The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskPaul@Sunnybrook.ca.
Question: My daughter is pregnant and has been smoking some marijuana to reduce nausea and vomiting from morning sickness. She says marijuana is a natural product and won’t hurt her unborn child. Is she right?
Answer: There is no evidence that marijuana causes obvious birth defects. And this fact may be contributing to the impression that it’s safe to use during pregnancy.
But “it is not a benign substance,” warns Dr. Erin Lurie, a Fellow in Addictions Medicine at the Centre for Addiction and Mental Health in Toronto.
A growing body of research suggests that exposure to marijuana in the womb has other, more subtle, effects – especially on the developing brain. In a nutshell, it may increase the baby’s risk of learning difficulties, impulsiveness, and inattention, as well as other behavioural and mental health problems later in life.
Separate research teams in Ottawa and Pittsburg have carried out the longest-running studies on the children of women who smoked pot during pregnancy.
The Ottawa study began in 1978, with the recruitment of about 600 pregnant women mostly from middle-class backgrounds. Some of the women had smoked marijuana; others smoked tobacco; still others used marijuana and tobacco. The rest abstained from both substances. Their children have undergone extensive testing at regular intervals into adulthood. A select sample from those offspring continue to be followed up.
The Pittsburg study started in 1982, and also included about 600 mothers, most from low-income backgrounds.
Both these studies, plus other research, point to the same conclusions. “I think the similar results lend a lot of credence to our findings,” says Peter Fried,the lead researcher of the Ottawa study and professor emeritus in the Department of Psychology at Carleton University.
In particular, the studies indicate that marijuana affects certain aspects of executive functioning, which primarily take place in the brain’s pre-frontal cortex.
Executive functioning “enables you to make decisions and anticipate the consequences of your actions,” Fried explains.
Marijuana also impairs attention and visual problem solving – for example, doing something as ordinary as a jigsaw puzzle.
As well, “the lack of sustained attention usually means they can’t inhibit themselves from doing other things.” This can translate into impulsive behaviour.
Fried says some of the effects of marijuana exposure were not immediately apparent in newborns. It wasn’t until the children reached four years old that cognitive testing revealed significant differences in the executive functioning of offspring of mothers who smoked dope, compared to kids of abstaining moms.
Researchers have a limited ability to measure executive functioning in very young children, he explains. “If there were better tests, the differences might have been spotted sooner.”
In recent years, the Ottawa researchers started doing functional-MRI brain scans on the study participants. These high-tech fMRI tests reveal that offspring exposed to marijuana prenatally seem to “utilize different parts of the brain” for performing certain tasks in comparison to unexposed offspring.
“It’s almost like the brain corrected itself” for the changes brought about by marijuana exposure, Fried says. “But interestingly, the length of time it took the subjects to respond (to a task) was somewhat longer.”
One thing is clear from the research: “The more the woman smokes up, the greater the likelihood there will be some effect on the offspring,” Fried says.
He emphasizes that his study was launched in the late 1970s, when marijuana was far less potent than it is today. The concentration of tetrahydocannabinol (THC) – the ingredient that makes people feel high – is much greater now. So, it’s possible that studies based on exposure decades ago, “may represent a somewhat conservative picture of the impact of marijuana use on a developing fetus,” Fried says.
Many public-health experts are concerned that more pregnant women will use marijuana once Canada legalizes recreational pot next year.
There are no reliable statistics on how many Canadians currently smoke marijuana during pregnancy. U.S. studies have found that 4 to 6 per cent of pregnant women acknowledge using it, although that figure is likely an underestimate, Lurie says.
The move to legalization seems to be reducing the stigma associated with marijuana consumption. “People just don’t even consider it to be a drug,” says Lurie says.
Some health care providers have noticed that more and more women are willing to discuss their use of cannabis during pregnancy.
“They are letting their guard down and feel safer disclosing its use,” says Kelly Polci, a social worker in the Women and Babies Program at Sunnybrook Health Sciences Centre in Toronto.
In some cases, women struggling with morning sickness are turning to marijuana – a remedy that is promoted on some websites.
“There is a lot of messaging on the Internet saying that marijuana is safe to use during pregnancy, while it is actually not,” says Dr. Maya Nader, a family physician at St. Michael’s Hospital in Toronto.
“Women need to know that health care providers can recommend other morning sickness treatments that don’t carry the risks of marijuana.”
What’s more, women should also be aware that breastfeeding and marijuana are a bad combination. THC is stored in fat tissue and can remain there for up to two months, gradually being released into breast milk. That means some children can get a dose of THC from breastfeeding – even after their mothers have stopped smoking marijuana, Nader says.
Abstinence is the best approach. But if a pregnant woman or new mom is having trouble quitting, she should talk to her doctor in order to reduce the potential harm to her offspring, Lurie advises.
Sunnybrook’s Patient Navigation Advisor provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.