Can CBD help with pregnancy, and is it safe to use when pregnant?
- Based on research, high doses of CBD in pregnant test animals have caused problems with the reproductive system of developing male fetuses.
- However, to date, there has been no comprehensive study on humans investigating the effects of CBD alone on the developing fetus, expectant mother, or breastfed baby.
- Still, the FDA warns that CBD has the potential to harm people even before they become aware of it.
- Experts advise expectant mothers and those who are contemplating pregnancy or breastfeeding to do more research and consult with a medical professional before commencing on a CBD regimen.
Why Some Pregnant Women May Be Thinking of Taking CBD During Pregnancy
Expectant mothers are looking to relieve common symptoms of pregnancy, such as morning sickness, cramping, headaches, nausea, vomiting, dizziness, cramping, and fatigue, and CBD is currently being marketed as a natural cure for most of these symptoms.
Those who seek a natural alternative to other pain medications may be inclined to turn to CBD, as anecdotal evidence shows that CBD may be used to help relieve and manage chronic pain in many cases.
However, a study was conducted on pregnant test animals, and the results showed that maternal exposure to high concentrations of cannabinoids impacted the production and development of sperm cells. The effect on fertility in the animal models’ male offspring was linked to problems with the reproductive system of developing male fetuses.
More research is still needed, especially in long-term studies with human subjects. To date, there has been no comprehensive research investigating the effects of CBD alone on the developing fetus, expectant mother, or breastfed baby.
The FDA continues to gather and study the data on the potential hazards of CBD on both mother and baby during pregnancy and breastfeeding.
The Dangers of Using CBD Oil When Pregnant
Furthermore, there have been no studies conducted on CBD’s effects when used by pregnant women. Consequently, the FDA warns that CBD has the potential to harm people, and that harm can happen even before they become aware of it.
Not all CBD products are created equal. Even product labels may not be a reliable indication of a product’s actual CBD content or potency.
Many CBD products tested by the FDA were found to contain trace amounts of THC and contaminants like toxic heavy metals, pesticides, bacteria, and fungus.
Thus, experts warn all pregnant, as well as breastfeeding mothers, to avoid CBD products altogether to keep themselves and their babies free from any potential danger.
Some people often use the terms cannabis and marijuana interchangeably, although the two terms do not mean the same thing.
Cannabis is the broad term for all products derived from the Cannabis sativa plant. A cannabis plant contains over 100 components, called cannabinoids.
Cannabinoids that come from plants are specifically called phytocannabinoids. Endocannabinoids, another group of cannabinoids, also exist in the body. Cannabis impacts the body’s endocannabinoid system (ECS) and helps to create balance for optimal bodily functions.
Technically speaking, the family genus cannabis is where both marijuana plants and hemp plants belong. Both of these plants contain varying amounts of cannabidiol (CBD) and tetrahydrocannabinol (THC).
Marijuana is a cannabis plant that contains substantial amounts of THC, the cannabinoid that is primarily responsible for inducing a euphoric and intoxicating effect on the user.
Farmers do not use the fibers and stalks of marijuana commercially. Instead, they cultivate marijuana plants specifically for the flowers, which, among all the parts, contain the highest levels of THC.
Medical marijuana is the term used to describe the whole, unprocessed marijuana plant or its essential extracts to help treat symptoms of illnesses and disorders.
However, to date, the U.S. Food and Drug Administration (FDA) has not approved or recognized the marijuana plant as medicine.
Cannabis plants that contain less than 0.3% THC in dry weight are legally considered as hemp. The seeds and stalks of hemp plants are used to create a wide range of products, including food, medicine, nutritional supplements, plastic composites, paper, textiles, and building materials.
Hemp naturally contains a substantial amount of CBD, and the level of THC in hemp is 33 times less than that of the least potent marijuana strains. Hence, oil extracted from hemp is non-intoxicating, making it generally safe for use.
— Catherine Monk, Ph.D., Professor of Medical Psychology, Departments of Obstetrics and Gynecology, and Psychiatry at Columbia University Irving Medical Center in New York
Side Effects of CBD Use
In recent years, cannabis and cannabis-derived products have become increasingly accessible in the market. People looking to use these products as a natural alternative to pharmaceutical prescriptions have contributed to CBD’s widespread use in the form of edibles, beverages, supplements, and cosmetics.
