Missouri’s medical marijuana program is still getting off the ground, but Lee’s Summit obstetrician and gynecologist Emily Gray has already had one patient tell her she plans to enroll.
Before the patient left, Gray made sure the woman, who had already had her baby, wasn’t breastfeeding.
“We do know that marijuana is not safe to be used during pregnancy or lactation,” Gray said. “So we recommend against it.”
Yet despite the known risks to using cannabis while pregnant, including impaired brain development for the fetus, nothing in Missouri’s new medical marijuana law prevents other doctors from helping pregnant patients obtain the drug. Doctors are only required to discuss the risks.
A large study published earlier this year in The Journal of the American Medical Association found that the percentage of pregnant women who report using marijuana doubled from 2002 to 2017.
That roughly coincides with the rapid push to legalize marijuana for medical or recreational use that has now spread to more than half the states. Missouri voters opted last year to legalize medical marijuana, causing some concern in a state that already ranks in the bottom half in both infant and maternal health.
“In general in states where marijuana is legalized it seems like there has been an uptick in women that are using marijuana, so with the expansion in Missouri there very well might be an increase in use here,” said Gray, who works at a University Health women’s care clinic. “But we will continue to counsel women against use of marijuana in pregnancy and in breastfeeding.”
The JAMA study analyzed survey data from more than 450,000 women ages 12 to 44. It found that the percentage who reported using pot while pregnant rose from 3.4% to 7%. The percentage who reported using it daily jumped from 0.9% to 3.4%.
The authors speculated that widespread legalization may be causing women to have a false sense of security about marijuana’s safety — especially if they haven’t been informed about the risks.
Instead of considering the risks, some women might think marijuana is actually beneficial.
A 2018 National Institutes of Health study of more than 400 marijuana dispensaries in Colorado found that 70% of them recommended cannabis to treat morning sickness.
That’s particularly dangerous advice, Gray said.
“Marijuana is not a good treatment for morning sickness,” Gray said. “We know that it causes problems with brain development, and the first trimester — when most women suffer from morning sickness — is such an important time for brain development and for the other organs to develop. (Marijuana) exposure during that time can be so detrimental to a baby.”
Many of the possible risks haven’t been fully studied, said John Lantos, the director of pediatric bioethics at Children’s Mercy Hospital.
Given what’s already known about the effects of marijuana on fetal development, there are ethical questions about doing any research that involves marijuana use while pregnant — even when the researchers are only observing women who were already using marijuana anyway.
“I don’t think we know how dangerous (it is) or at what dose there is a danger,” Lantos said. “It’s a general problem of studying anything women do during pregnancy.”
That being the case, Gray said most physicians recommend total abstinence.
“We know for sure that marijuana use can affect brain development of the baby when it’s growing,” Gray said. “We’re going to have to continue studying that to see all of the effects that happen later in life.”
She said new research also shows possible associations with pre-term births and some heart defects.
The Centers for Disease Control, the American College of Obstetricians and Gynecologists and the March of Dimes (a nonprofit that works to prevent birth defects and infant mortality) all advise against using marijuana while pregnant.
Morning sickness is not one of the conditions that Missouri’s new law specifically says should qualify patients for medical marijuana. But there is nothing in the law to keep physicians from certifying pregnant women based on other conditions.
Missouri’s patient certification form merely requires them to initial that they have discussed with the patient — pregnant or not — or the patient’s caregiver, “the risks of medical marijuana use to fetuses and the risks of medical marijuana use to breastfeeding infants.”
Gray said an OBGYN would be unlikely to sign off on a certification form. But the same could not be said of the clinics that have cropped up specifically for the purpose of doing medical marijuana evaluations.
A representative of one of those clinics, Green Health Docs KC on the Country Club Plaza, said its policy is to not accept pregnant patients. Messages left at two other clinics in the Kansas City area drew no response.
Residents must have a doctor’s OK to apply for a medical marijuana card, which makes them eligible to grow up to six marijuana plants. The state began granting those cards this summer but doesn’t expect the first legal marijuana to be sold from Missouri dispensaries until early next year.
Gray said she and other OBGYNs are prepared to talk to patients about drug use, and it’s important for those patients to be upfront with their doctors whether they’re using marijuana legally or illegally.
“Our goal is to provide women with education so they can make the best decision for them,” Gray said. “It’s not my job to judge a woman, it’s just my job to provide her the information she needs to make the best decision for her — for her health and for the baby.”