A research letter brought out in December 2017 in the Journal of the American Medical Association reported that the use of cannabis among expectant women had increased by a certain percentage dating back to 2009.The news agency later published an article entitled “Pot-smoking on the Rise among United States’ pregnant women.”
The story went viral and this caused uncertainty among pregnant women and concern among health professionals.
The most atrocious allusion in the news was submitted by Dr. Marcel Bonn-Miller, a boffin at the University Of Pennsylvania Perelman School Of Medicine even though was not part of the JAMA study. He clearly stated in his quote that the more people research on consumption of cannabis during pregnancy the more people become aware of how vital the drug could be.
The actual study only covered a small group of expectant women in Northern California and not the whole U.S.A.Many of those women in Northern California were not aware of their expectancy when they were using the drug but put an end to it when they knew their condition. He also mentioned that people are just abrading the surface of the matter in terms of internalizing consumption of marijuana in pregnancy. The story was quite baffling and shocking at the same time.
The worry attached to this study is very justifiable in that the main component, 9-tetrahydrocannabinol (THC), has ability to penetrate through the placental barrier and enter the fetal bloodstream.
The uncertainty among pregnant women comes in when they do not understand how the tetra hydro cannabinol affects them and their children as far as long-term health is concerned. The question has been quite difficult to answer for a long time. In short, there are no simple or exhaustive responses to the question when it comes to protection and correspondence of marijuana usage during pregnancy. Persons in the medical field; doctors, medical professionals, nursesare Doctors, nurses, and other medical professionals are exemplary reserved when it comes to talks about marijuana drug. They either ignore the topic of discussion or firmly reprobate all consumption. Interestingly some of them change the talk into a discourse on criminal behavior. Due to the doctor‘s reaction to such quizzes, pregnant women seek answers to their questions from the internet, close friends and acquaintances.
Kelly, a 26-year-old studying in a college in North California, delivered a healthy baby girl some six month ago. During the first 4 months of her pregnancy, she consumed marijuana micro doses to help from a water pipe to help with the early morning qualms and restlessness. She said that using cannabis could be a certain abrader but consuming it during expectancy is could be considered more than just smoking. Kelly added that in as much as it does not directly affect the pregnant woman, the woman should consider the human being in her stomach and treat it as one. Most consumers smoke using blunts and joints which is not that clean as compared to smoking using a water pipe hence it would endanger life of a toddler. Kelly went on to say that apart from the drug issue, expectant mothers should ask themselves questions whether they have eaten, drunk enough. Generally, people should ensure they eat, drink well and watch their smoking ways habits. A health care provider should be obliged to discuss such issues with pregnant women.
Kelly is knows how to read and comprehend a research study since she has been doing a biology degree for three years now. She states that there is no solid evidence based on the researches done on cannabis and its devastating results on kids. There’s a lot of unreliable evidence hence she was desperately looking for that fact when making the choice to use marijuana. Kelly went online and did a detailed research and enquired from a few mothers who had smoked during their pregnancy and they said they had no such difficulties. The mothers went ahead and gave some advice to her about how to manage her use of marijuana during her expectancy.
When Kelly first went to OBGYN I she was designated to in my county, she let them know she was using marijuana because she was scared of the social services aspect and their response proved that they did not care at all.The doctor responded that they are looking for concrete evidence on things that affects toddlers. This experience was only Kelly’s hence people should not take it as conventionally applicable.
The lack of ultimate scientific information related to the effects of marijuana does not justify women should consume marijuana when expectant.Her story leaves many asking themselves various questions about marijuana and pregnancy .The urge to get this answers made one go to the University of Washington’s Health Sciences Library where a detailed search was done through its Pub Med database which helped her come to the realization that the issue of marijuana and pregnancy is itself in its puerile stage. Researches that were peer-reviewed only goes back to the late 1980s which is contrary to the study of alcohol and its effects on expectant women which extends back to the late 1880s.
