Lindsay Hoppe, a 37-year-old blogger and photographer in Sacramento, California, experienced constant nausea and daily vomiting during her first two pregnancies. So, during her third, she tried to alleviate these symptoms by eating small amounts of cannabis-infused cookies and popcorn throughout the day. She had less nausea and almost no vomiting on days when she consumed edibles, and since she'd had to go off her medication for bipolar disorder when she got pregnant, it also helped her become less anxious and irritable. The child she was pregnant with, now 10, has not experienced any health problems.

Jackie McGuire, a 34-year-old computer programmer in the San Francisco Bay Area, used vaporized cannabis flower to alleviate nausea and loss of appetite while she was pregnant.

“When I would use it as soon as I woke up, it would calm down my stomach and give me an appetite,” she remembered.

But Shakira, a 39-year-old in Florida, wishes she had not smoked weed while she was pregnant. Her daughter was born prematurely, and she suspects her smoking had to do with it.

“My contractions started earlier,” she remembered. “I'm not against it all — I just don't think it should be done while pregnant.”

Lindsay, Jackie, and Shakira are three of many women who have used cannabis during pregnancy. A study published in June 2019 in the Journal of the American Medical Association found that 7% of pregnant women in the U.S. has used cannabis over the past month, compared with 3.4% in 2002. While in their first trimester, a full 12.1% of pregnant women had consumed cannabis in 2017. Dispensaries are taking note of this: 69% of 400 dispensaries in Colorado surveyed for a 2018 study in Obstetrics and Gynecology had recommended cannabis as a treatment for morning sickness.

There's debate over the safety of cannabis for pregnant people and their babies. A 1994 study of 44 Jamaican babies in Pediatrics found that 1-month-olds whose mothers had used marijuana actually had better nervous system stability, alertness, mood, and ability to self-regulate than those whose mothers didn't smoke.

However, this study has been criticized by clinicians as poorly designed, said Levan Darjania, Ph.D., Chief Scientific Officer of Vertical Wellness. Other research has associated cannabis use during pregnancy with less-favorable outcomes. Preliminary results from one ongoing study suggest that rats whose mothers are exposed to chemicals that mimic cannabis during pregnancy exhibit reduced connections between nerves in the hippocampus, a brain area involved in learning and memory. And, confirming Shakira's suspicions, a 2016 study in Reproductive Toxicology found that mothers who used cannabis up until 20 weeks' gestation had five times the risk of experiencing premature births.

To clear up the confusion around marijuana and pregnancy, we had experts answer some common questions about it.

How Safe is Cannabis During Pregnancy?

If you ingest cannabis during pregnancy, it likely will reach the fetus.

“Cannabinoids enter the blood and cross easily through the placental barrier,” Darjania said. “Fetal exposure to the active compounds in cannabis is both efficient and prolonged. It should therefore be expected that this exposure can profoundly influence the development of the endocannabinoid system.”

Many factors, like the dose, the method of administration, and the parent's genetics, can affect the safety of cannabis use during pregnancy, said Dr. Joseph J. Morgan, professor of Cannabis education at the University of the Sciences in Philadelphia and a partner of Green Flower Media. Morgan recommends talking to your obstetrician-gynecologist (OB/GYN) if you're thinking of using cannabis while pregnant.

(Photo by Ignacio Campo/Unsplash)

However, regardless of your particular situation, the safest route is to stop using cannabis altogether once you get pregnant. The American College of Obstetrics & Gynecology's guidelines state that “because of concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking, women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use.”

You should also avoid smoking during the postnatal period to prevent secondhand exposure, Darjania added. “Biomedical evidence overwhelmingly indicates that cannabis use during pregnancy and possibly in the postnatal period remains a significantly under-recognized problem that has the potential to cause long-term harm.”

What are Risks of Using Cannabis During Pregnancy?

Cannabis use during pregnancy has been associated with lower birth weight and intelligence in children, Morgan said, particularly if the parent has used contaminated products.

Darjania said other issues associated with cannabis use during pregnancy include:

Depletion of brain receptors for the neurotransmitter dopamine at birth

Verbal reasoning problems

Increased risk for aggression, anxiety, and depression during early development. depression, delinquency, antisocial behavior, and difficulty with abstract reasoning for adolescents.

Impaired visual memory and increased drug-seeking among adults.

For the parent, large amounts of cannabis can actually lead to nausea and vomiting rather than alleviate it, Morgan said. It can also cause impaired judgment and risky behavior, which could affect the fetus as well.

There's also the risk of potential legal penalties (jail sentences, children placed in protective custody) if a parent admits to cannabis use during pregnancy. Depending on the doctor's practice and the institutional requirements, a doctor may actually be obligated to inform authorities if a patient is using cannabis while pregnant, Morgan said.

Why Might Someone use Cannabis During Pregnancy?

The purposes for which people use cannabis during pregnancy include relief from nausea, improvement in sleep, and reduction of pain and spasms, Morgan said. And if you're on a medication that can be dangerous during pregnancy, sometimes substituting cannabis can prevent certain complications.

A 2006 study in Complementary Therapies in Clinical Practice found that over 92% of 40 women who used cannabis for nausea during pregnancy found it helpful. However, there were issues with the design of this study as well, Darjania said, and any benefits of cannabis for pregnant people should be weighed against the risks.

“Nausea and vomiting, while very disruptive to the woman, are typically self-limited and do not have long-term health consequences for the mother or baby,” he said.

How Can You Minimize the Risks?

Because medical experts don't yet know enough about marijuana's potential effects, it's best to completely avoid cannabis during pregnancy. There is no low-risk way to consume. But if you can't be swayed from using it, Morgan urges getting lab-tested cannabis free from contaminants including microbes, pesticides, solvents, additives, and heavy metals. It should have a reputable third-party lab certification of cannabinoid content. And to avoid damage to the fetus's lungs, it's better to vaporize flower than to smoke or vape concentrates. Also, it is likely that THC is responsible for many of the risks associated with cannabis use in pregnancy. Using low potency products with minimal THC could be less harmful.

Darjania recommends that pregnant women unwilling to cut cannabis out completely at least minimize their use. “If complete abstinence is not possible, women should be advised to reduce regular cannabis use during pregnancy, as current evidence indicates that daily use of cannabis is most strongly associated with future adverse neurobehavioral outcomes.”

This explainer outlines the conversation around cannabis use and pregnancy. It is in no way intended to be read as medical advice. Always consult with a trusted medical professional.

Feature image: More women are reporting cannabis use during pregnancy. According to a study published in June 2019 in the Journal of the American Medical Association, 7% of expectant mothers said they used cannabis in the past month, more than double the 3.4% of pregnant women in 2002 who reported cannabis consumption. (Ashton Mullins/Unsplash)