Can CBD cause fetal alcohol syndrome, and is it safe to use when pregnant?
- In a 2019 study, which was published in Nature Research Journal, researchers found that the brain and facial developmental effects caused by the exposure of animal subjects to cannabinoids CBD and THC were very similar to what is seen in fetal alcohol syndrome in humans(1).
- Results of the said study also showed that when alcohol was administered together with either CBD or THC, the congenital disabilities doubled.
- Unfortunately, defects caused by fetal alcohol syndrome are not reversible. If a child is suspected of having fetal alcohol syndrome, talk to a doctor immediately.
- Given the lack of information on the use of marijuana, its cannabinoids, and CBD oil during pregnancy, experts advise pregnant women to refrain from using CBD and any cannabis products during pregnancy.
CBD and FAS
A 2019 study, published in Scientific Reports, tested whether cannabinoids intensify alcohol-induced congenital disabilities(2). The study was the first research to show such a connection in mammals.
Results showed how a single exposure to cannabinoids during early pregnancy could cause growth problems in a developing embryo.
The investigation was performed in mice, which are very accurate models for the development that occurs during early pregnancy, according to Scott Parnell, Ph.D., the study’s senior author and assistant professor of cell biology and physiology in the UNC School of Medicine.
In the study, cannabinoids and cannabinoids with alcohol were given in varying amounts on day eight of the animals’ pregnancy, which is equivalent to the third and fourth weeks of human pregnancy.
This period is when alcohol and cannabinoid exposure is most damaging to a growing embryo, and the time when some women do not realize they are pregnant.
The CBD amounts administered to the mice were equivalent to the accepted therapeutic range for humans. Meanwhile, the THC concentration given was comparable to levels reached by a person smoking marijuana.
In the study, researchers found that the brain and facial developmental effects caused by exposure to cannabinoids CBD and THC were very similar to what is seen in fetal alcohol syndrome.
Parnell and his team of researchers also found that when cannabinoids and alcohol interact, the probability of these congenital disabilities more than doubled.
Parnell says that CBD and THC may be causing defects due to the interactions at the cellular level that disrupt the signaling between cells and molecules that regulate growth and development.
According to Parnell, there is a lack of information on the use of marijuana, its cannabinoids, and products like CBD oil during pregnancy in humans. He also reiterated that there is no safe period to consume alcohol during pregnancy, and the research shows the same is true of marijuana use.
—Eric Fish, Ph.D., author of the study and research associate in the UNC School of Medicine Bowles Center for Alcohol Studies
The Dangers of Using Cannabis During Pregnancy
CBD oil is extracted mainly from hemp plants and is neither psychoactive nor addictive. It has been gaining popularity among people who are searching for a natural remedy for ailments such as stress and pain.
Pregnant women who experience discomforts brought about by their pregnancy, such as pain, nausea, and vomiting, might be inclined to use CBD.
A 2012 study published in the Journal of Experimental Medicine suggests that using CBD can reduce pain and inflammation(3).
The researchers also found that subjects were not likely to develop a tolerance to the effects of CBD, eliminating the need to increase their dose continually.
In the British Journal of Pharmacology, a 2011 study shows how CBD may alleviate nausea and vomiting produced by chemotherapy(4).
However, given the lack of longitudinal research on human subjects on the use of CBD oil during pregnancy, women are advised against using it under any circumstances.
Doctors are also wary about recommending it because of its close association with marijuana and the lack of research on it alone.
The American College of Obstetricians and Gynecologists (ACOG), in its 2017 Committee Opinion, states that “Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of alternative therapy for which there are better pregnancy-specific safety data(5).”
The American Academy of Pediatrics (AAP) has also warned pregnant women against using any marijuana byproducts, citing the effects of marijuana on fetal development and later neurodevelopmental and behavioral outcomes(6).
“I am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.”
— Surgeon General VADM Jerome Adams
The U.S. Food and Drug Administration (FDA), in its Consumer Updates, also strongly advises against the use of CBD, THC, and marijuana in any form when pregnant or while breastfeeding(7).