The very first research on marijuana consumption and fetal health condition began less than 30 years ago. In addition, the nature of the study has been doubly bounded .For many years now, researchers interested in studying the effects of marijuana have had to overcome important roadblocks put in place by the national government. Interfering with the fetus or expectant mother’s health in the name of scientific study traverses into elusive ethical colonies is not permitted by the regulations of professional institutional review boards and associations whose task is to review ethical implications of researches to be conducted.
Due to all this, researches are left to depend on biochemical analysis and self-report surveys .The two are the least invading research techniques even though both of them lead to difficulties in the study data and can introduce variable and unreliable results.
Drawbacks in Self-Report Studies
These studies rely on getting data filled through questionnaires by expectant mothers as referenced by Reuters in a study conducted the previous years. Here, data was entirely dependent on the mothers being honest about their personal use of cannabis. Giving that info in states that marijuana is not legal such as Idaho and Texas can put the mother at such a great risk. Many states have gone to the extent of arresting parents who use marijuana and also the loss of custodial rights experienced. In such scenarios, expectant women do not give clear reports and thus researchers get a difficult time finding good data. Self-reports are less intrusive and allow for evaluation over a long period of time though usually influenced by social desirability factors such as forgetfulness as found by researchers of a 2011 study that compared self-reporting and urinalysis exams of expectant mothers.
The Risks of Self-Reporting
By bringing up the social desirability aspect in the 2011 study, the article brought up another factor which is the socio-demographics.Mothers of color are at a great risk of self-reported cannabis use. African-Americans in the US are at least four times more likely to be arrested for marijuana use than a white person despite having the same consumption rate.
This affects how a subject in a study would provide data.For those with lower socioeconomic status, cannabis may be one of the only great options for treating first-trimester nausea and sleep problems during pregnancy.
Worrying Racial Differences
Two Universities in 2017 looked at the ways medical providers counseled expectant mothers in their prenatal visits. Any mention of marijuana use was either ignored or treated as a confession to a crime committed. The color of the skin of the expectant mothers made a difference to the responses the medical providers had. The study concluded that medical providers do not provide enough counseling on marijuana use during pregnancy.
In another study conducted recently on provider’s responses when patients disclosed marijuana use, it was found that 24% of providers did not even accept that disclosure and 49% did not give any form of counseling on use and effects of marijuana on pregnancy. 70% of the time was spent on correctional content such as legal implications by child protective services. To note, African- American patients were more likely to receive correctional counseling.
Women in higher socioeconomic brackets who documented their cannabis use might have healthier pregnancies for reasons not related to their cannabis consumption.
The authors of a 2011 Pediatric study noted that such women may underreport their drug use which may lead to an overestimation of the link between marijuana use and birth outcomes.
About That JAMA Research
The JAMA research report that was provided in 2017 December has a lot to show. The study included approximately 4 million women in California treated in the Kaiser Permanente Northern California (KPNC) network.
California as a location of the study raises historical, cultural and socioeconomic questions. It is racially mixed and very diverse and was the very first state in 1996 to legalize medical use of marijuana. Residents of California embrace use of marijuana at a higher level than the rest of the country. On average, embrace legalization at a much higher level than the rest of the country.
It is ironical that stories headlining the Northern California-based research were inclined to imply that the results applied to women who were pregnant around the country.
NorCal Does Not Equal America
Three states prohibit the use of marijuana for cultural and medical use thought attitudes are different in more conservative states. Another survey indicates that 7.22% of adolescents between 13-17 years use cannabis with California having a big percentage and Alabama a lower one. If variables such as demographics are not taken into account especially when the public is consuming such news, it can lead to conclusions that are not so reliable.
Pregnancy Awareness Also Matters
Reuters had a headline on women and marijuana smoking being on the rise among pregnant women in the US. Women could be consuming marijuana even before they know that they are pregnant but the data provided did not indicate this.
Patients involved in the study were tested one time. Women sometimes do not to know that they are pregnant until after 3-8 weeks. In this case, the subjects might have not known they were pregnant when they took marijuana.
Urinalysis can help show the use of marijuana in the form 2-3 weeks previously.
Subjects in the Kaiser study may have partaken cannabis way prior before they knew they were pregnant and some may have continued the use even after confirming their status. This, we may never know as there were no further tests done. What’s a More Reliable Study? What does it look like?
