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Marijuana: the Effects on Pregnancy, the Fetus, and the Newborn

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Marijuana: the Effects on Pregnancy, the Fetus, and the Newborn Journal of Perinatology https://doi.org/10.1038/s41372-020-0708-z REVIEW ARTICLE Marijuana: the effects on pregnancy, the fetus, and the newborn Gilbert I. Martin1,2 Received: 10 February 2020 / Revised: 18 May 2020 / Accepted: 28 May 2020 © The Author(s), under exclusive licence to Springer Nature America, Inc. 2020 Abstract There is growing evidence that there is an increased use of Marijuana (cannabis) during the perinatal period. This review summarizes pertinent legislation (past and present) and the physiology and pathophysiology of cannabis use during pregnancy. The literature which involves issues concerning cannabis and pregnancy is expanding but at present has many gaps and unanswered questions. The effects on the newborn are significant and treatment recommendations including breastfeeding are presented. Also included is a description of developmental delay during the first 2 years of life in infants exposed to prenatal marijuana. In addition, this commentary discusses the increase use of the newer “synthetic” cannabinoids which have greater psychotropic activity and can cause significant harm. 1234567890();,: 1234567890();,: Introduction United States Federal Bureau of Narcotics produced litera- ture saying that marijuana was an addicting substance Throughout the world the use of marijuana for both med- which led users to narcotics addiction. It was then portrayed icinal and recreational use has increased dramatically over as a “gateway drug”. The Marijuana Tax Act of 1937 placed the past decade and especially in the last few years. Along a tax on the sale of cannabis [1]. In the 1950s marijuana was with the opioid crisis, the use of many drugs has become known as an accessory to the “beat generation”. In the commonplace. It has been difficult to design randomized 1960s there was increase use by college students and hip- controlled investigations which investigate the effects of pies as its widespread acceptance became a symbol of marijuana on the developing fetus, newborn, infant, and rebellion against authority. In 1970, the Controlled Sub- child. However with the passage of legislation (state) we stance Act [2] repealed the Marijuana Tax Act and mar- will be able to in a relatively short period of time achieve a ijuana was listed as a Schedule I drug along with heroin, greater understanding of the effects of marijuana. Exposed LSD and ecstasy. In 1972 the National Commission on newborns can develop symptoms from Δ-9-tetra- Marijuana and Drug Abuse recommended “partial prohibi- hydrocannabinol (THC) exposure, but treatment of this tion” and “lower penalties” for possession of a small withdrawal is variable. The following material will expand amount of marijuana. our knowledge about the effects of marijuana on the fetus In 1996 the Compassionate Use Act in California (also and newborn. known as Proposition 215) was the first state to legalize marijuana for medicinal use for chronic illness [3]. The United States Supreme Court (2005) opined that the Federal Marijuana history and legislation government had the constitutional authority to prohibit marijuana for all purposes. The Court indicated that Con- Marijuana was part of a list of drugs in the United States gress and the Food and Drug Administration should resolve Pharmacopeia from 1850 to 1942. However, in 1930 the this issue. Complicating matters, many states have passed laws recognizing marijuana’s medicinal value. In 2012 California and Washington became the first states to lega- lize marijuana for recreational use. In 2014, the * Gilbert I. Martin Rohrabacher-Farr or Commerce Justice Science Amend- [email protected] ment was signed into law. This amendment does not just 1 Loma Linda’s Children’s Hospital, Loma Linda, CA, USA prevent Federal direct interference with state implementa- 2 NICU, Emanate Health Queen of the Valley Campus, 1115 South tion but it also ends Federal medical cannabis raids, arrests, Sunset Ave, West Covina, CA 91790, USA criminal prosecutions, and other Federal interference G. I. Martin regulations. It is clear that Federal agencies are grappling pattern that produces wide leaflets that express themselves with state conflicts. In 2016 guidelines and policies were in a light green hue. In general, the marijuana plant has produced to manage the conflict between Federal and State broad leaves, dense-type buds and a bushy appearance. Laws dealing with marijuana. As of 2019 there are five categories of state legalization descriptions. These categories are: legalized, medical and decriminalized, medical, decriminalized, and fully Illegal. Ten states have completely legalized the sale of marijuana for medical, recreational purposes. Recent polls in