I do note that although most anecdotal reports have had
a good outcome after using cannabis for Hyperemesis gravidum
some women have still lost their pregnancy, or had small or preterm
babies who required time in the neonatal ICU. Their friends and
doctors often blame the classic scapegoat cannabis, and even
a couple of scientific studies have made this assumption.
Any opinion (Medical or otherwise) given that does not take this into account must be considered questionable at best.
Other ways of using this herb are available, which are not harmful in and of themselves, for instance more refined products such as cannabis oil and resins can be either taken orally (in capsules, tincture, tea, or the classic “Brownie”) or vaporised for inhalation (like an E-cig) rather than burnt. Plant material can also be placed in an electric device called a 'vaper' which heats the material to a temperature sufficient to evaporate the cannabinoids and terpenes, but not to incinerate the material and produce those toxic compounds.
There are even possibilities of the raw plant material being juiced as a health food, which provides (TRY TO FIND basic INFO) without any psychoactive action at all because there is no Decarboxylation process to activate the THC.
Unfortunately NZ's current law makes these administration methods even more illegal than the toxic burning, because they are all either classified as 'Class B Drugs' with heavier penalties imposed or else require special 'Utensils' to administer them.
Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis
The effects of prenatal tobacco and marijuana use on offspring growth from birth through 3 years of age
Studies have demonstrated no THC metabolites (that is final, broken down versions of the chemical after your body has used the cannabinoids) in foetal tissue. That means that although there are cannabinoid receptors present from quite early in foetal development, nevertheless the THC is not being processed in the way that gets adults high. Essentially this chemically proves that the unborn baby is not getting 'stoned', even though the mother may well be. However low levels of metabolites have been found in the urine of 1 week old breastfed babies whose mothers used cannabis.
Supplementation of a maternal low-protein diet in rat pregnancy with folic acid ameliorates programming effects upon feeding behaviour in the absence of disturbances to the methionine-homocysteine cycle
Effects of Prenatal Tobacco, Alcohol and Marijuana Exposure on Processing Speed, Visual-Motor Coordination, and Interhemispheric Transfer
<<<Research on MTHFR gene coming soon>>>
The study should be done on pregnant women who have a healthy diet, take a good multiVitamin, don't ever drink, smoke or use other drugs, and who also regularly take Cannabis, which is known free of all contaminants and only taken by Non-toxic methods. Hundreds, if not thousands, of these Diamonds in the Rough would need to be located, and a comparable group who do not use cannabis at all, to get a really good study of the effects. Their folate levels, MTHFR status, and the folate count of the cord blood at birth needs to be recorded as well.
Obviously there is a logistical issue to find such subjects 'naturally occurring' to put it one way, but this is what would have to be done to prove the facts once and for all without legally or ethically unacceptable experimentation.
This is a subject that needs covering in any discussion of legalising cannabis, and particularly because there are indications products obtained from the herb may be useful to significantly shorten and ease the pain of labour, and to relieve Hyperemesis gravidum, the literal translation of which is "Excessive vomiting in pregnancy", a severe debilitating form of morning sickness that effects 2% of all pregnant women and can have severe long term health consequences for both mother and baby.
There is however a lot of controversy over the use of cannabis during pregnancy. There are concerns of potential harm to foetal development from the use of any biologically active substance during pregnancy, whether that substance be coffee or chemotherapy or anywhere between these extremes. But what does the evidence really show us about cannabis exposure in utero, and the potential medicinal applications for mothers?
It is fairly well-known that Queen Victoria lead the way for women to use pain relief in childbirth by example - taking Nitrous oxide - less commonly known is that she also took cannabis tincture. The scientific research of her day showed that cannabis would shorten labour times (by about half), and reduce the risk of haemorrhage while relieving pain, and she had used cannabis successfully for relief of menstrual pains throughout her life.
Professor Philip Robson of Oxford in 1998 stated “If you could have an agent which both speeded labour up, prevented haemorrhage after labour and reduced pain, this would be very desirable. Cannabis is so disreputable that nobody would begin to think of that and yet that is really an obvious application that we should seriously consider with perhaps some basic research and pursue it.”
