Abstract
To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.
References
United Nations Office on Drug and Crime. World Drug Report 2013. Available from http://www.unodc.org/wdr/en/cannabis.html Accessed 2 July 2013.
European Monitoring Centre for Drugs and Drug Addiction. Available from http://www.emcdda.europa.eu/stats07/gpstab08a.
Hayes JS, Lampart R, Dreher MC, Morgan L . Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy. West Indian Med J. 1991; 40 (3): 120–123.
Morrison DM, Spencer MS, Gillmore MR . Beliefs about substance use among pregnant and parenting adolescents. J Res Adolesc 1998; 8 (1): 69–95.
Campolongo P, Trezza V, Ratano P, Palmery M, Cuomo V . Developmental consequences of perinatal cannabis exposure: behavioral and neuroendocrine effects in adult rodents. Psychopharmacology (Berl) 2011; 214 (1): 5–15.
Moreno-López L, Stamatakis EA, Fernández-Serrano MJ, Gómez-Río M, Rodríguez-Fernández A, Pérez-García M et al. Neural correlates of the severity of cocaine, heroin, alcohol, MDMA and cannabis use in polysubstance abusers: a resting-PET brain metabolism study. PLoS One 2012; 7 (6): e39830.
Behan AT, Hryniewiecka M, O'Tuathaigh CM, Kinsella A, Cannon M, Karayiorgou M et al. Chronic adolescent exposure to delta-9-tetrahydrocannabinol in COMT mutant mice: impact on indices of dopaminergic, endocannabinoid and GABAergic pathways. Neuropsychopharmacology 2012; 37 (7): 1773–1783.
Gleason KA, Birnbaum SG, Shukla A, Ghose S . Susceptibility of the adolescent brain to cannabinoids: long-term hippocampal effects and relevance to schizophrenia. Transl Psychiatry 2012; 2: e199.
Hayatbakhsh MR, Kingsbury AM, Flenady V, Gilshenan KS, Hutchinson DM, Najman JM . Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000–2006. Drug Alcohol Rev 2011; 30 (2): 181–187.
Schou J, Prockop LD, Dahlstrom G, Rohde C . Penetration of delta-9-tetrahydrocannabinol and 11-OH-delta-9-tetrahydrocannabinol through the blood-brain barrier. Acta Pharmacol Toxicol (Copenh) 1977; 41 (1): 33–38.
Bar-Oz B, Klein J, Karaskov T, Koren G . Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse. Arch Dis Child Fetal Neonatal Ed 2003; 88 (2): F98–F100.
Harbison RD, Mantilla-Plata B, Lubin DJ . Alteration of delta 9-tetrahydrocannabinol-induced teratogenicity by stimulation and inhibition of its metabolism. J Pharmacol Exp Ther 1977; 202 (2): 455–465.
Wu CS, Jew CP, Lu HC . Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. Future Neurol 2011; 6 (4): 459–480.
Dreher MC . Poor and pregnant: perinatal ganja use in rural Jamaica. Adv Alcohol Subst Abuse 1989; 8 (1): 45–54.
Oei JL, Abdel-Latif ME, Craig F, Kee A, Austin MP, Lui K NSW and ACT NAS Epidemiology Group. Short-term outcomes of mothers and newborn infants with comorbid psychiatric disorders and drug dependency. Aust N Z J Psychiatry 2009; 43 (4): 323–331.
Australian Drug Foundation. Cannabis Facts. Available from http://www.druginfo.adf.org.au/drug-facts/cannabis Accessed 2 July 2013.
National Cannabis Information and Prevention Centre. Cannabis Information. Available from www.ncpic.org.au Accessed 2 July 2013.
Bostwick JM, Reisfield GM, DuPont RL . Clinical decisions. Medicinal use of marijuana. N Engl J Med 2013; 368 (9): 866–868.
Cravatt BF, Lichtman AH . Fatty acid amide hydrolase: an emerging therapeutic target in the endocannabinoid system. Curr Opin Chem Biol 2003; 7 (4): 469–475.
