Aristotle's Child

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Marijuana Use in Pregnancy: Implications for State Laws

Medical marijuana laws must address the risks associated with use in pregnancy.

Not surprisingly, there was quite a strong response to my previous blog about marijuana use in pregnancy, in which I discussed the long term deficits in executive functioning in children and adolescents prenatally exposed to marijuana. I received many supportive comments, but there were several replies that were downright venomous and some a tad threatening! Makes one wonder what the writers were smoking when they responded to the column. In any case, I stand by my previous statement.

And now, a brand new study has come out of NIH, published in Obstetrics and Gynecology, documenting that marijuana use in pregnancy places a pregnancy at two times increased risk for stillbirth: death of the fetus at or after 20 weeks gestation. This was a huge study across 59 hospitals nationwide. All women in the study had a blood test for cotinine—a breakdown product of nicotine—and the fetal umbilical cords were tested for several types of drugs, including cocaine, methamphetamine, prescription painkillers, and marijuana. The women also answered a survey regarding their drug use patterns during pregnancy. Based on all these data, women who smoked marijuana were 2.3 times more likely to have a stillbirth than women who did not smoke marijuana during pregnancy. Why is this important? Because the United States has one of the highest stillbirth rates (6 per 1,000 births) among developed nations of the world, affecting 26,000 newborns in this country each year.

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There will remain many proponents for smoking marijuana in pregnancy, but for my part, I have a few questions. Do any of the newly passed state laws allowing the medical use of marijuana or legalizing marijuana altogether consider precautions that should be taken to warn pregnant women against its use? Are physicians advised to ask a woman seeking a prescription for marijuana when her last period was or if she could possibly be pregnant? Is a pregnancy test recommended before writing such a prescription? Is the general public aware of the risks associated with marijuana use in pregnancy? The answer to all these questions is a resounding no.

Don’t get me wrong. I am very much in favor of medical marijuana laws. Marijuana has earned its place in the pantheon of medications that can relieve suffering, especially among patients going through the rigors of chemotherapy, AIDS, glaucoma, certain aspects of chronic pain, and other debilitating conditions. But we have to at least recognize that marijuana’s use during pregnancy has its own risks, and we need to incorporate guidelines into the new and emerging marijuana laws that recognize and communicate that risk. Marijuana use is fast fading from the legal agenda, but its use, especially during pregnancy, remains a public health issue.

Ira J. Chasnoff, M.D., is a Professor of Clinical Pediatrics at the University of Illinois College of Medicine in Chicago. His most recent work is The Mystery of Risk.

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