To this day no research has been done on this subject at all.
Many cultural traditions recommended the use of cannabis in various forms (usually teas or other oral delivery methods) throughout pregnancy and breastfeeding as a remedy for Nausea, Depression and Anxiety, and of course to stimulate a healthy appetite. It was traditionally seen as a tonic for good maternal health and nutrition and to ensure a healthy baby.
Just because it was traditional doesn't mean it was right … after all they used to use mercury oxide for teething babies … but in this case, these traditional applications may be based on a valid medicinal application, as cannabis is a well known anti-emetic. Anecdotal reports (which is still the only information available for this subject) indicate that many women worldwide that continue to use Cannabis during pregnancy do so from a perception from 97% of women that it relieves the symptoms of their morning sickness.
The reasons for these women to choose cannabis for relief vary … often these women simply self medicate, noticing that a few puffs helps their morning sickness so they don't bother going to a doctor for it ... sometimes they perceive it as a natural alternative to the prescription medications (which do have potential side effects for mother and baby), sometimes they've tried the prescriptions and either found cannabis to be more effective, or they had troubling side effects from the other medications.
Many of these women have had debilitating Hyperemesis gravidarum. This condition can result in serious malnutrition and weight loss in early pregnancy, a time at which the foetus is very vulnerable.
Mothers have related losing over 10kg body weight in early pregnancy before starting to take cannabis and subsequently regaining this weight and normal pregnancy gains. Many of these women had previous miscarriages they attribute to their malnutrition due to excessive nausea. These women perceive their self-medication with cannabis as having saved their pregnancy.
The prescription medications available for Hyperemesis gravidum were originally designed for AIDS and cancer sufferers. The vast majority of these drugs have not been well studied for safety of use in pregnant mothers, and many have shown potential to harm the baby in animal studies too. The risk is considered justified, as the certain health deterioration of the mother and the impact that will have on the baby's development is far more pressing. The studies on cannabis use in pregnancy have demonstrated it to be, in two words or less 'mostly harmless', and anecdotal reports indicate it to be far more effective than the prescription medications available for this condition.
I cannot here adequately expand on the details of this condition, the prescription medications and the use of cannabis to relieve this debilitating disorder. The .pdf linked to at the left by Wei-Ni Lin Curry gives a first person account of this disorder with all these informations. Although only an anecdotal report and formatted as a cross between a personal recounting and a more scientific report, the author has researched some of these points quite well. Observation of anecdotal reports is ultimately the first step to full research and scientific advancement, and most are not even so well evidenced and presented as this one is.
So what scientific proof is there as to the potential harm to foetal development? In the 80's a number of alarming possibilities were proposed as early studies investigated small babies, preterm birth, small head circumference and similar disorders, with wildly conflicting results. Ideas of lower-IQ kids and birth defects were propounded, worries about babies going into dangerous withdrawal at birth, reports of tremors, prolonged startles and even a strange cry were made, but all of these were eventually disproved when studies ultimately failed to find any consistent negative effects at all up to the age of about 5.
The conflicting results are largely because clear studies are made near impossible by the various limitations (legal and ethical) involved with studying the use of an illegal substance on pregnant women.
These studies are limited to essentially asking pregnant women whether they have used an illegal drug during pregnancy and waiting to see how the baby turns out. Unfortunately these women are understandably concerned with legal or social reprisals (eg loss of child custody, or peer criticism) and frequently do not admit to the use of Cannabis, even in an anonymous trial, or may understate their levels of use (“oh no Doc, I just had couple puffs like, a week ago”) which does make the Scientist's job a bit tricky!