Klein TW, Cabral GA . Cannabinoid-induced immune suppression and modulation of antigen-presenting cells. J Neuroimmune Pharmacol 2006; 1 (1): 50–64.
Rieder SA, Chauhan A, Singh U, Nagarkatti M, Nagarkatti P . Cannabinoid-induced apoptosis in immune cells as a pathway to immunosuppression. Immunobiology 2010; 215 (8): 598–605.
Downer EJ, Campbell VA . Phytocannabinoids, CNS cells and development: a dead issue? Drug Alcohol Rev 2010; 29 (1): 91–98.
Croxford JL, Yamamura T . Cannabinoids and the immune system: potential for the treatment of inflammatory diseases? J Neuroimmunol 2005; 166 (1-2): 3–18.
García-Gutiérrez MS, Ortega-Álvaro A, Busquets A, Pérez-Ortiz JM, Caltana L, Ricatti MJ et al. Synaptic plasticity alterations associated with memory impairment induced by deletion of CB2 cannabinoid receptors. Neuropharmacology 2013; 73: 388–396.
Lee CC, Chiang CN . Maternal-fetal transfer of abused substances: pharmacokinetic and pharmacodynamic data. NIDA Res Monogr 1985; 60: 110–147.
Hutchings DE, Martin BR, Gamagaris Z, Miller N, Fico T . Plasma concentrations of delta-9-tetrahydrocannabinol in dams and fetuses following acute or multiple prenatal dosing in rats. Life Sci 1989; 44 (11): 697–701.
Blackard C, Tennes K . Human placental transfer of cannabinoids. N Engl J Med 1984; 311 (12): 797.
Jutras-Aswad D, DiNieri JA, Harkany T, Hurd YL . Neurobiological consequences of maternal cannabis on human fetal development and its neuropsychiatric outcome. Eur Arch Psychiatry Clin Neurosci 2009; 259: 395–412.
Verney C, Zecevic N, Nikolic B, Alvarez C, Berger B . Early evidence of catecholaminergic cell groups in 5- and 6-week-old human embryos using tyrosine hydroxylase and dopamine-b-hydroxylase immunocytochemistry. Neurosci Lett 1991; 131: 121–124.
Volkow ND, Fowler JS, Wang GJ, Swanson JM, Telang F . Dopamine in drug abuse and addiction: results of imaging studies and treatment implications. Arch Neurol 2007; 64: 1575–1579.
Seeman P . Targeting the dopamine D2 receptor in schizophrenia. Expert Opin Ther Targets 2006; 10: 515–531.
Klimek V, Schenck JE, Han H, Stockmeier CA, Ordway GA . Dopaminergic abnormalities in amygdaloid nuclei in major depression: a postmortem study. Biol Psychiatry 2001; 52: 740–748.
Krishnan KR . Psychiatric and medical co-morbidities of bipolar disorder. Psychosom Med 2005; 67: 1–8.
Schacht JP, Hutchison KE, Filbey FM . Associations between cannabinoid receptor-1 (CNR1) variation and hippocampus and amygdala volumes in heavy cannabis users. Neuropsychopharmacology 2012; 37 (11): 2368–2376.
Ebrahim SH, Gfroerer J . Pregnancy-related substance use in the United States during 1996–1998. Obstet Gynecol 2003; 101 (2): 374–379.
Australian Institute of Health and Welfare. 2010 National Drug and Alcohol Household Survey. Available from http://www.aihw.gov.au/publication-detail/?id=32212254712 Accessed 2 July 2013.
Fergusson DM, Horwood LJ, Northstone K . ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Maternal use of cannabis and pregnancy outcome. BJOG 2002; 109 (1): 21–27.
Moore DG, Turner JD, Parrott AC, Goodwin JE, Fulton SE, Min MO et al. During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the Development and Infancy Study. J Psychopharmacol 2010; 24 (9): 1403–1410.
Burns L, Mattick RP, Cooke M . The use of record linkage to examine illicit drug use in pregnancy. Addiction 2006; 101 (6): 873–882.
Little BB, Snell LM, Van Beveren TT, Crowell RB, Trayler S, Johnston WL . Treatment of substance abuse during pregnancy and infant outcome. Am J Perinatol 2003; 20: 255–262.