While new and different types of products continue to emerge, these products also raise questions and concerns for many consumers. Understandably, pregnant women have more concerns as the products may not only pose risks to themselves but to their unborn babies as well.
Generally, CBD’s side effects include the following:
- Somnolence, characterized by sleepiness or drowsiness, impacts an individual’s alertness.
- Gastrointestinal distress, which may manifest as a decrease in appetite or diarrhea, is another typical effect of CBD use.
- Mood changes, which may come in the form of agitation and irritability, may also be experienced by some CBD users.
Although these side effects should improve once CBD use is terminated or its doses substantially reduced, keeping one’s self well-informed is crucial to ensure the safety of all concerned.
There are more severe side effects of high doses and prolonged use of CBD, and they include the following:
- CBD may cause liver injury. A study conducted on mice concluded that CBD manifested visible signs of hepatotoxicity, possibly from a reduction or prevention of bile flow. Research suggests that anyone taking CBD regularly and in high doses may be prone to developing liver disease.
- CBD impacts the metabolism of other drugs and causes grave side effects. CBD can reduce or increase the effects of certain prescribed pharmaceuticals by interacting with cannabinoid receptors throughout the endocannabinoid system within the body and by inhibiting the activity of cytochrome P450 enzymes.
A study shows how CBD can temporarily deactivate the activity of cytochrome P450, which can affect how the body breaks down other compounds.
- Both research and anecdotal evidence indicate that CBD use may cause nausea, drowsiness, diarrhea, reduced appetite, and dry mouth. Though it is often well-tolerated, these side effects may cause discomfort and pain.
The FDA’s Position on CBD
The use of CBD-infused products are widespread nowadays, and manufacturers are becoming increasingly creative as they offer CBD many forms and flavors that consumers would find appealing.
The 2018 Farm Bill legalized hemp, but the legal status of hemp-derived cannabidiol remains confusing.
While CBD can be derived from hemp or cannabis, it is technically a marijuana plant if the hemp plant contains over 0.3 percent THC.
Thus, in 2016, the FDA released a document that reiterates the agency’s position on the regulation of CBD-infused products.
- The FDA has seen only limited data about CBD safety. These data, while inconclusive in scope, point to factual risks that need to be considered before using CBD.
- Some unscrupulous CBD product manufacturers market their goods with unproven medical claims to target buyers from different demographic groups.
The quality, potency, and purity of their products become questionable, primarily when they do not employ third-party lab testing to benefit the consumers.
- In June this year, the FDA has released a statement that it is currently prohibited under federal law to add CBD to food products or label CBD as a dietary supplement.
- The FDA has approved only one CBD product, Epidiolex, which is a prescription drug product to treat Lennox-Gastaut syndrome and Dravet syndrome. These two rare and severe conditions usually manifest in early childhood or infancy.
- The FDA recognizes that the drug approval process remains to be the best way to ensure that new medicines, including cannabis-derived drugs, are safe and effective to use by patients in need of proper medical therapy.
More Research Needed
The FDA is dedicated to supporting the discovery and development of new drugs, including cannabis and cannabis-derived drugs. The agency is presently working to gather more information about the safety of CBD and its byproducts, including conducting investigations that would address essential topics, such as:
- Cumulative Exposure to CBD: How much CBD is ingested, and how much is absorbed through the skin if people utilize it through a wide variety of consumer products?
For instance, what would be the effect of consuming CBD edibles, such as CBD gummies and CBD-infused beverages, in conjunction with the application of CBD-rich cosmetic products on the same day for an extended period?
- Specific Populations: The effects of CBD on other particular groups of people, such as children, adolescents, the elderly, expectant moms, and breastfeeding mothers.
- CBD and Animals: Is CBD safe to use in pets and other animals? Other factors should also be considered, including the animal’s species, breed, or class, as well as the safety of the human food products manufactured, like meat, milk, cheese, or eggs from food-producing species that use CBD.
