Cannabis Use in Pregnancy: Person-Centered Perspectives

ASAM’s public policy statement on cannabis states “Healthcare professionals should avoid recommending cannabis to pregnant persons”. The American Congress of Obstetricians and Gynecologist’s Committee Opinion on cannabis use states that “pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medical purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data”. Despite professional society guidance, cannabis use in pregnancy remains common. Although this may in part be related to cannabis use disorder, recent evidence suggests that the majority of people who continue use throughout pregnancy do not actually meet criteria for a use disorder.4 Reasons for continued use in pregnancy must be explored clinically and include: 1) Traditional therapy treatment failures; 2) Medical mistrust related to a history of the medical community under emphasizing the potential harms of prescription medications; and 3) The comparison of risks of cannabis use to the risks of traditional therapies and to the risks of untreated medical conditions. The purpose of this session is to discuss cannabis use in pregnancy in an up to date way from a person-centered perspective. The session will review what is known about cannabis use in pregnancy and what is unknown. Specific attention will be paid to medical versus non-medical cannabis use in the preconception, post conception and postpartum periods. Recent survey data regarding reasons for use in pregnancy will be presented. Evidence shows that reasons for use often change after conception and are correlated with continuation of use. Additionally, information regarding current policies and recommendations regarding substance use screening, testing and reporting in pregnancy and after birth will be reviewed. A discussion of how the federal illicit classification of cannabis coupled with the Child Abuse Prevention and Treatment Act results in high rates of reporting of women who use cannabis during pregnancy, even if the use is classified as medicinal. Suggestions for policy improvement, specifically policies that are both evidence-based and person-centered, will also be included. A panel discussion including two Obstetricians who are boarded in Addiction Medicine (Katrina Mark and Mishka Terplan) as well as a pediatrician (Davida Schiff) who serves as the Medical Director for the HOPE clinic for families affected by substance use disorder will provide a balanced clinical perspective on the topic.