A recent study published in JAMA Network Open has revealed that the combined use of cannabis and nicotine during pregnancy significantly increases the risk of maternal and neonatal morbidity compared to the use of just one of these substances.
The research highlights that this dual use is associated with a higher likelihood of infant and neonatal death, infants being small for gestational age, and preterm births.
The study analyzed data from pregnant individuals with singleton gestations and gestational ages ranging from 23 to 42 weeks, sourced from the California Department of Health Care Access and Information and the California Department of Public Health.
One of the most striking findings was that the rate of infant death was four times higher among users of both cannabis and nicotine compared to nonusers, and nearly double compared to those who used either substance alone.
Dr. Jamie Lo, the study’s corresponding author, emphasized the importance of these findings for patient counseling.
She advocates for abstinence from both substances during pregnancy but notes that even reducing use to one substance can significantly lower risks.
Future research aims to delve deeper into how factors like dose, timing (specific trimesters), frequency, and mode of cannabis or tobacco delivery impact maternal and offspring outcomes.
Additionally, it will be crucial to examine the long-term effects on children exposed to both substances in utero.
These findings underscore the need for increased awareness that the legality of cannabis does not equate to safety during pregnancy, and healthcare providers should counsel patients accordingly.
The dangers of using cannabis and nicotine products during pregnancy
According to the National Institute on Drug Abuse, cannabis use during pregnancy is linked to reduced fetal neurological function.
Additionally, a study found that nicotine impairs placental function, disrupting the delivery of adequate nutrition and oxygen to the fetus.
Experts unanimously recommend avoiding both substances during pregnancy.
Dr. Lea McMahon, chief clinical officer at Symetria Recovery, highlighted that addiction is a widespread issue, and many patients are concerned about using marijuana and nicotine while pregnant.
She advises her patients to focus on maintaining sobriety, noting that extensive media coverage and medical research advise against the use of both substances during pregnancy.
Dr. McMahon emphasized that neither cannabis nor nicotine is safe for use during pregnancy.
She urges all patients, whether pregnant or not, to seek comprehensive treatment for substance use disorders, aiming for complete sobriety and improved quality of life.
The following list outlines the key dangers of using these substances during pregnancy and the effects on fetal development;
Impaired Brain Development
- Cannabinoids disrupt brain growth and function.
- Nicotine affects neural pathways and synapse formation.
Low Birth Weight and Premature Birth
- Cannabis leads to fetal growth restriction.
- Nicotine reduces birth weight and increases preterm labor risk.
Higher Risk of Preterm Birth
- The risk of preterm birth is substantially increased when both cannabis and nicotine are used during pregnancy. This is due to the compounding effects on the placenta and the increased likelihood of placental abruption and other placental issues.
- Premature birth carries numerous risks, including respiratory distress, developmental delays, and higher mortality rates in infants.
Congenital Disabilities
- Nicotine increases the risk of congenital disabilities, such as heart defects and cleft palate.
- Potential links between cannabis use and congenital abnormalities.
Complications During Pregnancy and Delivery
- Nicotine raises the risk of miscarriage and placental problems.
- Cannabis affects pregnancy duration and can lead to premature labor.
Alleviating addiction before pregnancy
Pamela Berens, MD, a professor and OBGYN at UTHealth Houston, emphasized that the legality of cannabis in some states does not equate to its safety during pregnancy.
She noted the lack of comprehensive research on the effects of cannabis use during pregnancy and lactation, underscoring the importance of reducing use before and during pregnancy and ideally quitting entirely.
It’s highly recommended to cease cannabis and nicotine use before becoming pregnant. Quitting any addiction during pregnancy can pose risks to both the pregnant individual and the fetus.
Dr. Lea McMahon added that nicotine patches are not a safe method for quitting during pregnancy, as they deliver a high dose of nicotine that can harm the fetus.
Dr. McMahon believes the best approach to discourage cannabis and nicotine use during pregnancy is to abstain from both substances and to dispel the notion that one is safer than the other.
For those trying to overcome substance use disorders, avoiding behaviors associated with cannabis and nicotine use is crucial.
Public Health Implications
1. Need for Public Education and Awareness
Public education campaigns are crucial to inform pregnant women and the general public about the dangers of using cannabis and nicotine during pregnancy. These campaigns should:
- Highlight the specific risks to fetal development and long-term child health.
- Use various media platforms to reach a broad audience, ensuring messages are culturally sensitive and accessible to all demographic groups.
2. Role of Healthcare Providers
Healthcare providers play a pivotal role in addressing substance use during pregnancy through:
A. Screening and Counseling Pregnant Women
- Routine screening for cannabis and nicotine use during prenatal visits can identify at-risk women early.
- Counseling should focus on the risks associated with substance use and provide motivational support to quit.
B. Providing Resources for Cessation
- Healthcare providers should offer resources such as referral to smoking cessation programs, substance abuse counseling, and support groups.
- Ensuring pregnant women have access to comprehensive healthcare services, including mental health support, is essential for addressing underlying issues contributing to substance use.
3. Policy Recommendations
A. Stricter Regulations on Cannabis and Nicotine Marketing
- Implementing stricter regulations to limit marketing of cannabis and nicotine products to pregnant women is vital. This includes banning advertisements that target or appeal to young women and those of childbearing age.
- Policies should also enforce clearer warning labels on products highlighting the risks of use during pregnancy.
B. Support for Research on Prenatal Substance Exposure
- Increased funding for research into the long-term effects of prenatal cannabis and nicotine exposure is necessary to better understand and mitigate these risks.
- Encouraging interdisciplinary research that combines insights from obstetrics, pediatrics, neurology, and public health can lead to more comprehensive strategies to address the issue.
Conclusion
The combined use of cannabis and nicotine during pregnancy was linked to an increased risk of maternal and neonatal morbidity, according to a new study.
Experts noted that it’s best to avoid both substances during pregnancy.
It’s crucial to raise awareness among the public that although cannabis is legal in some states, it doesn’t mean it’s safe for pregnant people to use.
References
Metz, T. D., Allshouse, A. A., McMillin, G. A., Greene, T., Chung, J. H., Grobman, W. A., Haas, D. M., Mercer, B. M., Parry, S., Reddy, U. M., Saade, G. R., Simhan, H. N., & Silver, R. M. (2023). Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function. JAMA, 330(22), 2191–2199. https://doi.org/10.1001/jama.2023.21146
Bandoli, G., Jelliffe-Pawlowski, L., Schumacher, B., Baer, R. J., Felder, J. N., Fuchs, J. D., Oltman, S. P., Steurer, M. A., & Marienfeld, C. (2021). Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes. Drug and alcohol dependence, 225, 108757. https://doi.org/10.1016/j.drugalcdep.2021.108757
Jarlenski, M., & Spencer, N. (2022). Perceptions of Safety Around Use of Cannabis and Nicotine/Tobacco in Pregnancy. Clinical obstetrics and gynecology, 65(2), 319–333. https://doi.org/10.1097/GRF.0000000000000692
Terplan M. (2022). Prenatal Nicotine or Cannabis Exposure and Offspring Neurobehavioral Outcomes. Obstetrics and gynecology, 139(5), 939. https://doi.org/10.1097/AOG.0000000000004779
