Potential unintended consequences of legalizing cannabis use for pregnant women.

Cannabis use during pregnancy is associated with poor health outcomes for both mother and baby. However, its prevalence is increasing in the United States and Canada, while the perceived risk of using cannabis during pregnancy appears to be decreasing. This can be an undesirable unintended consequence of legalizing cannabis use.

Studies in humans and other animal species show that cannabis use during pregnancy is associated with low birth weight, neurodevelopmental disorders (for example, impaired memory and thinking in infants and children) and maternal anemia. Determining the degree of maternal and child health risks associated with cannabis is complicated by the lack of longitudinal studies in representative samples that monitor consumption of alcohol, tobacco, other substances and socio-ecological characteristics. However, given the available evidence, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and a recent advisory opinion from the US Surgeon General recommend that doctors screen and counsel women about the health risks associated with cannabis use and advise women to abstain. However, these recommendations in the United States are being made in a socio-ecological context in which cannabis use policies and beliefs are becoming more liberal and cannabis is becoming more available. This may explain the growing trends in cannabis use among pregnant women in the United States and some other countries.

Cannabis use during pregnancy in the United States has more than doubled since 2002, increasing from an estimated 2.4% to about 5.0% in 2016. Among pregnant women experiencing nausea and vomiting (such as morning sickness), cannabis use is even more prevalent, increasing from about 6.5% in 2009 to 11.1% in 2016. In Canada, the prevalence of cannabis use during pregnancy appears to have increased slightly, from 1.2% in 2012 to 1.8% in 2017.

A possible explanation for the growing trend in prenatal cannabis use is the legalization of cannabis use. Thirty-three states in the United States and the District of Columbia have legalized cannabis for medical use. In addition, Canada, Uruguay, 11 US states and the District of Columbia have legalized cannabis for recreational use. The laws allowing the use of cannabis for medical purposes appear to have been linked to an increase in cannabis use among the general adult population, as well as an increase in the frequency of cannabis treatment among pregnant women. In addition, the rise in biochemically proven cannabis use among pregnant women and cannabis-related adverse effects on the general population suggest that the rise in self-reported prevalence of cannabis use during pregnancy may reflect a real increase in the number of women who use cannabis during pregnancy. pregnancy, not the result of a more honest message – Legalization.

Reducing the perception of the risks of cannabis use during pregnancy can also be an unintended consequence of legalizing cannabis use. Legalization of cannabis use increases access to and availability of cannabis, especially through dispensaries. It is possible that dispensaries may advise on prenatal cannabis use, which is contrary to public health and clinical guidelines, leading women to believe that cannabis use during pregnancy is safe. In the United States, from 2005 to 2015, the likelihood of reporting no perceived risk of regular cannabis use increased by 13.0% (from 3.5% to 16.5%) among pregnant women who were not currently cannabis users and by 39. 6% (from 25.8 to 65.4%) among pregnant women who have used cannabis in the last month. In addition, pregnant women may increasingly perceive cannabis use as a safe remedy for morning sickness, especially with online misinformation about its health and safety benefits and cannabis dispensary recommendations. One statewide study found that most dispensaries recommend cannabis for morning sickness, medical dispensaries are more likely than retail dispensaries to make this recommendation, and more than a third of all dispensaries and 41.0% of medical dispensaries said callers who said who are in their eighth week of pregnancy and are suffering from morning sickness that cannabis is safe to consume during pregnancy. The economic benefits of legalizing cannabis use set the goal of making a profit in cannabis dispensaries in opposition to health messages aimed at preventing prenatal cannabis use.

Social consequences similar to those associated with drinking alcohol during pregnancy (eg civic obligations, mandatory reporting to child protection authorities) can result from cannabis use during pregnancy. For example, in the United States, many states consider substance use during pregnancy to be child abuse and punishable by law. These laws disproportionately affect low-income minority women due to discrimination. Few other countries criminalize substance use during pregnancy. However, policies that criminalize such substance use place the burden of responsibility for the health of the fetus and child on the mother without considering the socio-environmental factors that contribute to substance use behavior (e.g. cannabis use laws, poor medical advice in cannabis dispensaries, widespread availability of cannabis).

People and their social environment are inextricably linked. Therefore, as states and countries continue to legalize cannabis use, identifying and preventing the potential unintended consequences of such laws on maternal and child health will be critical. For optimal maternal and child health, women should refrain from using cannabis (and other substances) prior to conception, pregnancy and breastfeeding. Health-care providers should support women in these efforts by respectfully educating women about the risks of prenatal substance use and referring women to treatment when needed, rather than resorting to punitive measures. In addition, good practice should require dispensaries to display warning signs – similar to alcohol policy – of the risks of cannabis use, including cannabis use during pregnancy.

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