According to the Centers for Disease Control and Prevention (CDC), smoking or vaping marijuana when pregnant may also be damaging to the fetus(8). When expectant mothers smoke or consume marijuana, chemicals go through the placenta and reach the fetus.
Meanwhile, a 2011 study published by the National Institutes of Health demonstrated the long-term behavioral consequences of maternal exposure to cannabinoids during pregnancy and lactation(9).
Although the aforementioned study was conducted on animal subjects, and it did not specifically examine the impact of CBD when used alone, the researchers say that their findings are in line with clinical studies reporting hyperactivity and cognitive impairments in humans exposed in utero to cannabis.
What is FAS?
FAS or fetal alcohol syndrome is a congenital medical condition in a child that is a consequence of alcohol exposure during the mother’s pregnancy.
While symptoms of FAS differ from child to child, the condition may also lead to brain damage and growth problems. Unfortunately, the defects caused by fetal alcohol syndrome are not reversible.
According to a 2019 review published by the National Center for Biotechnology Information, alcohol is extremely teratogenic (causes developmental malformations) to a fetus, and its effects are irreversible(10).
The authors said that there is no safe time during pregnancy in which any amount of alcohol can be consumed without risk to the fetus, and they also listed several other FAS risk factors:
- Poor nutrition during pregnancy
- Women above 30 years old with a long history of alcohol are more likely to give birth to an infant with FAS
- Having a child with FAS increases the risk for subsequent children
- Women whose genetic susceptibility allows them to metabolize alcohol slowly may be at a higher risk
If a child is suspected of having fetal alcohol syndrome, talk to a doctor immediately. Early diagnosis of the disorder may help to reduce issues, such as learning difficulties and behavioral problems.
Symptoms of FAS
Signs and symptoms of FAS may include any combination of physical defects, cognitive disabilities, and inability to function and cope with daily life.
Physical defects may include:
- Slow physical growth before and after birth
- Small head circumference and brain size
- Vision difficulties or hearing problems
- Deformities of joints, limbs, and fingers
- Distinguishing facial features, such as small eyes, an abnormally thin upper lip, an upturned nose, and unusually smooth skin between the nose and upper lip
Issues with the brain and central nervous system may include:
- Poor judgment skills
- Poor attention and processing information
- Difficulty remembering things or situations
- Difficulty with reasoning and problem-solving
- Jitteriness or hyperactivity
- Trouble adapting to change
- Difficulty planning or working toward a goal
- Problems with behavior and impulse control
- Trouble getting along with others
- Rapid change of mood
Alcohol and Pregnancy
Like Parnell, the Centers for Disease Control and Prevention (CDC) and the U.S. Surgeon General also believe that alcohol is not safe during pregnancy.
According to these agencies, “There is no known safe amount of alcohol to drink while pregnant. There is also no known safe time during pregnancy or safe type of alcohol.”
In most babies exposed to alcohol in utero, congenital abnormalities do show up as physical abnormalities. Instead, these children exhibit subtle behavioral and learning problems that are often undiagnosed or misdiagnosed as Autism or Attention Deficit Disorder (ADD) rather than one of the Fetal Alcohol Spectrum Disorders.
In a study, which was published by Brain Sciences Journal in 2015, the author examined the potential role of endocannabinoids signaling in fetal alcohol spectrum disorder(11).
The author also found that outcomes of maternal alcohol use during pregnancy on the behavior of children depend on the amount and frequency of alcohol consumption as well as the timing of exposure.
—Dr. Kenneth Jones – Co-discoverer ‘Fetal Alcohol Syndrome’ in 1973
Results from a review published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 2003, indicated that prenatal alcohol exposure is linked to a characteristic pattern of intellectual disability, particularly in arithmetic and some aspects of attention, such as planning, mental flexibility, and response to feedback(12).
According to the researchers, as children exposed to alcohol grow old, deficits in socio-emotional functions become more apparent, particularly in the areas of judgment and interpersonal skills.
These deficits are severe and have been documented most extensively in children with FAS. However, children prenatally exposed to reduced levels of alcohol often exhibit the same problems.
