is important to consider the dose, and the age and health of the baby," said Seattle lactation consultant Renee Beebe. "But there is a lot we don't know."
THC, a central compound in cannabis, does pass into breast milk, although if or how much that impacts a baby is not well understood. Beebe recommends that mothers review iBreastfeeding.com, a website by Dr. Thomas Hale, a clinical pharmacologist at Texas Tech University School of Medicine and a leading expert on drug impacts on mother's milk.
His stance is clear: "While the effect of cannabis on infants from breastfeeding mothers is limited, cannabis use in breastfeeding mothers should be strongly discouraged."
Use and Child Protective Services
When her nausea came down a notch at around five months of pregnancy, Karen stopped using marijuana.
"I wish I could have freely talked about it with my doctor, but I was really worried I'd be reported to state authorities as a drug-abusing, bad mother," said Karen. Her oldest daughter is now 7 and shows no apparent ill effects from her in utero exposure.
In 2006, had THC been detected in Karen or her newborn, the baby might have been held in the hospital and Karen assessed by state social workers for parental fitness.
Marijuana's new legality doesn't change that possibility, said Washington Child Protective Services spokeswoman Chris Case. If a doctor feels a woman is abusing a substance – even legal substances like alcohol and now pot – he or she can request a CPS risk assessment.
However, said Case, doctors are unlikely to make that call unless it is clear that the woman is abusing the drug.
A Rush on Brownies?
Karen said she never considered using marijuana to help reduce the anxiety she felt during her three day labor. Instead, her doctor gave her Ambien, a strong sedative, and Stadol, a strong narcotic.
"Had it been legal then, I might have. I can't imagine a little pot would have been any worse for my daughter than the hard drugs I got," she said.
Still, many health care providers don't anticipate widespread marijuana use by pregnant and nursing women, now that it's legal in Washington.
"I personally do not think there will be droves," of mothers using the drug, said Walker.
"What I do think is that it will increase the comfort a woman has in disclosing that she is using marijuana or thinking about it with her care provider," she added. "And that is a good thing – for them to come out of the closet and get the information they need."