There is a large variation in dose rates between studies, with different scientists classifying “Heavy use” (usually rated by average number of “Joints” used) as variously “More than 21 per week”, “More than 1 per day” or even “More than 1 per Week”. Other studies failed to record level of usage at all, merely classifying women as “Users” or “Non-users”, by which methodology any woman who had one joint in her entire pregnancy would have the same classification as one who had several every day, and in one example a study divided the cohort into two groups by “More or less than 2 joints per month”, which gives no truly “Non-using Group” and the “Using Group” starts at a very low level.
Next we look at the product being studied. The “street-grade” cannabis available to the typically lower-socio-economic mothers who took cannabis in these studies is often of poor quality, and these pregnant mothers are taking a product contaminated with things like hair spray, horse tranquilliser, pesticides, lead (yes the heavy metal), herbicides, carbon monoxide, polynuclear aromatic hydrocarbons (PAHs).
You will note I am including PAHs and CO1 in the contaminants list. That is the chemicals produced by burning the plant material, like carbon, tar and other carcinogenic compounds. I include these in this contaminants category because they are simply a by-product of a poor delivery system. They are not part of the plant, they are not what we are here to evaluate, and they are a confounding factor introduced into all these studies.
Carbon monoxide exposure alone has been shown to be linked to preterm delivery, low birth weight, congenital malformations, sudden infant death, neurodevelopmental problems and congenital malformations. Since 'smoking' is still the primary way these women were taking the product this is a contaminant that was certainly in all the studies referred to.
Another problem arises with “Confounding Factors”, other things that can give false results such as:
This is just some of the “Variables” involved, which all means that this same population of babies who have been exposed to cannabis in utero was already at high risk of a devastatingly long list of health and developmental disorders before cannabis even entered the picture.
An example of this problem is a 2011 study of 24,874 women in Australia. This study concluded that there was an association of prenatal cannabis use with low birth weight, preterm labor, small for gestational age, and admission to the neonatal intensive care unit. The study controlled for mother’s age, level of education, marital status, ethnicity, parity, weight, cigarette smoking, alcohol consumption, use of other illicit drugs (heroin, amphetamines, ecstasy, and hallucinogens), and use of prescription drugs (including methadone). Although the study claims to have collected socio-demographic information, they did not adjust for any such factors in their results. They also made no attempt to record the folate status and supplementation or lack of it.
Additionally this study was based on investigating the records in the standard new patient book-in form at a single maternity hospital catering to lower-socio-economic mothers. These women had no idea that the information was to be used for scientific research: in fact the information was actually gathered for the purpose of identifying women to refer to antenatal drug use services, a data gathering procedure that is very likely to result in women being unwilling to report drug use. Therefore this study remains confounded for multiple reasons and the results are rather questionable.
There is the possibility of 'Interactive' effects involved in any of these factors too, for instance: some studies have shown that concurrent cannabis use makes the detrimental effect on the foetus of alcohol or tobacco worse, yet cannabis taken alone showed no effect.
A study in rats proved that the concurrent administration of THC (equivalent doses of approximately 0.5-5.0 joints for a human) enhanced the proapoptotic (cell-destroying) effects of alcohol so much that the equivalent of a single shot for a human produced the same “Massive” apoptotic death usually seen in very high doses of alcohol.
This is an example of a Synergy … the whole is more than the sum of its parts … unfortunately in this instance it is a negative synergy where Cannabis potentates the detrimental effects of the other drugs on a foetus.
An example of the effect all these complications have on research is the conflicts in two long term study cohorts responsible for all the information we have on long term cognitive and behavioural effects in older children and adolescents exposed to cannabis in utero. One group is studying a cohort of so-called "high-risk" mothers of low socio-economic status. The other group studies a cohort of low-risk, white, upper-class families in Ontario, Canada. Both studies control for several factors such as concurrent substance use and socio-economic status. Other factors such as maternal age, folate status, and the quality or contamination of the cannabis they consumed is unknown.
Papers coming from these studies often conflict, with small increases in impulsivity, behavioural issues, and cognitive/memory deficits at some ages, but no association at others. Lower verbal and reading scores and memory after 3-4 years of age was another potential result shown. However, even the authors say it is not certain whether this is because of cannabis exposure or other confounding factors that have not been determined.
