Doctors for Drug Policy Reform Statement on Cannabis Use During Pregnancy and Breastfeeding

Doctors for Drug Policy Reform (D4DPR) Statement on Cannabis Use During Pregnancy and Breastfeeding

• Unless advised otherwise by a qualified clinician, pregnant women should avoid drugs of any kind, including pharmaceuticals (over-the-counter or prescribed), cannabis, tobacco, alcohol, caffeine, opioids, amphetamines, and other drugs.
• To date, the benefits and risks of cannabis use during pregnancy remain uncertain. Studies show that cannabis use during pregnancy may be harmful, have no effect, or be beneficial. These studies have only examined the effects of illegally-obtained smoked cannabis use in pregnancy. The risks and benefits of regulated cannabis, including all routes of administration (e.g. topicals, transdermals, edibles, tinctures, or vape pens), or when cannabis is used under a physician’s care, are unknown. Other shortcomings of current evidence include a publication and funding bias towards negative outcomes and the focus on association studies without appropriate consideration of cause and effect.
• The well-being of both the mother and fetus must be considered if cannabis (including cannabinoids like CBD that are not prominently psychoactive) is recommended for medical use during pregnancy. The benefits must clearly outweigh the risks. Medical use should be avoided in pregnancy when safer alternatives exist.
• Breastfeeding transfers THC (the main psychoactive component of cannabis) to the infant. The benefits of breastfeeding must therefore be balanced with risks of infant exposure.
• Adult (e.g. recreational or social) use of cannabis should be discouraged as a part of routine counseling of women who are planning to become pregnant, pregnant, or breastfeeding. Such counseling should be non-judgmental. Counseling should consider the frequency and quantity of use, route of administration, and the potential for misuse. Cannabis misuse should be identified and treated. If a urine toxicology test is indicated, it should be done only with patient consent, including counseling on the consequences of a positive drug screen. Based on our present state of knowledge, the use of cannabis during pregnancy should not be criminalized, used as evidence of poor parenting, or used to disrupt a family unit.
• Clinicians advising pregnant or breastfeeding women on cannabis use should be knowledgeable about the endocannabinoid system, the effects of cannabis on both the mother and child, and the relevant local policies, regulations, and reporting requirements.
• Cannabis products should carry a warning that the effects of cannabis use on a fetus, infant, and child are unclear but could be harmful.

Selected References: The National Academies of Sciences, Engineering and Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research; Washington, D.C., 2017. p264Committee on Obstetric Practice. Committee Opinion No. 722 (American College of Obstetricians and Gynecologists): Marijuana Use During Pregnancy and Lactation. Obstet Gynecol 2017; 130 (4), e205-e209.Ryan SA, Ammerman SD, O'Connor ME, Committee on Substance Use and Prevention and Section on Breastfeeding (American Academy of Pediatrics). Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes. Pediatrics 2018; 142 (3).