Recreational marijuana use is now legal in seven states and the District of Columbia, but the effect of the drug on pregnant women and their unborn babies presents a research challenge. In this video, Katrina Mark, MD, of the University of Maryland, discusses some of the barriers involved in researching the effects of marijuana during pregnancy, how legalization may help providers get a more complete picture of their patient's health, and the role of OB/GYNs in advocating for clear labeling of the product to better educate pregnant women about its potential risks.
The following is a transcript of her remarks:
It's really a challenging thing to study because there is... there are a lot of confounding factors. Most women who smoke marijuana also smoke tobacco, and so it's difficult to separate out the difference. There are some long-term neurological effects that have been studied and generally agreed upon to be true, but again, there's a lot of limiting factors because we're not doing controlled, randomized studies on these things. They're all cohort studies where we look at women who did smoke marijuana during their pregnancy and see what happens to their babies.
But there's probably differences in those women anyway. Maybe those women already have psychological differences or they have socioeconomic differences. They have different diets, different exposures during their pregnancy and life that could potentially cause long-term changes in their babies, too.
So I'm not sure that it's something that we're ever going to have really pristine studies on because it's just not ethical. So what we know now is that it appears to have some long-term neurological problems, and so I think we should really be explaining that to women. I think when it was illegal, a lot of women just got the message, "It's illegal. It's bad," and didn't really get the full picture of why is it bad. Not just because it's illegal. What is the problem with it?
Now that it's becoming illegal people... or becoming legal, people are thinking, "Great, it's not illegal anymore. That must mean that it's healthy for me." But again, just like in alcohol and tobacco, that doesn't necessarily mean it's healthy. It just means it's not illegal. Health concerns and legal concerns really should be two totally separate things, and they get kind of clouded and mixed together I think sometimes, so it's a really challenging problem.
The other thing that I think is so hard as a clinician to explain is that we have very clear understanding of what happens with alcohol. You can see a baby that has fetal alcohol syndrome and people get that. But with marijuana, there's such subtle differences that you can't show a woman a picture of what it looks like to have a baby who was exposed to marijuana perinatally, so it's a really tough thing to explain to people when the evidence even to the clinicians is a little bit confounded.
I hope that it's going to open up the conversation a bit more with patients because I think the fact that it hasn't been legal up until now has led some patients to not be forthcoming and honest about their use, and there are other substances that are legal now like tobacco and alcohol, which we know are harmful in pregnancy and discussing those openly with your OB/GYN provider is important so that we counsel patients about the harms that are... the potential harms to their unborn baby during their pregnancy.
So if anything, I'm hoping it's going to be helpful. As physicians, our job is to take care of the mother and the baby and not to punish them in any way for doing things that are illegal. So if it makes them more comfortable talking to us about all of the substances they're using, then it can only be helpful.
But I think it's very important for OB/GYN physicians to be part of this discussion because I think the legalization of marijuana has come a little faster than some of the regulations we might have liked. So surgeon's general warnings are on alcohol and tobacco products now warning pregnant women that they may be harmful during their pregnancy, but such things don't exist in anywhere, but maybe Oregon, explaining to women that these things can be harmful.
So I think that our job as women's healthcare providers is to advocate that all the information is given to the women – both by us and by the manufacturers and distributors of these products – so that they understand the potential risks to themselves and their babies.