Jayne O'Donnell and Claire Thornton | USA TODAY

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Corrections and clarifications: An earlier version of this story misidentified the meaning of the acronym NIDA. It stands for the National Institute on Drug Abuse.

Claire Alcindor’s fourth pregnancy last year was the hardest. The only way she could keep food down was by smoking marijuana, which also helped with her depression.

She was living in Maryland, in a location where marijuana is legal, but still worried “people would think I’m a bad mom” – or worse. Friends warned Child Protective Services might start investigating her. But it seemed worth the risk, especially given the reported effects of some prescription nausea and depression drugs.

“I needed to eat, I needed to stay alive and survive this pregnancy,” says Alcindor, who now lives in Las Vegas.

As more communities legalize or decriminalize marijuana use across the country, federal regulators and many doctors, however, say pot is not a risk worth taking while pregnant.

"I would say we are really rolling the dice with our kids if we expose them to it," says Dr. Neeraj Gandotra, chief medical officer at the Substance Abuse and Mental Health Services Administration at the Department of Health and Human Services. "We have a preponderance of evidence marijuana does affect brain development."

Jordan Parks

Studies out this summer in the Journal of the American Medical Association also reported a sharp increase in the number of pregnant women smoking marijuana and an alarming link between cannabis use and preterm births, defined as 37 weeks or earlier. Canadian researchers compared the outcomes of birth by 5,639 mothers who reported cannabis use during pregnancy with 92,873 mothers who said they didn't use it.

The authors concluded marijuana is "likely unsafe" because preterm births were twice as common in marijuana users vs. non-users. (12% vs. 6.1%). That's despite finding a positive effect between marijuana use and lower incidences of preeclampsia – a dangerous condition that includes high blood pressure – and gestational diabetes,

There are a lot more skeptical women to convince, however.

Between 2002 and 2017, pregnant women who used marijuana in the previous month increased from 3.4% to 7% overall and from nearly 6% to just over 12% during the first trimester, according to new federal data published in the Journal of the American Medical Association. There are more than 16,000 members of the group "Ganja Mamas" on the What to Expect website.

Dr. Emily Dossett, a psychiatrist and professor at the University of Southern California's medical school, now heads Women's Health and Reproductive Psychiatry for Los Angeles County's Department of Mental Health. She also works at the USC Medical Center, where an increasing percentage of her patients smoke marijuana during pregnancy.

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She has had patients who were on medication for depression and anxiety or even prescriptions for epilepsy who stopped taking them for the "more natural choice" of marijuana, despite the lack of knowledge about exactly what's in even medical marijuana.

"We don’t have any evidence it is safe, but many women at this point don't even question it as a potential problem," Dossett says. "It is often coupled with a distrust of the medical system and particularly medications for mental illness."

Doctors are especially worried because THC – tetrahydrocannabinol, the ingredient in marijuana that gets people high – crosses the placenta. That means babies' brains could be being altered, says Dr. Cynthia Rogers, director of the Perinatal Behavioral Health Service at Washington University in St. Louis, Mo.

The parts of the brain exposed are involved in emotion processing and executive functioning, Rogers says. Recent studies looking at older children related behavioral problems to exposure to marijuana in utero, she says.

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Yet even doctors who support medical marijuana say medical professionals aren't warning women enough. They say there is misinformation and an overall lack of information on using cannabis products during pregnancy. Medical marijuana is now legal in 33 states.

A National Institutes of Health study released in June 2018 that included more than 400 Colorado dispensaries found nearly 70% recommended treatment of morning sickness with cannabis.

“Women aren’t getting a consistent message,” says Dr. Jordan Tishler, president of the Association of Cannabis Specialists and an advocate for legalizing medical marijuana.

Tishler, an emergency physician who teaches at Harvard Medical School, says marijuana dispensaries push their products for all sorts of ailments, including nausea caused by morning sickness. “There’s an industry out there that wants to sell a lot of marijuana-based products regardless of whether it’s safe or good for anybody,” Tishler says.

In the NIH study, officials called dispensaries and told them that they were pregnant and suffering from extreme nausea. Transcriptions of phone conversations were recorded. In one case, a dispensary employee told a woman, “Edibles wouldn’t hurt the child, they’d be going through your [digestive] tract."

