Clarissa Mercado could not get out of bed.
A few weeks into her fourth pregnancy, the 33-year-old from Pittsburgh felt sicker than she had ever felt in her life. He spent his days vomiting. Smoothies with fresh ginger, cookies in the morning, even water made her throw up. And no morning sickness remedies, natural or prescription, helped.
Finally, after a second visit to the emergency room for treatment for her symptoms, Mercado decided to try something she had vowed not to do while pregnant: smoke cannabis.
“It was an instant relief,” Mercado said. “Within 3-4 hits of me smoking this hog, I was feeling so much better.”
Cannabis use during pregnancy is on the rise in California and the United States. The trend reflects increased use in the general population as more states legalize recreational pot. An estimated 8% of women, about 1 in 12, used cannabis during pregnancy in 2020, compared to 3% in 2002.
The increase comes despite growing evidence that marijuana can harm pregnant women and their babies, with studies linking use during pregnancy to a range of illnesses, including premature birth, low birth weight being born, anemia in mothers and behavioral, mental health and developmental problems in children.
The CDC and major medical organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) uniformly recommend against the use of cannabis during pregnancy and while breastfeeding, whether by smoking , vaping, dabbing, eating or drinking, or applying creams or lotions to the skin.
But the message gets muddled at ground level. The legalization of cannabis, the lessening of stigma around its use, the perception that cannabis products are “natural” and the lack of communication by some health care providers about the risks of marijuana during pregnancy may lead some women to conclude it is harmless, studies show.
“The lack of trust between patients and providers of prenatal care I think is unfortunate,” said Katie Woodruff, lead author of a study at UCSF and a public health social scientist with the group ANSIRH (Advancing New Standards in Reproductive Health) of the university. “One of the harms on the part of the patient is that they turn to other sources of information, so they go online. … I can tell you that if you spend five minutes on Google, you will find (inaccurate comment) saying ‘that’s great, it’s great, it’ll make your baby soft, it’ll make your baby not too big at birth”. There’s a lot of misinformation out there.”
Even if women talk to a medical provider about cannabis during pregnancy, they may not receive adequate information or support, Woodruff and her team found. In interviews with more than 30 pregnant and postpartum women who used cannabis during pregnancy, they found that those who discussed it with their doctors received a range of messages, from outright approval to legal threats.
Woodruff said she is now interviewing medical providers for a separate study, and their responses so far seem to support the women’s experiences, with some doctors saying they are confused about the evidence on marijuana during pregnancy. or that they are not sure how to approach the problem. with their patients.
Meanwhile, cannabis dispensaries can add to the confusion. A Colorado study found that 70 percent of the state’s dispensaries in 2018 recommended marijuana products to treat morning sickness. There is no evidence that marijuana helps with morning sickness, according to ACOG.
Reasons for use
People who use cannabis during pregnancy tend to use it before they get pregnant, studies show. Mercado, for example, said she smoked marijuana and consumed edibles for years to help her sleep and for anxiety before she got pregnant. She stopped using it during each of her first three pregnancies because she had heard about the potential negative repercussions (all of her children from those pregnancies are healthy, she said), but the fourth has been much more difficult.
She was unable to perform her job as an insurance claims adjuster and had to take a leave of absence. She felt exhausted and depressed.
“I would cry because nothing would work and I just wanted to feel normal again,” Mercado said. “I couldn’t do things in my house. I’m a super tidy freak and I couldn’t get up and do the dishes.”
Like Mercado, most women who turn to cannabis while pregnant do so for medicinal purposes. In addition to using it for morning sickness, some report that marijuana helps relieve body aches. Others use it to cope with mental health conditions such as anxiety, depression and post-traumatic stress disorder.
There are federally approved alternative treatments that pregnant women can take for these conditions. But because marijuana products are often marketed as natural, women may assume they’re safer than pharmaceutical drugs, said Kelly Young-Wolff, a research scientist at Kaiser Permanente in Northern California.
Adding to the confusion is the dearth of large-scale studies and definitive data. Many studies have been small, lack diversity of participants, or are based on old data that don’t take into account the stronger potency of today’s cannabis products, Young-Wolff said.
While there are uncertainties, the evidence so far paints a disturbing picture. Studies have linked cannabis exposure in utero to low birth weight, premature birth and stillbirth, as well as an increased risk of childhood obesity, anxiety, attention problems and other behavioral problems. Scientists also know that marijuana chemicals pass through the placenta to the developing baby and can linger in the body for days.
However, there are many more questions that researchers and patients want answers to. For example, are some forms of cannabis consumption, such as smoking or smoking, more harmful than other forms such as using CBD oil or eating a marijuana-infused candy? What is the difference between using a small amount of marijuana every now and then during pregnancy and heavy use every day? Does it make a difference which trimester cannabis is used in?
Researchers at Kaiser Permanente in Northern California hope to answer these questions by drawing on a wealth of data on marijuana exposure among the health system’s 600,000 pregnant patients. According to the organization, it is the only large system in the nation to screen all patients who consent to exposure cannabis and others drugs when starting prenatal care, both through questionnaires and urinalysis. The health system also has data on the health of women’s children after birth.
With federal funding, Young-Wolff and her colleague Lyndsay Avalos are collecting and analyzing data on more than 400,000 pregnant Kaiser patients and their children screened for prenatal marijuana use between 2009 and 2020.
Young-Wolff hopes the research will help guide future public health regulations.
Laws and policies regarding the use of cannabis during pregnancy vary across the country. In some states, women can — and do — face criminal prosecution for using marijuana during pregnancy, said Lindsey English, an attorney with National Advocates for Pregnant Women.
In California, marijuana use during pregnancy is not considered a criminal matter, and health care providers are not required to report pregnant women to child protective services before the child is born, according tod Theresa Mier, spokeswoman for the Department of Social Services. However, providers may be asked to report evidence of maternal substance abuse at the time of delivery if they determine there are other signs of risk to the child.
For Mercado, there are no easy answers. She understands that there may be risks to using cannabis during pregnancy, but she is not convinced that it is any less safe than taking prescription drugs.
He has spoken openly with his doctor and gynecologist about his cannabis use. Both advised him to stop, but have not pushed the matter, he said. Now in her third trimester and feeling better, she said she plans to quit smoking for the rest of her pregnancy.
But she also believes she wouldn’t have been able to survive the first part of her pregnancy without marijuana.
“I felt like I had no other choice,” he said.
Claudia Boyd-Barrett reports for the USC Schaeffer Center for Health Policy and Economics’ Health Information Center. This story was supported by a grant from First 5 LA.