There is no comprehensive research studying the effects of CBD on the developing fetus, pregnant mothers, or breastfed babies.
Dishonest, misleading, unverified, or false claims associated with CBD products may lead consumers to delay getting critical medical care, such as proper diagnosis, treatment, and supportive care. Thus, women who are pregnant or contemplating pregnancy must consult with their doctor.
Medical professionals, such as obstetrics and gynecology doctors, can advise on the most effective remedy to alleviate typical pregnancy symptoms or treat other issues during pregnancy using available treatment options approved by the FDA.
The FDA pledges to continue to update the public as it learns more about CBD through its investigatory new drug process.
The FDA’s top priority is to defend and promote public health. This priority includes making sure that consumers are kept well-informed about products that may put their health and safety at the highest risk.
Effects of Marijuana on Pregnancy
Marijuana contains varying levels of THC and CBD. Unlike THC, its psychoactive counterpart, CBD is a non-intoxicating cannabis compound. CBD is also not addictive and is believed to be relatively safe to use for an extended period.
However, CBD’s long-term effects are largely unknown, and most CBD products are untested.
Meanwhile, marijuana has changed over time, as the marijuana available in certain products today is much stronger than in the previous formulations.
A study showed that between 1995 and 2014, the THC concentration in cultivated marijuana plants had surged three-fold. In another survey conducted among marijuana users in Washington, researchers found that marijuana available in dispensaries in some states has concentrations of THC between 17.7% and 23.2%.
Similarly, marijuana use by expectant mothers is on the rise, and the results of studies are alarming.
A survey was conducted on pregnant women in the United States. Recent data on self-reported medical and non-medical cannabis use among the subjects were compared with that of the period between 2002 and 2017. Results showed that marijuana use among pregnant women doubled.
Meanwhile, in a study done to analyze the trends in marijuana use by females in California, researchers found that there was a 69% surge in marijuana use among pregnant women between 2009 and 2016.
In another study, researchers found that many retail dispensaries recommend marijuana to pregnant women for morning sickness.
More research is necessary to comprehend better how marijuana may affect an expectant mother and her baby during pregnancy. Still, experts recommend that pregnant women do not use marijuana.
— Surgeon General VADM Jerome Adams
How Marijuana Impacts the Developing Fetus
When a pregnant woman consumes or smokes marijuana, cannabinoids enter the blood.
In a study done on rhesus monkeys, results demonstrated that through the bloodstream, THC rapidly crosses the placenta and enters the fetal brain.
- Research suggests that marijuana may interfere with the body’s endocannabinoid system, which is essential for a healthy pregnancy and fetal brain development.
Marijuana may also interrupt the delicate equilibrium of the ECS in the female reproductive system.
- Studies have shown that in utero marijuana exposure is associated with unfavorable results, including lower than average newborn birth weights.
- In a study published by the National Center for Biotechnology Information, scientists conducted a systematic review of the relationship between cannabis exposure and stillbirth or spontaneous abortion, and they found no association.
However, it should be noted that there was limited evidence, so one should treat the findings with caution.
- Research in 2016 suggests that the association between maternal marijuana use and adverse neonatal outcomes appears to be a result of concomitant tobacco use, among other confounding factors.
- In 2018, a study was conducted to evaluate the relationship between prenatal cannabis use and adverse neonatal outcomes, such as small infant size for gestational age, low birth weight, preterm birth.
It was reported that maternal marijuana use was linked to a 50% increased risk of low birth weight regardless of the mother’s age, ethnicity, education, and tobacco use.
— The American College of Obstetricians and Gynecologists (ACOG)
As a safety measure, the American College of Obstetricians and Gynecologists (ACOG) cautions pregnant women or those contemplating pregnancy not to start or discontinue marijuana use.
The American Academy of Pediatrics (AAP) recommended in 2018 that it is imperative to advise all adolescents and young women that marijuana should not be used anytime during pregnancy.
Also, a pregnant woman who uses marijuana may unknowingly put the baby’s health at risk after birth. Small quantities of THC have been found in breast milk even after six days from the last recorded use.
