First on CNN: Ob/gyn group advises against cannabis use during pregnancy, recommends universal screening

By Deidre McPhillips, CNN

(CNN) — New guidance from the American College of Obstetricians and Gynecologists advises that people abstain from cannabis use during pregnancy and lactation and recommends that providers ask all of their patients about cannabis use before, during and after pregnancy to help avoid potential risks.

Cannabis use has increased among pregnant people in the United States amid broadening legalization and growing social acceptance, and the nation’s leading group of ob/gyns says it issued the new recommendations Thursday to offer providers “evidence-based guidelines for counseling, screening, and strategies to reduce cannabis use.”

A 2019 analysis of over 450,000 pregnant American women ages 12 to 44 by the National Institute on Drug Abuse found that cannabis use more than doubled between 2002 and 2017.

“When things become more normalized in society, it’s a very natural tendency for us to think that we don’t have to think about the potential risks,” said Dr. Amy Valent, an ob/gyn with the Oregon Health & Science University who helped develop the new guidance.

“People have been using cannabis for years, and it’s not associated, as far as we know, with … birth defects,” she said. “But should that be the bar for pregnancy safety?”

There is a “paucity of data rigorously investigating the safety or efficacy of cannabis use in human pregnant or lactating individuals,” according to the new guidance from ACOG, which was shared first with CNN.

A lot has changed since the group’s last opinion on the issue from 2017. The research that is now available shows that cannabinoid receptors are present in the fetus as early as 5 weeks, and the main psychoactive component of cannabis, THC, can cross the placenta and transfer into breast milk – and that exposure is associated with risks of adverse outcomes.

Changing cannabis laws and reports of increased use during pregnancy initially spurred interest and questions among ACOG members, Valent said, and ongoing policy inconsistencies called for a concise summary of the science. Dozens of experts involved with an ACOG committee for clinical consensus in obstetrics have been developing this new guidance for years, assessing all related research that has been done over the past two decades.

Their assessment suggests that cannabis exposure during pregnancy has been associated with low birth weight, admission to the neonatal intensive care unit and perinatal mortality. There are also potential neurodevelopmental consequences from cannabis exposure, including attention deficit disorders, memory challenges and intellectual disabilities.

It’s difficult to quantify the amount of cannabis use and the associated degree of adverse outcomes, Valent said, but the goal with this guidance is similar to others around substance use during pregnancy.

“We have to recognize all the different conditions and environmental things that can influence fetal growth and development, and the (pregnant patient) themselves, of course,” she said. “How can we risk-reduce their pregnancy to be able to help support a healthier version?”

Drug tests ‘strongly discouraged’

The new guidance makes a pointed distinction between validated screening tools and biologic testing for cannabis use.

Drug tests using hair, urine or other biological materials have resulted in biased treatment against members of racial and ethnic minority groups, the guidance says, and their use is “strongly discouraged.”

Instead, universal screening through various interview methods or self-reporting creates opportunities for intervention before delivery – and “supports equitable and nondiscriminatory health practices.”

It’s important that the screening conversation “remains nonjudgmental and supportive,” said Dr. Cara Poland, a faculty member at Michigan State University and board-certified addiction medicine physician, who was not involved with the creation of the new guidance.

Many people are not aware that cannabis can affect a pregnancy, and doctors can ask permission to discuss the topic, Poland said. One way to open up the conversation could involve saying something like: “Would it be OK with you if I asked you some questions about cannabis and other drug use?”

It’s also critical that the screening avoid the risk of punishment, experts say.

State laws on drug testing during pregnancy and the involvement of child protection agencies are inconsistent and can lack clarity, the new guidance says, and providers should be aware of local implications.

“Our obligations as health care systems and individual providers in reporting substance use can make this space uniquely different to navigate than other spaces,” Poland said.

“You’re not at risk of losing your child because you are not adherent in other areas of medical recommendations,” she said. For example, “nobody’s reporting on whether or not somebody’s following their diabetes diet. When somebody is diagnosed with gestational diabetes, you treat it.”

Simply having the discussion may raise a patient’s awareness of potential risks and influence their behavior during pregnancy, according to the ACOG guidance. Many patients may use cannabis in an effort to self-manage nausea associated with pregnancy or to relieve anxiety and stress.

Better communication between patients and their providers about these underlying symptoms may help curb cannabis use, experts say.

Each patient is different, and asking about other ways they’ve tried to manage their symptoms can reinforce a personalized approach to care, Valent said. Sometimes cannabis can actually be the root cause of nausea, she said, or it may be helped by exercise, eating more often or taking certain medicines.

“The benefit of screening is that it starts conversations and then comes individualization to patient needs,” Valent said. “We really need to be able to talk more broadly with our patients about their symptoms and how we can best support them. I think there’s beauty to communication and conversation, and hopefully this guidance just helps support people to understand that we just want to provide a more comprehensive conversation.”

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