Perinatal substance abuse has been a public health epidemic for many years. Throughout several decades’ researchers have spent time studying the effects of commonly abused substances such as nicotine and alcohol. However, the recent legalization of cannabis in several states has prompted researchers to focus their efforts in another direction. Many patients and mothers believe cannabis has no detrimental health effects due to the lack of research around it, but with the new information learned each year, we can now provide patients and pregnant mothers with evidenced based education. That stated, this paper will discuss the most commonly used substances during pregnancy, and in detail describe morbidity, mortality, mother and newborn treatments, and offspring effects later in life as it relates to cannabis use during pregnancy.
To begin, it is important to discuss the most common substances abused during pregnancy. The most common substances that are abused are said to be nicotine, alcohol and cannabis (Forray, 2016). With that stated, it is important to recognize that several of these substances are used together; leading to increased detrimental effects to both mother and fetus. One program by the Colorado Department of Health & Environment called the Pregnancy Risk Assessment Monitoring System, monitors health trends of Colorado mothers. This program sends out monthly surveys to Colorado women asking several questions as it pertains to pregnancy, including questions about substance use (Colorado Department of Public Health & Environment, 2019). The 2018 survey had 1,218 participants, and of those participants 8.2% said they used cannabis, 7.1% said they used cigarettes, and 14.4% of participants voiced they used alcohol at some point during pregnancy (Colorado Department of Public Health & Environment, 2019). While these numbers are a generalized representation of Colorado mothers, it is important to note that substance abuse can vary drastically from community to community. Communities that are impoverished are likely to see more mothers suffering from substance abuse simply due to the lack of resources available to them. These mothers and infants have significantly higher risks of complications during pregnancy, especially if the mother does not seek prenatal or antenatal care. In order to avoid the detrimental effects of substance abuse, healthcare professionals must provide up-to-date education to mothers, ask the right questions, and direct these patients to the right resources in order to improve the health outcomes mother and baby.
Now that the reader has a better understanding of common substances abused during pregnancy, the paper will highlight specific issues as it relates to cannabis use during pregnancy. To begin, this paper will discuss morbidity and mortality as it relates to a pregnant mother that uses cannabis, and her fetus. First, it is important to discuss maternal risk associated with cannabis use. In recent months, several news stations have reported a string of lung illness’ associated with cannabis vaporizer pens. As of November 20, 2019, there have been a confirmed 47 deaths linked to Vitamin E Acetate that is found in cannabis vaporize pen concentrates (Center for Disease Control and Prevention, 2019). While this information is not directly related to pregnant women, it is still important information to make them aware of, as they are at no less of a risk than the general public. In addition, it is important to discuss morbidity and mortality as it relates to the fetus or neonate. There continues to be a lot of confounding findings amongst researchers regarding the effects of cannabis on a fetus. For example, an article by Journal of Obstetrics and Gynecology found that mothers who used cannabis were not at any higher risk for small for gestational age babies or spontaneous preterm birth, than in a mother who did not use cannabis; but did find that cannabis use was associated with an increased risk for morbidity and death in neonates (Metz et al., 2017). Another credible resource states that there is an association between maternal cannabis use and intrauterine growth restriction, preterm birth, and stillborn (Perry et al., 2018). While much of this research is still speculation, it is still important for healthcare workers to educate mothers about the potential adverse effects mentioned above in order to discourage mothers from using cannabis.
Furthermore, it is important to discuss treatments available to mothers and infants who have been exposed to cannabis. Generally, use or withdrawal from cannabis is not known to cause any significant fatal effects. The most common withdrawal symptoms are anxiety, irritability, depressed mood, restlessness, disturbed sleep, gastrointestinal symptoms, and decreased appetite (M. Weinstein & A. Gorelick, 2011). While these symptoms are not life-threatening, they do pose risk of abuse or neglect to a newborn if the mother is in a depressed or irritable state. There is not a definitive treatment for withdrawal or dependence, but one controlled trial has tested the use of Buspar. To date Buspar is the only medication with the proven ability to reduce cravings, irritability, and reduce cannabis use (M. Weinstein & A. Gorelick, 2011). That stated, Buspar used for the treatment of withdrawal in a pregnant mother was not tested in this study. The safety of this would have to be determined safe by a physician, if benefits outweighed risk to both mother and fetus. Furthermore, it is important to discuss neonatal withdrawal symptoms. Cannabis withdrawal is mild in comparison to other substances and very few physiological issues have been noted. The most common symptoms observed are prolonged and exaggerated startle reflex, high-pitched cry, and sleep cycle disturbances (Jaques et al., 2014). At this time, there is no medical or pharmacological treatment for cannabis abstinence in neonates and symptoms should dissipate as the drug as excreted from the system.
Next, it is important to discuss the effects cannabis may have on this offspring as they grow into childhood. Research shows that children who were exposed to cannabis in utero are at increased risk for hyperactivity, lower cognitive function, attention problems, and issues with behavioral and executive functioning (Perry et al., 2018; Jaques et al., 2014).These issues can significantly affect a child’s ability meet developmental milestones such as gaining a sense of industry (versus inferiority). A sense of industry is also a sense of accomplishment; and to gain this, children need not only a loving supportive home, but they must have the ability to cooperate, compete, and cope effectively with others (Perry et al., 2018). At this point peer approval is important, and can significantly be impacted by memory issues, depression, and behavior problems brought on by exposure to cannabis in utero. Not only that, but for children to successfully meet this milestone they must have successfully gone through other stages such as trust versus mistrust, autonomy versus doubt, and initiative versus guilt which may also have been impacted by developmental delays early in life. That stated, this information is important to relay to a pregnant mother. A mother who understands that what she does may impact her child for years to come may be more apt to quit using cannabis.
In conclusion, this paper has discussed the most commonly abused substances, and in detail morbidity, mortality, treatments, and developmental delays as it relates to mothers who abuse cannabis during pregnancy. Although cannabis is one of the most commonly abused substances among pregnant mothers, research continuous to be limited to a few potential effects. Even though evidence-based research limited, new information is continuously published regarding this exact topic. The most important take away for the reader is to educate themselves about known information in order to provide pregnant patients with the most up-to-date education. This education may be exactly what is needed to encourage these mothers to abstain from cannabis.
References
Center for Disease Control and Prevention. (2019, November 21). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Retrieved November 22, 2019, from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
Colorado Department of Public Health & Environment. (2019, September 30). PRAMS 2018 summary tables. Retrieved from https://www.colorado.gov/pacific/cdphe/pregnancysurvey
Forray, A. (2016). Substance use during pregnancy. F1000Research, 5, 887. doi:10.12688/f1000research.7645.1
Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., … Oei, J. L. (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, 34(6), 417-424. doi:10.1038/jp.2013.180
M. Weinstein, A., & A. Gorelick, D. (2011). Pharmacological treatment of cannabis dependence. Current Pharmaceutical Design, 17(14), 1351-1358. doi:10.2174/138161211796150846
Metz, T. D., Allshouse, A. A., Hogue, C. J., Goldenberg, R. L., Dudley, D. J., Varner, M. W., … Silver, R. M. (2017). Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. American Journal of Obstetrics and Gynecology, 217(4), 478.e1-478.e8. doi:10.1016/j.ajog.2017.05.050
Perry, S. E., Lowdermilk, D. L., Cashion, K., Alden, K. R., Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2018). Maternal child nursing care (6th ed.). St. Louis, MO: Elsevier.