The recent JAMA report of an increase in marijuana use among pregnant women, raises increasing concerns about its impact on children’s health in 2018. This comes at a time when non-medical marijuana will be available legally in California and is anticipated to become legal in several other states.
The study by the Kaiser Permanente Northern California group reported an increased use among pregnant females from 4 percent to 7 percent from 2009 to 2016, and especially among women ages 18 to 24 years years old.
The question is whether the broader public knows this, and what medical professionals are doing about it.
There is enough evidence regarding the negative health effects of marijuana during pregnancy. Neonatal outcomes of marijuana use in pregnancy were first described in 1982, with hundreds of studies since then.
These babies show a decrease in birth weight and increased likelihood of admission to the neonatal intensive care unit. Long-term, it can lead to impairments in verbal reasoning, comprehension, short term memory as well as poorer test scores. Behavioral problems include increased aggression, inattention, impulsivity and hyperactivity.
But this information is not getting out to the public.
In interviews with pregnant women using marijuana, common sources of information about perinatal marijuana use included Internet searching and anecdotal experiences from family or friends. Most women reported that they did not receive any helpful information from health care providers or social workers in prenatal visits. Some assumed that when providers did not address marijuana use, this meant that marijuana use did not pose a significant concern for their pregnancy.
Providers, too, admitted they were not familiar with identified risks of marijuana use during pregnancy and that they did not perceive it as dangerous as other illicit drugs like opiates and cocaine, alcohol, or cigarette smoking. Counseling focused more on legal issues such as required urine toxicology screens and contact to child protective services, than on health risks of marijuana use.
Legalization may exacerbate existing health disparities. Marijuana use is reported to be higher in young, urban, socioeconomically disadvantaged women, who are already at risk for poor access to prenatal care and adverse birth outcomes. Some perceive that using marijuana during pregnancy was less expensive than smoking cigarettes.
Yet there are no specific education campaigns, manuals, or policy statements on marijuana use during pregnancy from any federal agency or professional society. This is a dangerous gap in information.
Although public opinion has shifted about marijuana use, child welfare has not.
The Child Abuse Prevention Treatment Act directs states to assess substance-exposure at birth and provide a “plan of safe care” for infants identified.
However, states differ greatly in terms of policy. Some require reporting of substance-exposed newborns to child protective services, while others consider substance use during pregnancy as grounds for civil commitment, or define substance use, including marijuana, as child abuse.
Of course, there are benefits to medical marijuana. Pregnant mothers often say they used marijuana because of nausea and decreased appetite during pregnancy.
It is true that the exact effects of marijuana use during pregnancy are unknown. Part of the difficulty is in studying an isolated effect of marijuana, when its use is often accompanied by other substances. Many studies have relied on self-reports, and childhood outcomes are confounded by many other factors such as parenting.
We need a clear public health message to address prenatal marijuana use.
Marijuana legislation, medical or non-medical, needs to include professional education about the impact of marijuana on pregnancy and children’s health. Informational materials can be available at dispensaries, and government warnings can be issued, as federal agencies did for tobacco and alcohol use for pregnant women. Training for physicians on how to counsel patients must be required.
As medical professionals, we must acknowledge the risks of marijuana use during pregnancy, and recommend guidelines that communicate these risks to the public.
Dr. Nana Matoba is an assistant professor of pediatrics in Northwestern University’s Feinberg School of Medicine, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voices Fellow through The OpEd Project.