the United States have represented that the majority of Amer- icans now favor some form of marijuana legalization. With the increasing prevalence of cannabis use there is a decreasing perception of risk of harm from cannabis pro- Cannabis produces a variety of different compounds ducts [4]. The conflict is increased as the Federal govern- called “Cannabinoids”. These compounds include Δ 9- ment through the Controlled Substances Act does not tetrahydrocannabinol (THC) and Cannabidiol (CBD). THC recognize the difference between medical and recreational induces psychoactive effects. CBD is a phytocannabinoid, use of cannabis. and is made by extracting the material from the cannabis Further complicating matters is that marijuana produc- plant and then diluting it with a carrier oil like coconut or tion and its various types have created a new “cottage hemp seed oil. CBD contains a minimal concentration of industry”. New products have been produced which con- THC and therefore is not psychotropic. Recently synthetic centrates the THC and delivery systems such as vaping and marijuana had been produced which are man made and are eating the THC (dabbing) and allows a more immediate and chemically different then cannabis. The other name for longer lasting effects on the central nervous system. There these synthetic cannabinoids is “fake weed” because it are over 700 cannabis strains that have been recognized as imitates the effects of marijuana. The packaging and mar- new marijuana products. Growers are experimenting with keting of these products is enticing to the public. The cannabis cultivation. Varieties of names are chosen and can chemicals present in these synthetic marijuana imitations reflect different properties of the plant (taste, color, and are often unknown and variable. The effects on the brain of smell). Growers are also experimenting with hybrid vari- synthetic cannabinoids are much stronger than regular eties which can be cultivated to vary clinical effects. New cannabis and include paranoid delusions, anxiety, severe product names of these strains include, Acapulco Gold, agitation, hallucinations, and even total memory loss. The Bedrocan, Blue Dream, Charlotte’s Web, Green Crack, and most common names for these synthetic cannabinoids are Skunk to name a few. Fiscally, marijuana economics is K2, Spice, Spike, Mr. Happy, Scooby Snax, and Kush. It is potentially a billion dollar business. illegal to sell, possess, or distribute synthetic cannabinoids. Many states count on the revenue from taxes on mar- Possession of these products can in fact result in felony ijuana sales in determining fiscal budgets. charges. There are now issues regarding driving under the influ- ence of marijuana (drugged driving) and there are varied legal positions regarding this practice. Will criminal pro- secution for marijuana use during pregnancy deter women The endocannabinoid system from seeking prenatal care which can only have a deleter- ious effect on morbidity and mortality? The endocannabinoid system (EDS) is involved in reg- ulating and modulating movement, memory, thinking, coordination, appetite, thermoregulation, sleep, pain, plea- Cannabis classifications sure sensations, the immune system response, and sensory and time perception [5]. THC is a phytocannabinoid which Marijuana is defined as a variety of cannabis that contains is similar in structure to anandamide. Because of this more than 0.3% THC and produces psychotropic or similarity in chemical structure, THC attaches to the can- euphoric effects. There are several species of cannabis nabinoid receptors on the neurons, activates them, and the which are recognized. These include cannabis sativa,a final effects are those described above. This EDS is critical warm-weather species categorized by tall plants and thin to normal function. We know in children, adolescents and leaves; cannabis indica, a cold water species with short adults that THC may alter function of the hippocampus and dense plants and dark broad leaves; cannabis ruderalis is a orbitofrontal cortex which deals with memory and focus. short and stalky plant, with a rugged and shaggy growth The effects of THC on the hippocampus in the newborn is Marijuana: the effects on pregnancy, the fetus, and the newborn unknown and there have been no descriptions which newborn and as a neuroprotectant for neuronal loss [14]. describe that THC prevents newborns learning how to suck The CB1 receptor when stimulated by cannabinoids induces and swallow. However, the hippocampus does contain a a reduction in GABA (Gamma-aminobutyric acid) which is large amount of C1 receptors which are functionally sig- a prevalent inhibitory transmitter in the central nervous nificant in the newborn sucking reflex [6]. These issues system [15]. deserve further investigation. THC activates these protein-coupled receptors. CB1 Another
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