The National Organization on Fetal Alcohol Syndrome (NOFAS) says that over four decades of published research has shown alcohol to be toxic to a developing baby, as it can cause brain damage and congenital malformations.
Based on NOFAS Fact Sheets, an estimated 40,000 newborns each year are affected by FAS or have FASD.
The American Academy of Pediatrics (AAP) is against drinking during pregnancy, saying that, “Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity, or sudden infant death syndrome.”
Given that FAS causes unrectifiable problems, pregnant women are strongly advised against alcohol consumption.
Medical experts also give similar warnings to pregnant women who may be contemplating using CBD to relieve pregnancy discomforts.
Using CBD and any cannabis products during pregnancy is not recommended due to the given the lack of information on the use of marijuana, its cannabinoids, and CBD oil during pregnancy.
Fish, E.W., Murdaugh, L.B., Zhang, C. et al. Cannabinoids Exacerbate Alcohol Teratogenesis by a CB1-Hedgehog Interaction. Sci Rep 9, 16057 (2019). https://doi.org/10.1038/s41598-019-52336-w.
Xiong W, Cui T, Cheng K, et al. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. J Exp Med. 2012;209(6):1121–1134. doi:10.1084/jem.20120242.
Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011;163(7):1411–1422. doi:10.1111/j.1476-5381.2010.01176.x.
ACOG Committee Opinion Number 722. October 2017. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation?IsMobileSet=false.
Sheryl A. Ryan, Seth D. Ammerman, Mary E. O’Connor. Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcome. Pediatrics September 2018, 142 (3) e20181889; DOI: https://doi.org/10.1542/peds.2018-1889.
What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding. FDA Consumer Updates. Current as of Oct 2019.
National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention. 2018. Marijuana Fact Sheet: What You Need to Know About Marijuana Use and Pregnancy. https://www.cdc.gov/marijuana/factsheets/pregnancy.htm#9.
Campolongo P, Trezza V, Ratano P, Palmery M, Cuomo V. Developmental consequences of perinatal cannabis exposure: behavioral and neuroendocrine effects in adult rodents. Psychopharmacology (Berl). 2011 Mar;214(1):5-15. doi: 10.1007/s00213-010-1892-x. Epub 2010 Jun 17.
Vorgias D, Bernstein B. Fetal Alcohol Syndrome. [Updated 2019 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448178/.
Basavarajappa BS. Fetal Alcohol Spectrum Disorder: Potential Role of Endocannabinoids Signaling. Brain Sci. 2015;5(4):456–493. Published 2015 Oct 29. doi:10.3390/brainsci5040456.
Joseph L. Jacobson, Ph.D., and Sandra W. Jacobson, Ph.D. Effects of Prenatal Alcohol Exposure on Child Development. June 2003. https://pubs.niaaa.nih.gov/publications/arh26-4/282-286.htm.
Alcohol Use During Pregnancy
During pregnancy, anything a woman drinks can affect her baby. Alcohol is no exception. Having too much alcohol during pregnancy can lead to irreversible problems in a baby.
Drinking During Pregnancy
Several things happen to an unborn baby when a woman drinks during pregnancy. First, alcohol enters the bloodstream and crosses the placenta to reach the developing baby. This means that the baby is going to have a higher blood alcohol content than an adult because babies metabolize alcohol slower than adults. This prevents the baby from getting enough oxygen and optimal nutrition, leading to the tissues and organs not developing.
Is It Safe?
The American Pregnancy Association says that no amount of alcohol is safe during pregnancy. This is because alcohol enters the baby’s bloodstream in the same concentrations as in the mother’s bloodstream. However, it takes babies twice as long to eliminate the alcohol from their bloodstreams than their mothers.
One of the main concerns of drinking alcohol during pregnancy is that it can lead to fetal alcohol syndrome in the child. Because no research has determined a specific amount of alcohol that causes fetal alcohol syndrome, pregnant women should avoid all alcohol.