Neonatal Abstinence Syndrome Guidelines. NSW Ministry of Health. Available from http://www0.health.nsw.gov.au/policies/gl/2013/GL2013_008.html (accessed 14 November 13).
Winklbaur B, Kopf N, Ebner N, Jung N, Thau K, Fischer G . Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates. Addiction 2008; 103: 1429–1440.
Field T, Hernandez-Reif M, Diego M, Figueiredo B, Schanber S, Kuhn C . Prenatal cortisol, prematurity and low birthweight. Infant Behav Dev 2006; 29: 268–275.
Neggers Y, Goldenber R, Cliver S, Hauth J . The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstet Gynecol Scand 2006; 85: 277–285.
ÓKeane V, Marsh MS . Depression during pregnancy. BMJ 2007; 334: 1003–1005.
Orr ST, Blazer DG, James SA, Reiter JP . Depressive symptoms and indicators of maternal health status during pregnancy. J Womens Health (Larchmt) 2007; 16: 535–542.
Flynn L . The adolescent parenting program: improving outcomes through mentorship. Public Health Nurs 1999; 16 (3): 182–189.
Godding V, Bonnier C, Fiasse L, Michel M, Longueville E, Lebecque P et al. Does in utero exposure to heavy maternal smoking induce nicotine withdrawal symptoms in neonates? Pediatr Res 2004; 55 (4): 645–651.
Seib CA, Daglish M, Heath R, Booker C, Reid C, Fraser J . Screening for alcohol and drug use in pregnancy. Midwifery 2012; 28: 760–764.
Chang G . Alcohol-screening instruments for pregnant women. Alcohol Res Health 2001; 25: 204–209.
Grekin ER, Svikis DS, Lam P, Connors V, Lebreton JM, Streiner DL et al. Drug use during pregnancy: validating the Drug Abuse Screening Test against physiological measures. Psychol Addict Behav 2010; 24: 719–723.
Azadi A, Dildy GA 3rd . Universal screening for substance abuse at the time of parturition. Am J Obstet Gynecol 2008; 198 (5): e30–e32.
Ellsworth MA, Stevens TP, D'Angio CT . Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns. Pediatrics 2010; 125 (6): e1379–e1385.
Ostrea EM Jr, Knapp DK, Tannenbaum L, Ostrea AR, Romero A, Salari V et al. Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis. J Pediatr 2001; 138 (3): 344–348.
Friguls B, Joya X, Garcia-Serra J, Gómez-Culebras M, Pichini S, Martinez S et al. Assessment of exposure to drugs of abuse during pregnancy by hair analysis in a Mediterranean island. Addiction 2012; 107 (8): 1471–1479.
Moosmann B, Roth N, Auwärter V . Hair analysis for THCA-A, THC and CBN after passive in vivo exposure to marijuana smoke. Drug Test Anal 2013 (Epub ahead of print).
Farst KJ, Valentine JL, Hall RW . Drug testing for newborn exposure to illicit substances in pregnancy: pitfalls and pearls. Int J Pediatr 2011; 2011: 951616.
De Santis M, De Luca C, Mappa I, Quattrocchi T, Angelo L, Cesari E . Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women. Eur J Obstet Gynecol Reprod Biol 2011; 159 (1): 106–110.
Park B, Gibbons HM, Mitchell MD, Glass M . Identification of the CB1 cannabinoid receptor and fatty acid amide hydrolase (FAAH) in the human placenta. Placenta 2003; 24 (10): 990–995.
Khare M, Taylor AH, Konje JC, Bell SC . Delta9-tetrahydrocannabinol inhibits cytotrophoblast cell proliferation and modulates gene transcription. Mol Hum Reprod 2006; 12 (5): 321–333.
El Marroun H, Tiemeier H, Steegers EA, Jaddoe VW, Hofman A, Verhulst FC et al. Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study. J Am Acad Child Adolesc Psychiatry 2009; 48 (12): 1173–1181.
Kline J, Hutzler M, Levin B, Stein Z, Susser M, Warburton D . Marijuana and spontaneous abortion of known karyotype. Paediatr Perinat Epidemiol 1991; 5: 320–332.
