Warning labels on alcohol and cigarettes have long been in place, informing expectant women of the dangers of drinking and smoking. Now, marijuana—the most commonly used illicit drug during pregnancy—is on deck to join this group of potentially harmful substances. Newly proposed regulations from the American Medical Association (AMA), as outlined in resolution #922 (Cannabis Warnings for Pregnant and Breastfeeding Women), advocate for written warnings on medical and recreational marijuana products, as well as posted signage in establishments where they are sold.
"This resolution was introduced in part because the legalization of this substance is continuing and there are questions—and even misconceptions—about its safety during pregnancy. We want women to understand the risks involved," says Diana E. Ramos, M.D., MPH, a fellow of The American College of Obstetricians and Gynecologists (ACOG), an AMA delegate, and director of reproductive health at the County of Los Angeles Department of Public Health.
These risks are not as well documented as those related to alcohol or cigarette use, but they are not trifling. According to research, smoking marijuana while pregnant has been linked to low birth weight, miscarriage, placental abruption, and preterm birth (before 37 weeks), as well as behavioral problems later in childhood, including attention issues, behavioral problems, and lower test scores. "Smoking [marijuana] also makes it difficult for women to become pregnant and can harm the lungs, reducing the amount of oxygen a fetus receives during pregnancy," adds Linda Burke-Galloway, M.D., an ob/gyn in Orlando, Florida, and author of The Smart Mother's Guide to a Better Pregnancy.
The active ingredient in marijuana, THC (tetrahydrocannabinol), is capable of crossing the placenta, which means that the fetus could be exposed. In addition, it can also reach breast milk, a concern for women who nurse. "It's hard to fully understand the associated dangers, as some women who smoke it may also smoke cigarettes and/or drink. But because of the suggestion of a negative impact on the fetus, any use at all is simply not worth it," notes Dr. Ramos.
With its proposal, the AMA is advocating for regulations that will evaluate marijuana products in much the same way as cigarettes and alcohol, says Jonathan Emery, M.D., assistant professor of surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and an ob/gyn at the Women's Health Institute. "While this language from the AMA doesn't appear to ask for an outright ban on the substance—the legalization of marijuana isn't decided at the federal level but rather by individual states—this push will help doctors and other health care providers to warn expectant mothers of the many risks to themselves and their babies if they choose to consume marijuana, legally or not."
According to ACOG's committee opinion, about half of female smokers continue to use marijuana when they're expecting. "We need to do a better job of reaching these women, and I believe this resolution would help us do so," Dr. Ramos says. With marijuana becoming more widely available than ever before, these proposed regulations may be extremely prescient. "This is a political question that's gaining momentum in many states, but it's important to remember that the risks of substance use and abuse in pregnancy can happen in all 50 states, regardless of the legal status of a particular drug," Dr. Emery adds.
The best advice for women is to safeguard their health before conception, during pregnancy, and when breastfeeding. "A healthy baby needs a healthy mother, so if you are planning to have a child, or you find out that you are pregnant, it's time to stop smoking, drinking, and using drugs," urges Dr. Ramos. Counseling, medication, and behavioral therapies may also be useful in some cases, Dr. Emery adds.
And quitting ahead of time may help women avoid the kind of heartache that Hollie Sanford, a Cleveland mom, recently experienced. A county judge removed Sanford's newborn daughter from her home and placed the baby with a relative because the infant tested positive for a by-product of marijuana after birth. As it turns out, Sanford drank a marijuana-based tea to ease the aches and pains of pregnancy and labor, believing it was safer than over-the-counter or prescription medications. Fortunately, her daughter was allowed to return to Sanford a few weeks later. As it stands, almost half the states in the U.S. have some kind of legalized marijuana laws on the books—but Ohio isn't one of them.