Bigger studies stretching across the use of blood and urine as in the Kaiser study have been trusted to be the best research designs. But as usual, they also have their flaws. Prenatal consumption of marijuana can often be in relation with tobacco and alcohol usage. This therefore interferes with the isolation of effects of marijuana use.
The tolerance a mother has to cannabis can linger on for a long time thus affecting the data.Blood and urine samples can indicate use of marijuana even after several months which might have happened before a mother gets pregnant. These kind of studies are also expensive and thus affecting the research even more.
Limitations involved in such kind of studies include small samples, not having a control of use of substances such as alcohol.
“Consistency and Inconsistency”
Sometimes even the best research findings can leave medical personnel with conclusions like below as concluded in a 2012 study on fetal birthweight and cannabis.
The findings were consistent with research done before that had concluded that smoking marijuana led to lower birth weight, premature births and a reduced birth length. The data was however not consistent with other studies that had checked on marijuana use and birth outcomes. In short, the findings agreed with some studies but disagreed with others. This was attributed to not getting actual data from women and use of other drugs like tobacco.
The Precautionary Principle
The precautionary principle is often taken by medical professionals when science does not give them conclusive findings. It is a risk management strategy applied in such situations with shortcomings.
A common definition of the principle is that when there is a threat to one’s life or health, uncertain actions can be applied to avoid the harm.
When this principle is applied to marijuana and pregnancy, it is recommended that there be abstinence. This leaves women in an awkward situations and therefore they solicit or info from friends and the web.
What about Lower Birth Weight?
There have been extensive studies done on marijuana and birth weight though it has been inconclusive. The most recent studies include“The Health Effects of Cannabis and Cannabinoids,” which is a report that was released by the National Academy of Sciences in 2017. It was concluded that smoking marijuana during pregnancy was associated with reduced birth weights, but the association of marijuana and other outcomes was not conclusive.
In 2016 however, another study concluded that marijuana had no significant effect on birth weight which also contradicted another study done in 2010 by the CDC.
The 2017 report was clear that it was not really the cannabinoids that led to reduced birth weight but products such as carbon monoxide can do that.
Marijuana and IQ?
Harvard and Florida universities conducted a study in 2013 in Pediatrics and concluded that prenatal exposure to cannabis can lead to inattention at the age of 10 and difficulties in reading and spelling though it does not affect ones IQ generally.
Another study done in Sao Paulo on mice showed that exposure to THC affected the brain but in a molecular level. These effects can be experienced at a later stage in life.
Hard to Isolate the Effects of Cannabinoids
We are back to the confounding variables and how cannabis can in isolation be proved to affect a child. Kids who are slow even at learning still lead normal lives. So, how can we measure what’s normal and achievement?
A study done in Ontario found prenatal exposure to cannabis had no significant impact on the development of a baby. Another done in Jamaica in the 80’s found that kids exposed to marijuana prenatally excelled in test than those who were not
Does this therefore mean that marijuana is good for a mom to be and her baby?
Real-Life Decisions
Women are left at a loss with all the contradictions that come with different studies.
Kelly, 26-year-old North Carolina student, decided to reduce on her cannabis consumption later in her term as she was nervous on the effects THC could have had.
No Easy Answers: Weigh the Evidence
Is it necessary to be this reactive to pregnant woman taking cannabis? That is outright judgmental as more mothers are taking caffeine which produces a similar experience to a fetus. Kelly delivered a healthy baby girl weighing 9 pounds, 6 ounces. The little one has been able to hit all the developmental stages since her birth. We might not tell how healthy her future looks but as for now, everything looks well aligned.
Kelly notes that her pediatrician commented that her daughter was one of those most aware. Kelly says that she does not have an ounce of regret and would probably do it for a second time as she does not think taking cannabis in moderation is harmful at all.
Another thought on this as noted by the Alcohol and Drug Abuse Institute in University of Washington; They noted that science was inconclusive but publicly the message was clear, pregnant women should avoid use of tobacco, marijuana and alcohol.
