Abstract
As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
Highlights
A study examining national trends in the USA reported an increase of admissions to substance use treatment facilities for marijuana use during pregnancy from 29% in 1992 to 43% in 2012.6 It is clear that the use of cannabis has increased in the general population and in women of childbearing age; monitoring cannabis use during pregnancy remains difficult
There may be an increasing trend in the use of medicinal cannabis[110] both among those prescribed it for medical conditions and those self-medicating because of perceived efficacy in managing their emotional and mental symptoms, more research is needed to determine the safety of different strains and components, dosage and routes of administration, effect sizes for clinical outcomes and comparisons with existing treatments
Legalisation or decriminalisation may lead to the increased use of cannabis in pregnancy despite persisting risks
Summary
Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. A study examining national trends in the USA reported an increase of admissions to substance use treatment facilities for marijuana (cannabis) use during pregnancy from 29% in 1992 to 43% in 2012.6 It is clear that the use of cannabis has increased in the general population and in women of childbearing age; monitoring cannabis use during pregnancy remains difficult. One study found that out of 100 postpartum women, 11% disclosed cannabis use, whereas 14% tested positive by urinalysis and 28% by hair analysis.[7] This discrepancy in reporting makes it difficult to fully ascertain the prevalence of cannabis use during the perinatal period and might indicate an underlying reluctance to disclose cannabis use which is likely to affect the quality of care and support provided to women who use cannabis during pregnancy. Clinicians may find themselves in an ethically and clinically challenging position, balancing the health benefits of cannabis against the potential risks that may be incurred during pregnancy
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