Prenatal and Neonatal
Complications Of Cannabis
Marla D. Kushner, DO, FASAM, FSAHM
What is Cannabis?
 Tetrahydrocannabinol (THC) is the major psychoactive
ingredient in marijuana.
 Cannabinoids refers to all compounds that are
structurally related to THC
 Marijuana is the nations most commonly used illicit
drug
 Classified as a schedule I narcotic in the U.S.
Who is Using Cannabis?
 44% of males and 35% of females studied have used
marijuana at least once in their lifetime.
 In teenagers use has been rising and 6.6% of high
school seniors are daily users. Annual rate of about
38%
 Approximately 11% of pregnant women ages 18-25 in a
study measuring serum metabolites.
 5-30% of mothers reported marijuana use during
pregnancy
Other Names for Cannabis
 Afghan
 Dro
 Jane
 Nug
 Spliff
 Bhang
 Dry High
 Jive
 Otis
 Tea
 Joint
 Panama
 Texas Tea
 Black Rock  Dubby
 Bobby
Brown
 Broccoli
 Buddha
Grass
 Gage
 Kabizzle
 Ganja
 Kryptonite
 Gangster
 Kiff
 Giggleweed  Kush
 Bush
 Grass
 Loco Weed
 Dope
 Hemp
 Mary
 Draw
 Herb
 Mexican
Green
Red
 Pot
 Puff
 Reefer
 Resin
 Roach
 Sativa
 Smoke
 Thai Sticks
 Weed
 Pot
 Grass
 420
Most Common Forms
Marijuana
Hashish
Hash Oil
Synthetic Marijuana
Marijuana
 Prepared from the dried flowering
tops and leaves of the harvested
plant
 THC concentrations of leaves range
from 0.5%-5%
 THC concentrations from
unfertalized flowering plants range
from 7%-14%
Hashish
 Dried cannabis resin and
compressed flowers
 THC content of 2%-8%
Hash Oil
 Obtained by extracting THC from
hashish (or marijuana) with an
organic solvent
 THC concentration between 15%
and 50%
Synthetic Marijuana
High Potency
Up to 600 times more potent than
marijuana’s THC.
How Is Cannabis Used?
 Smoking as a “joint” containing 0.5-1.0
grams of cannabis
 “Bong” or water pipe. Increases
absorption of THC by the lungs.
 Orally via food products. Slows the onset
of effects
Cannabis
 THC is absorbed from the gastrointestinal tract
and lungs
rapidly distributed to:
 Brain (being highly lipophilic)
 Fat tissue
 Extensively bound to plasma proteins (97%)
How Is Cannabis
Metabolized?
 THC is metabolized in the liver to the active
metabolite, 11-OH_THC, which is rapidly converted
to 11-nor-9-carboxy-THC, which is inactive but is
the urinary marker for cannabis.
 THC is lipid soluble and can be deposited in the
fatty tissue. So half-life could be as long as 4 days
 Urine may be positive for weeks to months after
THC use has stopped.
Psychological effects of marijuana
include:
 euphoria, relaxation,
 slowed thinking and reaction time,
 altered perception, impaired coordination
 impaired motor performance,
 poor short-term memory,
 impaired attention and judgment
 panic attacks, anxiety, dizziness
 difficulty expressing thoughts in words.
Physiological effects of marijuana
include:
 increased heart rate
 reddened eyes
 dizziness
 dry mouth
 increased appetite,
 nausea
 respiratory disorder
 immune system dysfunction.
Other Effects of Cannabis
(cont.)
 “amotivational symptoms”
 Lower educational acheivment, lower income, impaired
cognitive function, social life and health in heavy users.
 Quitting high school
 Increased job turnover.
Prenatal Marijuana Use
Prenatal Use
 Up to 30% of mothers
 Unclear due to use of multiple drugs including alcohol,
tobacco, stimulants, and opiates.
 Harm caused by a toxic agent is a function of




Genetic makeup
Fetal and post natal environment
Dose
Developmental stage of the fetus at time of exposure
Prenatal Use
 Often other characteristics of these mothers may have
an effect
 High stress
 Lack of prenatal care
 Sexually transmitted infections
 High risk behaviors
Prenatal Use
 Metabolites of marijuana enter the fetal blood stream
 Active metabolites can penetrate the fetal blood-brain
barrier and interfere with early neuronal cell
development or cause neuronal death.
 Indirect affect: marijuana causes vasoconstriction that
restricts the fetal oxygen supply.
Prenatal Marijuana Use
Perinatal Use
 Rapid transit to the fats in breast milk
Is it safe to breastfeed?
 Lactating mothers should refrain from consuming
cannabinoids.
 Advise mothers to discontinue breastfeeding if they cannot
stop using cannabinoids; incorporate the known risks of
formula feeding.
 Cannabinoid exposure through milk has no appropriate
studies of. In every case, nursing babies should be closely
monitored.
Passage of THC into breast milk
 Perez-Reyes et al (1982) suggested THC is excreted into
human breast milk in moderate amounts.
 Based on their findings, 0.8% of the weight-adjusted maternal
intake of one joint would be ingested by an infant in one
feeding (ie, the baby would receive 0.8% of its mother’s
dose/kg).
 Heavy user milk-to-plasma ratio (ie, levels in milk vs levels in
maternal blood) was as high as 8:1.
Lactation & THC
 Animal studies suggest that marijuana can decrease the
amount of milk produced
 Suppressing prolactin production
 Through a direct effect on the mammary glands
THC in breast milk
 Astley and Little (1990) suggested that exposure to
THC through breast milk in the first month of life could
result in decreased motor development at 1 year old.
 No studies have adequately addressed the effects on
long-term neurodevelopment.
THC in the neonate
 Lethargy
 Less frequent feeding
 Shorter feeding times are other observations reported after
babies’ exposure to THC through breast milk.
 A mother’s ability to nurse and care for her child might be
compromised because marijuana can affect mood and
judgment.
Breastfeeding and THC
 A baby’s brain is still forming, THC could theoretically
affect brain development. It is also important to avoid
environmental exposure to maternal marijuana smoke.
 Nursing mothers who are using marijuana should be
referred to appropriate services for counseling.
Studies
 Ottawa Prenatal Prospective Study
 One week shorter gestation period and true ocular
hypertelorism (wide spaced eyes) and severe epicanthus (skin
folds at the corners of the upper eye lids
 Mothers who smoked >5 joints a week
 Maternal Health Practices and Child Development
 >1 joint a day during first trimesters showed deficits in school
achievement, reading and spelling.
 Mild withdrawal symptoms and poor autonomic control,
particularly of state regulation(ability to adjust level of
alertness required for a task)
Developmental Problems
 Higher order thinking





Problem solving
Memory
Planning
Impulsivity
Attention
AGE 10
 Exposure during first and third trimester
 More depressive symptoms
Ages 16-21
 Doubled the risk of tobacco and marijuana use
 1.3 times more likely to be high frequency users, even
after extensive control for other factors known to
increase use.
Ages 18-22
 MRI study showed altered neuronal functioning during
a psychological test that involves remembering the
placement of images on a screen
Prevention
 Raising awareness among pregnant
women
 Legislation for synthetic marijuana
Treatment
 CBT
 Motivational enhancement
 CM therapies
Contact information:
[email protected]
Phone: 773-244-9600
Thank you!