Fetal Alcohol Syndrome
Fetal alcohol syndrome causes both brain damage and growth problems in babies whose mothers drink alcohol during pregnancy. Fetal alcohol syndrome can cause many problems, including physical defects, brain and central nervous system problems, and social and behavioral issues. The CDC estimates that fetal alcohol syndrome is present in two to seven births out of 1,000.
However, some assessments indicate that 2 to 5 percent of school-age children show symptoms of fetal alcohol spectrum disorders. Fetal alcohol spectrum disorders is an umbrella term that describes a range of disorders resulting from exposure to alcohol in the womb. Fetal alcohol syndrome is the most severe of these disorders.
Children with fetal alcohol syndrome can suffer from a range of physical problems, such as slow growth in the womb and after birth, kidney problems, vision or hearing problems, heart problems, and small head circumference and brain size. They may have deformed joints, limbs, or fingers.
Children with fetal alcohol syndrome also have several distinctive facial features. These include small eyes, a very thin upper lip, a smooth area between the nose and upper lip, and a small, upturned nose.
Children with fetal alcohol syndrome may also suffer from brain and central nervous system problems, such as poor coordination and balance, quickly changing moods, hyperactivity, and difficulty with memory. They may also have trouble identifying the consequences of their choices.
Finally, fetal alcohol syndrome can lead to social and behavioral issues as the child ages. In school, the child may have trouble getting along with others or making friends. He or she may be unable to adapt to change, and it may be difficult for him or her to switch from one task to another. While doing homework, the child may have problems focusing and keeping track of time.
While not present at birth, secondary disabilities can result from fetal alcohol syndrome. These include attention deficit hyperactivity disorder; mental health problems, such as depression or anxiety; alcohol or drug misuse; and problems staying employed or in school.
There are several ways to avoid fetal alcohol syndrome:
- Women can avoid alcohol when trying to get pregnant. A baby’s brain, heart, and blood vessels all begin to form in the first few weeks of pregnancy, before a woman may know she is pregnant.
- Women can avoid alcohol during pregnancy. Children whose mothers do not drink during pregnancy are not at risk for fetal alcohol syndrome.
- If they’re not using birth control, women can consider giving up alcohol during their childbearing years. Women who do not use a form of birth control are at risk for an unplanned pregnancy, and they may unknowingly be putting their baby at risk while drinking alcohol.
- Women can get help for an alcohol problem before getting pregnant. Women who have alcohol problems should not get pregnant without first breaking their addiction. Pregnancy can make it even harder to break an alcohol addiction, and in the meantime, an unborn baby can suffer.
While fetal alcohol syndrome cannot be reversed, the sooner it is caught, the more likely it is a doctor can help reduce the risk of long-term problems in the child.
When Alcohol Is Dangerous During Pregnancy
The first trimester is the most dangerous time to drink alcohol. This is because the facial features and important organs, such as the bones and central nervous system, are all at key stages of development. However, drinking alcohol in the second or third trimester can also be equally dangerous for a baby.
Even moderate amounts of alcohol can lead to a range of problems, such as miscarriage, low birth weight, early labor, stillbirth, or learning disabilities later in childhood. However, some research suggests light drinking during pregnancy is unlikely to harm an unborn baby.
How Much Alcohol Is Safe?
The study said that pregnant women who had up to four drinks per week had an 8 percent higher risk of having a small baby and a 10 percent higher risk of premature birth. By comparison, light to moderate smoking led to a 22 percent higher risk of premature birth.
Getting drunk can cause serious harm to an unborn baby, so if a woman does decide to drink during pregnancy, she should never get drunk. She should limit her intake to no more than one or two drinks per week.
Women who suspect they are addicted to alcohol should not become pregnant, and if they are already pregnant, they should get help immediately. Whether a woman is pregnant, there are resources to help break alcohol addiction, including the Addiction Hotline at 1-888-299-5213 and www.aa.org.
There is not enough research to determine if any amount of alcohol is safe during pregnancy, which is why many doctors recommend staying away from it completely. However, pregnant women who decide to have a few drinks should consult their doctors and only drink in moderation for the best chances of delivering a healthy baby.