Dispensary employees also sometimes told women to consult with their health care provider, but few did so without being prompted. The study also found 36% of recommendations said cannabis use is safe during pregnancy.

Weed vs. prescription drugs: What's safer for nausea?

Carmen, who is four months' pregnant in Georgia, had to be hospitalized to treat nausea during her first pregnancy six years ago. She decided to use marijuana during her pregnancy now because she's afraid about pharmaceutical side effects and also doesn't want to be hospitalized again. USA TODAY is not using Carmen's last name or hometown because marijuana isn't legal in Georgia.

Carmen had to triple the dose of the prescription drug Zofran during her first pregnancy to relieve her extreme symptoms. She was so nauseous that she couldn't consume food for long periods of time.

“Using marijuana was more effective than taking multiple pills," she says.

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Carmen says she researched side effects of marijuana on the fetus when figuring out whether to use cannabis during pregnancy. But she says the studies she saw covered both smoking marijuana and smoking cigarettes, without differentiating. She says that because marijuana is more natural than the tobacco products in cigarettes, she didn’t know how to interpret the studies.

What especially worried Carmen were reports about birth defects in babies whose mothers had taken Zofran, the brand name for odansetron. But Samantha Parker, assistant professor of epidemiology at Boston University and lead author of a study on odansetron, "this is a relatively safe medication for treatment of nausea and vomiting during pregnancy."

In fact, HHS' Gandotra says ondansetron and Phenergan, the branded version of promethazine, are his top choices for nausea in pregnant women. The others are diphenhydramine and metoclopramide.

Up to 13% of pregnant women with nausea and vomiting take Zofran, Parker says.

There is more data on the possible effects of prescription drugs on fetuses compared with effects from cannabis, even though doing actual studies on pregnant women raises ethical concerns.

HHS' National Institute of Drug Abuse awarded grants to four universities, including the University of Washington, to study pregnant women who smoked marijuana during pregnancy with other pregnant women who didn't.

Pamela McColl, a Canadian child rights activist, is working with an international group of physicians and the advocacy group Smart Approaches to Marijuana to stop the research because something that puts babies at risk shouldn't be done unless it's a medical necessity. She also says the researchers have a responsibility to report the very women they are studying under mandatory reporting laws.

"We have enough science to go out there with public health messages that pregnant women should not touch marijuana," says McColl, citing research including a May study of 12 million births that was published in the Journal of Obstetrics and Gynecology Canada.

Tricia Wright, a Hawaii doctor who runs a research center for pregnant women struggling with substance addiction, says patients tell her their doctors haven't told them cannabis use during pregnancy isn't safe.

National Institute for Drug Abuse Director Nora Volkow says marijuana during pregnancy "Is not worth the risk" but defended the agency's research funding because "I don't want us to cry wolf."

With mixed messaging on marijuana, pregnant women in need of relief are not able to make fully informed decisions, physicians say.

“I don’t think any woman goes into pregnancy wanting to hurt her child, so if she’s using it it’s either because she doesn’t understand the science or hasn’t heard the science,” Wright says.

Rogers stressed that women experiencing side effects of pregnancy need to speak with an obstetrician.

Many, however, are reticent about speaking to their doctors about marijuana use. Online pregnancy groups are filled with women worried about what will happen if they test positive for pot. Claire Alcindor says that's one of the reasons she is so skeptical about the research on marijuana – there's a far larger universe of babies she believes are unaffected by the exposure and not considered because their mothers didn't speak up.

Courtesy of Claire Alcindor

Alcindor, whose content creation firm is called Big Black Brands, is also the owner of Zarico herbal skin care products, which include postpartum baths. She has about 10,000 followers on Facebook, where "I always share my story" of her natural lifestyle, including home births.

"I did a ton of research" on marijuana, Alcindor says. "It was my first pregnancy where I was exploring marijuana, and I never read anything about it being harmful to the fetus. The moms were a lot more calm, able to eat, able to be happier."

Alcindor may be unconvinced, but Gandotra says she should be.

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"I’m worried about this from a public health standpoint that we are allowing our better judgement to be swayed and, most importantly, we are not fully realizing the risks and we won’t see the full impact until a generation later."

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