Breastmilk that is tainted with THC may impact the newborn baby’s brain development. A study revealed that THC might cause problems with neurological development, which may lead to reduced or impaired poor cognitive function and hyperactivity.
Since marijuana smoke contains many of the same harmful components as tobacco smoke, researchers of a study strongly discourage smoking or vaping of marijuana or tobacco around a baby.
Pregnant women must understand the risks involved in using CBD-infused products or other cannabis products. It is not only the mother’s health that is in danger when complications arise from the use of products that have not been proven safe for use during pregnancy.
Pregnant women should be wary of the potential harm that the exposure or ingestion of CBD products may have on themselves and their unborn babies. It is wise for expectant mothers to consult with their doctors before they start a CBD regimen during their pregnancy.
Treating Diseases During Pregnancy
Treating the Common Cold During Pregnancy
Symptoms such as cough, nasal stuffiness, discharge, sneezing, and sore throat can be due to a mild upper respiratory illness also known as the common cold. It is caused by numerous viruses and is usually a self-limiting illness. However, sometimes the infection spreads to other nearby organs, leading to a serious bacterial infection. Because of immunologic changes during pregnancy, pregnant women are susceptible to many infections. Although there are many over-the-counter (OTC) medications that help to relieve symptoms of the common cold, there are only a few medicinal ingredients in these products.
Analgesics commonly found in OTC cold medications are acetaminophen, ibuprofen, and acetylsalicylic acid (ASA). The safety of acetaminophen in pregnancy is well documented.
Acetylsalicylic acid use has been associated with delivery complications and adverse effects in newborns; therefore, use in analgesic doses is not recommended in late pregnancy. Low doses of ASA (40 to 150 mg) have not been associated with concerns at any stage of pregnancy. However, the use of NSAIDs, other than low-dose ASA, in the third trimester is associated with premature closure of the ductus arteriosus and should be avoided if possible.
Dextromethorphan (DM) is a cough suppressant commonly found in OTC cold medications. There are a number of human studies on the use of DM during pregnancy that did not find an association between this drug and an increased risk of birth defects. The Collaborative Perinatal Project, for example, followed 300 mother-child pairs who took DM during the first trimester and 580 mother-child pairs with exposure anytime during pregnancy.
Pseudoephedrine and phenylephrine are the most common oral decongestants in OTC cold medications. In some studies, decongestant use in the first trimester has been associated with a small increase of defects thought to arise, in some instances, from vascular disruption, such as gastroschisis, small intestinal atresia, and hemifacial microsomia.
Xylometazoline and oxymetazoline are inhaled decongestants, which are also available OTC. Oxymetazoline was evaluated in human pregnancies, and a single dose given to each of 12 pregnant women did not alter maternal or fetal circulation. It is important to note that although OTC inhaled decongestants are considered relatively safe for use during pregnancy, women should be cautioned regarding rebound effects from overuse of these products.
Diphenhydramine and chlorpheniramine are the most commonly used antihistamines in cold preparations. These first-generation antihistamines are associated with drowsiness but have not been found to increase the risk of malformations above baseline.
Guaifenesin is an expectorant also found in many cold medications. There have been several studies involving hundreds of pregnant women that did not report increased risk of major malformations.
Treating Constipation During Pregnancy
Although the recommended first-line therapy for constipation includes increasing fiber, fluids, and exercise, these are sometimes ineffective. Therefore, laxatives such as bulk-forming agents, lubricant laxatives, stool softeners, osmotic laxatives, and stimulant laxatives might be considered. Although few of the various types of laxatives have been assessed for safety in pregnancy, they have minimal systemic absorption. Therefore, they are not expected to be associated with an increased risk of congenital anomalies. However, it is recommended that osmotic and stimulant laxatives be used only in the short term or occasionally to avoid dehydration or electrolyte imbalances in pregnant women.
Many patients find relief from constipation with an increase in dietary fiber and fluids, as well as daily exercise. Probiotics that alter the colonic flora might also improve bowel function.
