Women who are pregnant, planning a pregnancy or breastfeeding should be screened for cannabis use and strongly discouraged from it, the American College of Obstetricians and Gynecologists said in new clinical guidelines published on Friday.
Cannabis use during pregnancy has been rising for years. Many women rely on the drug to cope with nausea and other pregnancy symptoms.
But the college warned that mounting evidence linked cannabis to preterm births, low birth weights and a greater need for neonatal intensive care, as well as neurocognitive and behavioral problems in children.
“Patients are often using cannabis to help with some kind of medical ailment, not recreationally — in their mind, they think it’s a more natural way to deal with a medical problem,” said Dr. Melissa Russo, an author of the new guidance.
“But there are lots of natural things that are not safe,” Dr. Russo said. There are no studies demonstrating that cannabis is effective for pregnant or lactating women, she added, “and research now shows there are potential adverse effects.”
The college warned against blood or urine tests for cannabis screening. Instead, it urged physicians to talk with women about their habits, and to encourage them to stop using marijuana as soon as possible while offering alternative therapies for medical ailments.
The screening should be universal in an effort to avoid bias and racism, the college said. It noted that pregnant Black and Hispanic women are four to five times as likely as white women to be tested for drug use. Black women are almost five times as likely to be reported to child protective services for suspected drug use.
The new guidelines say that cannabis should be discouraged among breastfeeding women, but that breastfeeding should continue even with use of the drug because the benefits most likely outweigh the potential risks.
“We cannot be rigid in our approach,” said Dr. Amy Valent, another author of the guidelines, noting that breastfeeding is important for many mothers.
Studies have found that 4 percent to 16 percent of women use cannabis during pregnancy, with rates of up to 43 percent in women age 19 to 22. Women in the first trimester are the most likely to turn to cannabis as they cope with nausea and vomiting, studies show.
A recent analysis of 51 studies involving millions of pregnancies found that prenatal cannabis use almost doubled the incidence of low birth weights among babies. It increased the incidence of preterm births by 50 percent, and of the number of babies born small for their gestational age by 57 percent.
The review also found evidence suggesting that prenatal cannabis might be tied to an increased risk of newborn death during or shortly after birth.
Dr. Cara Poland, an addiction medicine specialist who runs a perinatal clinic in Grand Rapids, Mich., said that studies had linked prenatal exposure to cannabis to an increased risk of poor attention, impulse control and visual-motor coordination in children, as well as to increased odds of attention deficit hyperactivity disorder in middle childhood.
There is also some evidence that children exposed prenatally may be more likely to develop anxiety and depression, she said.
“As permissibility in the social environment increases, people think that cannabis use is lower risk and tend to use it more,” Dr. Poland said. Yet levels of THC, the psychoactive ingredient in cannabis, have increased three- to fourfold in recent decades.
“We know that THC crosses the placenta and concentrates in fetal tissue, especially the brain,” Dr. Poland said. “That means even small amounts may carry a risk today that is greater than previously.”
“We don’t have evidence for any amount of cannabis being proven safe in pregnancy, so the safest choice is to avoid it completely,” she added.
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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