Great Britain’s Princess Kate is a perfect example of the dichotomies of pregnancy. On the one hand, she seems to have a golden glow and her hair stays silky and luscious thanks to pregnancy hormones and her likely regimen of proper prenatal care and vitamins. She wears beautiful designer clothes that continue to look amazing on her thin frame long into her pregnancy. On the other hand, when she is not attending official events and presenting the flawless face of royalty, there is a good chance that she is in one of the palace bathrooms, throwing up with stunning regularity. Kate suffers from hyperemesis gravidarum, a very severe type of “morning sickness” (which can actually happen at any time of day). The University of Maryland Medical Center describes hyperemesis gravidarum as being characterized by “losing more than 5 percent of your body weight, intractable vomiting, retinal hemorrhage, and potential renal and liver damage.” Cannabis is known to help alleviate symptoms of nausea and increase appetite — but would it be a wise idea for Kate, or any other expectant mother, to use cannabis to alleviate her pregnancy sickness?
Understanding the effects of cannabis (or any kind of drug) on pregnant mothers and their neonates has been difficult in the United States because there is a strong reluctance to fund the proper longitudinal studies. They are time consuming, take years, and are very costly. Dr. Melanie Dreher holds several degrees, including a Ph.D. in Anthropology and a Masters of Philosophy, both from Columbia University, an MA in Anthropology from Columbia, and last but not least, a BS in nursing. Dr. Dreher’s anthropological eye had her interested in cross-cultural studies investigating substance abuse and use on the health, development and task performance in adults and their exposed children. She looked to Jamaica to find populations of pregnant women that specifically used cannabis in the hopes that the results would not be confounded by the use of nicotine, alcohol, or hard drugs (typical in most study participants, especially in industrialized countries). Her study, funded by Patients Out of Time (POT) is titled “Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica” and it had some very unexpected results.
Dr. Dreher chose Jamaica to launch her 1989 study because the community used cannabis for very specific reasons. She wrote that they “viewed marijuana as a sacred substance and may use ritually on a daily basis. Marijuana also is known for its therapeutic and health-promoting functions. It is consumed as a tea by family members of all ages for a variety of illnesses and to maintain and promote health.” Women smoking marijuana (as opposed to drinking it as a tea) are discouraged in Jamaica, but a group of Rastafarian women called the “Roots Daughters” were said to “think, reason, and smoke like a man. They smoke marijuana on a daily basis in a manner not unlike that of their male counterparts and continue to smoke during pregnancy and the breastfeeding period.”
To conduct the study, Dreher recruited local midwives to find 30 women who were pregnant and were light, moderate, or heavy cannabis users. She then matched a sample of 30 women who were non-users with comparable age, parity, and socioeconomic status, then took into account medical and obstetrical histories.
Three days after the mothers in the study gave birth, the infants were assessed using the Neonatal Behavioral Assessment Scale. The NBAS takes into account some 14 different behaviors from reflexes to general irritability and is typically used until an infant is about three months old. The study found that on day one, between the using and non-using mothers that there were no significant differences. This also applied on day three. There was also no significant difference in birth weight, length, or head circumference. At one month, however, study results started to get really interesting. Dreher wrote that “the heavily exposed neonates were more socially responsive and were more autonomically stable at 30 days than their matched counterparts. The quality of their alertness was higher; their motor and autonomic systems were more robust; they were less irritable; they were less likely to demonstrate any imbalance of tone; they needed less examiner facilitation to become organized; they had better self-regulation; and were judged to be more rewarding for caregivers than the neonates of non-using mothers at one month of age.” Dreher revisited the same children at ages four and five and found that there were no differences between the children who were exposed and non-exposed in utero.
But Dr. Peter Fried, who did a study funded by the National Institute on Drug Abuse in 1978, had quite different conclusions. He wrote that, “beyond the age of three, there are suggestive findings indicating a putative association between prenatal marijuana exposure and aspects of cognitive behavior that fall under the rubric of executive function. Particularly, the facets of this construct which appear impacted are the domains of attention/impulsivity and problem solving situations requiring integration and manipulation of basic visuoperceptual skills.”
The differences between the outcomes of the studies come down to several factors. One is, of course, who’s paying for it. Dale Sky Jones, the Executive Chancellor of Oaksterdam University in San Francisco, suggests that NIDA is “more interested in finding harm instead of benefit” when it comes to cannabis. The other factors are socioeconomic status, education, prenatal care, nutrition and whether the mothers used other substances while pregnant. The Jamaican study was unique because the subjects were only using cannabis and other substances could be completely factored out of neonatal outcomes.
Socioeconomic factors in particular may have a startling effect on neonatal outcomes. Women that struggle with poverty have many obstacles to a healthy pregnancy. Poverty can greatly impact childhood outcomes because of less parental availability, lack of parental attention, or having to work multiple jobs. Impoverished women may not have health insurance and as a result may not get the proper prenatal screenings or be able to afford the food for proper nutrition and prenatal vitamins. In fact, research shows that low socioeconomic status can lead to low birth weight, higher levels of emotional and behavioral difficulties, higher aggression, and higher likelihood of health problems later in life.
Jones points out, “Once you factor out socioeconomic deficiencies, the research doesn’t show that there is an effect from cannabis. In fact, growing up in foster care is way more developmentally damaging than the occasional use of any hard drug.” An intriguing aspect of the Jamaican study belongs to the Roots Daughters. They were more educated than the others in the group, were less likely to have a father in the home but had more adult members in the household. Dreher wrote, “conventional wisdom would suggest that mothers who are long-term users are less likely to create optimal caregiving environments for their neonates. In this area of Jamaica, where the heavy use of the substance by women is associated with a higher level of education and greater financial independence, it seems that Roots Daughters have the capacity to create a postnatal environment that is supportive of neonatal development.” She continues to say, “It is possible that with more adults present to assist the mother and respond to the neonate and with fewer children to compete for attention, the mother is better equipped to facilitate the neonate’s interaction with his/her environment.” This, in turn, gives rise to better future outcomes in all areas of child development, regardless of cannabis use.
Paul Armentano is the Deputy Director of NORML and points out that the adverse effects of cigarette smoking and alcohol on babies in utero have been well-studied and documented and those substances still remain legal. They have been definitively linked to fetal alcohol syndrome, low birth weight and long-term negative effects on behavior, cognition, language, and achievement. The research on cannabis during pregnancy is essentially ambivalent because there have been no longitudinal clinical studies on pregnant women who are regular users of only cannabis.
For a woman seeking relief from the aches, pains, and nausea that accompany pregnancy, it’s difficult to know where to turn for relief. Armentano notes, “Any maternal use of substances, even pharmaceuticals, are never tested on pregnant women because it’s unethical. Drugs are not tested in clinical settings on a pregnant population. The potential for great adverse effects depends on the size of the dose.”
How a woman chooses to treat pregnancy symptoms is a deeply personal choice and one that should not be taken lightly. Both legal pharmaceuticals and illegal substances have never been tested vigorously on pregnant populations, and should you test positive for an illegal substance during pregnancy, Dale Sky Jones strongly cautions, “At worst, you will lose your child after giving birth in shackles in prison while serving your 12 year mandatory minimum sentence. Do you want me to say it again?”