Neugebauer R, Kline J, Stein Z, Shrout P, Warburton D, Susser M . Association of stressful life events with chromosomally normal spontaneous abortion. Am J Epidemiol 1996; 143: 588–596.
Linn S, Schoenbaum SC, Monson RR, Rosner R, Stubblefield PC, Ryan KJ . The association of marijuana use with outcome of pregnancy. Am J Public Health 1983; 73 (10): 1161–1164.
Forrester MB, Merz RD . Comparison of trends in gastroschisis and prenatal illicit drug use rates. J Toxicol Environ Health A 2006; 69 (13): 1253–1259.
Fried PA . The Ottawa Prenatal Prospective Study (OPPS): methodological issues and findings—it's easy to throw the baby out with the bath water. Life Sci 1995; 56 (23-24): 2159.
Lester BM, Dreher M . Effects of marijuana use during pregnancy on newborn cry. Child Dev 1989; 60: 765–771.
Scher MS, Richardson GA, Coble PA, Day NL, Stoffer DS . The effects of prenatal alcohol and marijuana exposure: disturbances in neonatal sleep cycling and arousal. Pediatr Res 1988; 24 (1): 101–105.
Fried PA, Watkinson B, Dillon RF, Dulberg CS . Neonatal neurological status in a low-risk population after prenatal exposure to cigarettes, marijuana, and alcohol. J Dev Behav Pediatr 1987; 8: 318–326.
Pacher P, Bátkai S, Kunos G . The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006; 58 (3): 389–462.
Fried PA, Watkinson B, Gray R . Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol 1999; 21 (5): 513–525.
Smithers LG, Lynch JW, Yang S, Dahhou M, Kramer MS . Impact of neonatal growth on IQ and behavior at early school age. Pediatrics 2013; 132 (1): e53–e60.
El Marroun H, Hudziak JJ, Tiemeier H, Creemers H, Steegers EA, Jaddoe VW et al. Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend 2011; 118 (2-3): 470–474.
Goldschmidt L, Richardson GA, Willford J, Day NL . Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry 2008; 47 (3): 254–263.
Fried PA, Watkinson B, Gray R . Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 1998; 20 (3): 293–306.
Fried PA, Watkinson B, Gray R . Differential effects on cognitive functioning in 13- to 16-year-olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 2003; 25 (4): 427–436.
Goldschmidt L, Richardson GA, Willford JA, Severtson SG, Day NL . School achievement in 14-year-old youths prenatally exposed to marijuana. Neurotoxicol Teratol 2012; 34 (1): 161–167.
Smith AM, Fried PA, Hogan MJ, Cameron I . Effects of prenatal marijuana on visuospatial working memory: an fMRI study in young adults. Neurotoxicol Teratol 2006; 28 (2): 286–295.
DiNieri JA, Wang X, Szutorisz H, Spano SM, Kaur J, Casaccia P et al. Maternal cannabis use alters ventral striatal dopamine D2 gene regulation in the offspring. Biol Psychiatry 2011; 70 (8): 763–769.
Wang X, Dow-Edwards D, Anderson V, Minkoff H, Hurd YL . In utero marijuana exposure associated with abnormal amygdala dopamine D2 gene expression in the human fetus. Biol Psychiatry 2004; 56 (12): 909–915.
Goldschmidt L, Day NL, Richardson GA . Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol 2000; 22 (3): 325–336.
Day NL, Leech SL, Goldschmidt L . The effects of prenatal marijuana exposure on delinquent behaviors are mediated by measures of neurocognitive functioning. Neurotoxicol Teratol 2011; 33 (1): 129–136.
Frank DA, Rose-Jacobs R, Crooks D, Cabral HJ, Gerteis J, Hacker KA . Adolescent initiation of licit and illicit substance use: Impact of intrauterine exposures and post-natal exposure to violence. Neurotoxicol Teratol 2011; 33 (1): 100–109.
Zammit S, Thomas K, Thompson A, Horwood J, Menezes P, Gunnell D et al. Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring. Br J Psychiatry 2009; 195: 294–300.
