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“Of course it is safe to smoke pot in pregnancy, just take look at Jamaica”! This type of comment perpetuates an “herban legend,” circulating specifically among those in the “it’s safe” camp. The reference to Jamaica is to the commonly quoted work of anthropologist Melanie Dreher PhD RN, who in 1989 conducted a small, qualitative, ethnographic study in Jamaica. She described a small community of Rastafarian women in a community that “highly esteems Cannabis as a sacred herb”. Earlier anthropological studies had described Jamaican women as rarely smoking ganja, but more commonly drinking Cannabis tea.
Dreher compared infants of women who continued smoking during pregnancy to those whose mothers discontinued use from birth to three months of life. In her small sample, only eleven women (36%) continued to smoke during pregnancy while eight of these eleven (72%) shifted to ganja tea only (Tea typically only has a small amount of THC, but is rich in THCA which is not known to bind to the cannabinoid 1 receptor [CB1]). Her study was different from everything else that had been published on the topic of Cannabis use in pregnancy at that time.
Most of the published literature on cannabis and pregnancy has primarily been viewed through the lenses of addiction and teratogenicity (causing birth defects). So, it is refreshing that she took a look through an anthropological lens of a Cannabis use phenomenon within a cultural context. Her primary aim was to look at practices and beliefs, and not clinical outcomes.
She did, however, follow up with a few babies who had prenatal Cannabis exposure. She used the Brazelton Scale to assess babies on the first and third days of life and again at three months (n =24 exposed infants ; n=20 non-exposed). The Brazelton Scale is a way to measure newborn behaviors that give clues about adaptive responses and vulnerability. She did not measure statistically significant differences between the two groups at birth, but at three months of age she found that a small number of the exposed infants appeared to be “less irritable” and “more socially responsive”. She concludes that this small sample size and “confounders” such as “environmental and maternal factors” likely had an effect on the outcomes she measured, so the results may not be significant.
While this has been a widely quoted study that has had importance for generating new hypotheses and exploring sociologic implications, there are several limitations. These limitations include bias in recruitment, the very small sample size, and confounding maternal and environmental factors. For Rastafarian women, it is an expectation of their religion to smoke ganja, and there is social value in sharing the practice. However they were “well aware” that ganja could be harmful to their babies. Even within the context of their economic and social factors, according to Dreher Cannabis use in pregnancy compels a risk/benefit analysis.
Since the time of these studies, defining the endocannabinoid system (eCS) has had reverberations through the science community. This discovery has fueled increase in both basic science and clinical research. Contemporary research has built on the sociological/anthropological approach of Dreher. Of particular value, the importance of the role of the eCS in developmental neurobiology has been well described.
It appears that when neurons are making their way out into the layers of the developing brain, that the cannabinoid 1 receptor (CB1) follows the signal of endocannabinoids to places of connection. If you can imagine throwing THC into the milieu, what is theorized is that THC may interfere with this natural signaling pathway by binding the receptor and potentially altering the course of neuronal migration.
This THC binding at CB1 receptor is conceptualized to intervene in the processes of making new neurons, and the ability of the nerve cell to make appropriate connections. Those specific embryonic connections, and those continually being made throughout brain development (into our third decade of life) define how the cortex gets organized. So while Dreher did not see anything notable within the first three months of life, there is now thinking that the effects of exposure may not show up until later in life and in a variety of ways.
Researchers in the field of neurobiology are now thinking about developmental effects of prenatal Cannabis exposure in the longer-term. Other behavioral effects have been observed in studies that followed children much later in life than Dreher did. The kinds of behaviors or developmental effects observed include: memory alterations, depression, changes in cognitive functioning, impulsivity behaviors, hyperactivity, attention deficit and potential for Tourette’s syndrome or chronic tic disorder.
Some of these observations have come from the Ottawa Prenatal Prospective Study (OPPS), conducted by Peter A. Fried in Ottawa, Canada. This work has followed exposed children of predominantly white, middle-class children into adolescence. He has looked at processes involved in Executive Function (EF) that include flexibility in problem solving, focused attention, working memory and other functions. These brain functions are primarily designated to the “pre-frontal cortex,” an area of the brain which is broadly involved in control of emotion, mood, stress function and impulsive actions.
Dr. Fried started seeing differences between exposed children and those who were unexposed (controls) at around 3-4 years of age, where he observed no differences in overall intelligence, rather in specific aspects of cognitive function relating to abstract/visual reasoning abilities. At 9-12 years of age he was still seeing these effects of prenatal Cannabis exposure on EF. His conclusion is that the effects of prenatal Cannabis exposure on offspring are “subtle”, that this type of research is still “quasi-experimental” and that there are too few studies upon which to make conclusive determinations. There continues to be a need for more of these types of studies.
As with the Dreher study, it is important to keep in mind the “mixing of effects,” often referred to in research as “confounding” factors. Confounders are an element to keep in mind in all research, whether as a researcher or just an interested reader of abstracts. Confounding elements can include: diet and lifestyle factors, nutrition, socioeconomic conditions, education, child:adult ratios in the home, other environmental exposures, genetics, biochemical factors and other drug exposure. It is difficult to control for all of these factors when trying to interpret any clinical data.
So where we are now, after the science base has expanded, is that we have even more compelling reasons for a conscious risk/benefit analysis of Cannabis use in pregnancy, as Dreher suggested. Cannabis use for relieving morning sickness and pain in labor has been historically documented. Based on the best available “evidence” (which usually excludes anecdotal reports) it is difficult to pinpoint a strong specific reason to support that Cannabis use in pregnancy is completely safe for the developing brain of a baby. There is also inadequate evidence to say that complete abstinence is the only safe approach.
Consideration needs to be given to the fact that Cannabis is much more potent now than it was even one decade ago, so dose may play a role in the tentative and putative effects. When human suffering could potentially be alleviated (such as horrible suffering of hyperemesis gravidarum) perhaps benefit from short-term use, or use of preparations with a high CBD:THC ratio, or from the more “raw” form of Cannabis (such as tea) could outweigh the risks?
Keep in mind that what Dreher first found was Rastafarian women using ganja tea in the context of community. In a tea preparation, about 9/10ths of the THCA remains in the acid form, rendering a much smaller “dose” of the neutral THC compound that so potently binds to the CB1 receptor. Beyond such use, it seems smart to take an informed approach toward Cannabis or anything we might expose our yet-to-be-born to, including: endocrine disruptors (plastics), other environmental toxins including heavy metals, pesticides and flame retardants, prescription drugs, over-the-counter drugs like acetaminophen, alcohol, and very importantly, maternal stress.
In short, conscious approaches to the health of our children and ourselves begins long before the prenatal period! So hug a sista today and encourage her to take immaculate care of herself (neurons included) with healthy organic foods, elimination of chemicals in the home, in cosmetics and body care items, to get quality sleep and also to care for one another by reinforcing social connections with intimacy, play, art and love!
Photo Credit: GerryShaw under (CC BY-SA 3.0) via Wikimedia Commons