Has Cannabis Legalization Increased Use During and After Pregnancy?

In recent years, it's become increasingly common to see marijuana praised as a natural medicine for countless conditions, and expanding legalization has largely destigmatized its use.

"Women are using it for health and wellness, menstrual cramps, endometriosis, fibroid tumors, and fibromyalgia," says medical marijuana practitioner Lynn Parodneck, MD. "So, women are learning to work with the products, and with learning to work with them, they're learning that it’s really helpful."

But for women who are pregnant or have recently given birth, the health benefits of marijuana use come with potential risk. And as more states opt to legalize cannabis and accessibility increases, these risks must be taken into consideration.

To paint a clearer picture of women's habits, a recent study published in JAMA Network Open set out to determine whether recreational cannabis legalization leads to increased cannabis use in women during different reproductive stages.

The Study

With a background in obstetrics and gynecology, Parodneck now serves as medical advisor to New York-based cannabis company TribeTokes, while also treating patients for a wide range of conditions.

“Because stigma is changing, people are starting to see what this can do," she says. "There’s a real change in attitude in people who initially said no. They understand that cannabis can work as medicine, and when it’s working as medicine people aren’t stoned. They’re comfortable, which is a big, big difference.”

The study sought to examine this change in mindset and usage among young women.

Using the Pregnancy Risk Assessment Monitoring System, PRAMS, researchers examined self-reported data from 73,551 women from Maine, Alaska, New Hampshire, and Vermont between 2004 and 2018. The former two states legalized marijuana during that time period, the latter two did not.

Participants reported on the range of reproductive stages, from preconception—the 12 months leading up to a pregnancy—to the prenatal period and postpartum period, which can last up to six months after pregnancy.

The results showed that cannabis usage during the preconception and postpartum stages increased significantly in states that had legalized recreational cannabis, as compared to participants in states that hadn't. Prenatal cannabis use did not increase.

More Research Is Needed

The study's lead researcher, Kara Skelton, PhD, notes that preconception and postpartum are critical windows of maternal health, and so much is still unknown when it comes to the effects of cannabis on maternal health. These findings reveal the critical need for further research, and additional funding opportunities are necessary to examine this topic.

"The importance of additional research in this area cannot be stressed enough," she says. "Cannabis legalization and commercialization, in particular, have brought with it more potent products in an array of forms not previously available, which research has not caught up with."

Prevention and Protection

Despite this dearth of research, both the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists advise women who are pregnant or breastfeeding to avoid using marijuana or any of its byproducts.

Parodneck, for the most part, agrees.

“Being pregnant is such a short amount of time in your life, keep (cannabis use) as minimal as possible," she says. "If possible, don’t.”

The use or ingestion of CBD or THC during pregnancy potentially could be harmful to the baby. Even topicals like oils or ointments, which Parodneck points out do not cross the blood-brain barrier and aren't absorbed systemically, are only safe "in theory."

Minimizing this harm is not the sole responsibility of women, however. Skelton recommends applying the decades of research around tobacco and alcohol control to cannabis control and regulation. For example, specific restrictions have been put in place to prohibit companies from marketing cigarettes and alcohol to children. The same can be done with cannabis products.

"Edibles pose a huge danger for children in terms of accidental child ingestion, so ensuring these cannabis-containing products are not appealing to children is critical," she says.

Protection strategies also could include the adoption of warning labels on products, as well as partnering with health professionals to educate women on cannabis usage risks and safe storage in the home. Prenatal care providers, lactation consultants, pediatricians, and behavioral health specialists all can play a role in disseminating important information.

With proper warnings and education, women can make informed decisions that ensure their own safety and that of their children.