By Deborah Becker and Khari Thompson
There's now more evidence that cannabis may not be safe for pregnant women to use.
A newly published study in the Journal of the American Medical Association finds that
women who use cannabis during pregnancy could be at higher risk for
preterm birth. The findings add to prior research that suggests cannabis use can increase the risk of stillbirth and affect brain development.
These
studies come as cannabis use among pregnant women is rising, with
cannabis dispensaries even marketing the drug as a natural treatment for
morning sickness and pain during pregnancy.
Michael
Silverstein, a pediatrician at Boston Medical Center's Grayken Center
for Addiction, penned an editorial titled "Cannabis Use in Pregnancy: A
Tale of 2 Concerns" to accompany the new study.
He spoke with us about
the research and the use of cannabis and other substances during
pregnancy.
The interview has been lightly edited for clarity.
Your editorial takes up two recent studies about cannabis use in pregnancy. What would you say is the overall message?
The
overall message from the first of the two studies is that cannabis use
in pregnancy has increased over the last 15 years. It's increased mostly
from non-medical cannabis use, with predominant use in the first
trimester.
The second study is the more complicated study
that looked at a cohort of Canadian women and demonstrated an increased
risk of preterm delivery among women who report cannabis use in
pregnancy.
But the risk seems relatively small — less than 3%, is that right?
The
difference in risk groups when you adjust for potential confounders was
just under three percent.
But when you look at what's called a relative
scale, it came out to a 41% increase. Some people like to look at
absolute differences, and some people like to look at relative
differences. But on either score, the risk did increase with reported
cannabis use.
Some dispensaries are actually
touting the use of marijuana to pregnant women saying it can ease, for
example, symptoms of morning sickness, it can help with pain, and it's a
more natural solution than, say, prescription painkillers. So what do
you do about that perception that marijuana use or cannabis use is safe
for pregnant women?
Yeah, I think that's an
excellent point. Whereas the history of cocaine use in pregnancy was a
history of exaggeration, I think what we're looking at here is a history
of misperception of safety. I would argue that marketing cannabis or
cannabis products as a treatment for morning sickness based on these
data is irresponsible.
How do you compare the use of cannabis with the use of other substances as a medical professional?
I
think there's no perfect metaphor or perfect comparison. There are some
people who look at the data on alcohol and say, "Really, those data
apply to heavy drinking and not to the occasional glass of wine with
dinner." There are other equally reasonable interpretations that say,
"Hey, there's no safe level here," so err on the side of caution and
don't drink during pregnancy. The lesson of [studies about] cocaine is a
lesson of racism that took science and cast aspersions over large
populations of predominantly minority children.
Is there one main message you would say that you'd like folks to take away from this?
I would say there are two main messages. The first is that cannabis use in pregnancy is likely unsafe. Full stop.
The
second message is even when the science is good, there's that next
layer of what society and the medical community and public health
communities do with those data. And that's more a lesson of history than
it is of science. Medical and public health communities and society, in
general, should be very careful about how this is discussed. We should
be very careful not to pass judgment on populations of people.
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