Bulk-forming agents are not absorbed or associated with increased risk of malformations 7; therefore, they are considered safe for long-term use during pregnancy. However, they are not always effective and might be associated with unpleasant side effects such as gas, bloating, and cramping. 4
Docusate sodium has not been associated with adverse effects in pregnancy in a number of studies, and it is thus also considered safe to use. There is one case report of maternal chronic use of docusate sodium throughout pregnancy, which was associated with symptomatic hypomagnesemia in the neonate.
Mineral oil is poorly absorbed from the gastrointestinal tract and does not appear to be associated with adverse effects. There is controversy about whether prolonged use reduces the absorption of fat-soluble vitamins, although this appears to be a theoretical rather than actual risk.
Lactulose and polyethylene glycol are poorly absorbed systemically. Their use has not been associated with adverse effects; however, individuals might experience side effects such as flatulence and bloating. Theoretically, prolonged use of osmotic laxatives might lead to electrolyte imbalances.
Absorption of bisacodyl is minimal as it has poor bioavailability. Senna does not appear to be associated with increased risk of malformations and is not readily absorbed systemically. However, women might experience unpleasant side effects such as abdominal cramps with the use of stimulant laxatives. Similar to osmotic laxatives, prolonged use might theoretically lead to electrolyte imbalances.
The first line of therapy for constipation includes increasing dietary fiber and water intake and moderate amounts of daily exercise. 3 If these are ineffective, laxatives are the second line of therapy. Because most laxatives are not absorbed systemically, short-term use has not been, and is not expected to be, associated with an increased risk of malformations. However, as with the general population, it is recommended that osmotic and stimulant laxatives be used only in the short term or occasionally to avoid dehydration or electrolyte imbalances and the theoretical risk of “cathartic colon.”
HIV Treatment in Pregnancy
How do people get HIV?
HIV is found in blood, semen (the fluid containing sperm), vaginal fluid, and breast milk. A person can become infected in one or more of the following ways:
- Sex (vaginal, anal, or oral) with a person who is infected with HIV.
- Sharing needles contaminated with HIV-infected blood.
- Receiving a transfusion of infected blood (extremely uncommon since 1985).
- Perinatal transmission that involves a baby becoming infected while in the mother’s womb or during birth, if the mother has HIV.
- Mothers can pass HIV to their babies through breastmilk.
Can HIV be prevented?
Since we know the ways that HIV is spread, we know how to keep people from getting infected. Contact with blood, semen or vaginal fluids should be AVOIDED and mothers with HIV should not breast feed their infants. Gloves should be warned when contact with blood is likely to occur. In the event of an accidental exposure to blood, immediate washing of the area with soap and water usually provides adequate protection unless the blood is able to enter the skin through an open wound.
I am/my female partner is HIV positive. Is pregnancy harmful to the health of women with HIV infection?
Studies indicate that pregnancy does not harm the health of women with HIV infection or increase the chance of women developing HIV related illnesses.
I am HIV positive and pregnant. Will my baby be infected as well?
Most babies born to HIV-positive mothers will not get HIV. But some will. A baby can get HIV from its mother during pregnancy (before birth), during delivery (the most common way babies get infected), and through breast feeding.
There is approximately a one-in-four chance of mother-to-child transmission of HIV infection without any treatment. But treatments and interventions exist that have been shown to significantly reduce the risk of infection to babies. If you would like to learn more about mother-to-baby HIV infection, register with MEDSCAPE and use their search engine to find articles on “Perinatal HIV.”
During pregnancy and delivery, you can take antiretrovial drugs to reduce the risk of transmission. If you take a combination of antiretrovial drugs during pregnancy and delivery, and your newborn receives one of these drugs, the chance of transmission drops to about 1%.
Other strategies that can help to reduce the risk of infection include a shortened delivery time, and in some circumstances, delivery by Cesarean section.
Drugs in Pregnancy
Pregnancy, whether planned or a pleasant surprise, brings with it important concerns about prescription and over the counter drugs. Not every medication poses a risk to your unborn baby. However, some do. Talk to your doctor. Discuss the relative risks and benefits of any prescribed drug therapy and do NOT take over-the-counter drugs or naturopathic remedies without first consulting your physician. If you are currently planning your pregnancy, supplement your diet now with appropriate amounts of folic acid.