Fried PA, James DS, Watkinson B . Growth and pubertal milestones during adolescence in offspring prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 2001; 23 (5): 431–436.
Muniyappa R, Sable S, Ouwerkerk R, Mari A, Gharib AM, Walter M et al. Metabolic effects of chronic cannabis smoking. Diabetes Care 2013 Mar; 36 (8): 2415–2422.
Westfall RE, Janssen PA, Lucas P, Capler R . Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'. Complement Ther Clin Pract 2006; 12 (1): 27–33.
Marijuana Policy Project. Available from www.mpp.org Accessed 11 November 2013.
Perez-Reyes M, Wall ME . Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med 1982; 307 (13): 819–820.
Ahmad GR, Ahmad N . Passive consumption of marijuana through milk: a low level chronic exposure to delta-9-tetrahydrocannabinol(THC). J Toxicol Clin Toxicol 1990; 28 (2): 255–260.
Astley SJ, Little RE . Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990; 12 (2): 161–168.
Murphy LL, Muñoz RM, Adrian BA, Villanúa MA . Function of cannabinoid receptors in the neuroendocrine regulation of hormone secretion. Neurobiol Dis 1998; 5 (6 Pt B): 432–446.
Academy of Breastfeeding Medicine Protocol Committee, Jansson LM . ABM clinical protocol #21: Guidelines for breastfeeding and the drug-dependent woman. Breastfeed Med 2009; 4 (4): 225–228.
Hale TW . Medications and Mother's Milk. Hale: Amarillo, TX, USA, 2006.
Nelson Marlborough District. Pediatric Guidelines Breastfeeding 2006. Available from http://www.nmdhb.govt.nz/filesGallery/New%20Website/03Health%20Concerns/BreastFeedingGuidelines06.pdf accessed 2 July 2013.
Klonoff-Cohen H, Lam-Kruglick P . Maternal and paternal recreational drug use and sudden infant death syndrome. Arch Pediatr Adolesc Med 2001; 155 (7): 765–770.
Bibb KW, Stewart DL, Walker JR, Cook VD, Wagener RE . Drug screening in newborns and mothers using meconium samples, paired urine samples, and interviews. J Perinatol 1995; 15: 199–202.
O'Tuathaigh CM, Clarke G, Walsh J, Desbonnet L, Petit E, O'Leary C et al. Genetic vs pharmacological inactivation of COMT influences cannabinoid-induced expression of schizophrenia-related phenotypes. Int J Neuropsychopharmacol 2012; 15 (9): 1331–1342.
Kaltenbach K, Berghella V, Finnegan L . Opioid dependence during pregnancy. Effects and management. Obstet Gynecol Clin North Am 1998; 25: 139–151.
Finnegan LP . Perinatal substance abuse; comments and perspectives. Semin Perinatol 1991; 15: 331–339.
Grella CE, Hser YI, Huang Yc . Mothers in substance abuse treatment; differences in characteristics based on involvement with child welfare services. Child Abuse Negl 2006; 30: 55–73.
Phillips D, Thomas K, Cox H, Ricciadelli LA, Ogle J, Love V et al. Factors that influence women’s disclosures of substance use during pregnancy: a qualitative study of ten midwives and ten pregnant women. J Drug Issues 2007; 37: 357–375.
Jemionek JF, Copley CL, Smith ML, Past MR . Concentration distribution of the marijuana metabolite Δ9-tetrahydrocannabinol-9-carboxylic acid and the cocaine metabolite benzoyl ecgonine in the Department of Defense Urine Drug-Testing Program. J Anal Toxicol 2008; 32: 408–416.
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SJ developed the manuscript; JLO developed the concept for article and prepared the manuscript for submission; and AK, PH, CC, SC, J Falconer, MA-L and J Feller reviewed and revised the manuscript and approved the final version for publication.
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Jaques, S., Kingsbury, A., Henshcke, P. et al. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol 34, 417–424 (2014). https://doi.org/10.1038/jp.2013.180
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DOI: https://doi.org/10.1038/jp.2013.180
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