A review of both studies in 2005 concluded that any association between pre-natal cannabis exposure and these neurobehavioural and cognitive deficits is "subtle" and appears to be more likely associated to children exposed to cannabis along with alcohol and/or tobacco, not cannabis alone.
The greatest problem these two study cohorts are encountering is that they are stuck within a so-called First world culture, where we have this concept of cannabis as a 'recreational drug'. This is a socially stigmatised view, creating a Dirty Culture, Dirty Study, where cannabis use is disproportionately high in those of low socio-economic standing, with high use of other drugs, very high use of tobacco and alcohol, and not always with the best diet and medical care. Getting a 'Clean Study' of cannabis under these limitations is virtually impossible.
In recognition of this issue, the american National Institute on Drug Abuse, who funded the two studies referred to above, also instigated a “EthnoGraphic” study of prenatal cannabis use in Jamaica, a culture where cannabis is 'normal', and not associated with any social stigma of uncleanliness.
“Ghanja” as it is known there has long been a valued medicinal herb with important cultural and religious uses. In the small rural type community studied the ghanja is all of similar potency and grown without the chemicals used in more “advanced” agriculture. Jamaican mothers in the study seldom used any alcohol or tobacco, and never other illicit drugs common in western societies.
They did however commonly use ghanja. Many Jamaican women take ghanja tea on a regular basis, and most of the women in the using group also smoked their ghanja. NIDA expected the the results from this cultural study would prove once and for all what effect cannabis may or may not have on foetal development, in contrast to the culturally conflicted reports already available to them.
The study showed no adverse effects of maternal prenatal use of ghanja on the children up to age 5. At that point NIDA withdrew their funding and the study was not continued. They had hoped that the study would show negative results, proving their case, and when instead it cast doubt on their other studies in their biased cultural and socio-economic setting, they lost interest in the study entirely and refused to provide any further support. After all they are the National Institute on Drug Abuse – naturally it follows that a harmless verdict is not worth spending more money on.
For this reason we have no information on the further development of these Jamaican children after age 5, so no verdict on the risks of ADHD or other issues that only appear later. The same scales of evaluation were used as in the american and canadian studies at this stage, with some minor adaptations to make them more accurate for the cultural setting of Jamaica. Some additional newly developed supplementary items designed for detecting more subtle effects were also added to the standard newborn evaluations, in an attempt to detect small differences that other studies had not.
The birth outcome and evaluations at 3 days old of the ghanja babies were no different to the control group babies. At 1 month old, the ghanja babies were significantly more interactive than the control group, however it is unclear whether this is due to the ghanja using mothers/families interacting with their babies more and providing a more interesting and stimulating environment.
At 4-5 years old, the study showed no effects on the same cognitive scales as were used in the other cultural studies that showed lower memory, verbal and cognitive scores. Instead what was shown was that these factors were most influenced by education and a stimulating home environment. I am currently unable to confirm whether the canadian and american cohort studies evaluated or controlled for these factors, as most of the full text versions are not available on my budget, and none of the free full texts mention any evaluation of home and family environment at all.
Unfortunately the study was of an extremely small sample population. It can be hard to be certain of the results of a study with a cohort of this size until the results are repeated in the same situation. However on the plus side the smaller sample size actually allowed for more accurate evaluation of the mother's and children's characteristics. Inaccuracies of self-report on the part of the mothers (for instance 3 mothers who were classified as non-users but turned out to use ghanja tea) were found and corrected in the info. The housing quality and home environment scales were able to be similarly confirmed and reported more accurately than those of the sometimes 20,000+ women in other studies, who simply fill out questionnaires at the doctor's office or hospital.
The dose rate in this cohort was huge compared to the other studies, and still showed no negative effects. The study subjects were divided into Non, low, moderate and high users, with 'High' levels determined as 21 or more 'Spliffs' per week. A Jamaican 'Spliff' (later described by the study author as "Substantial") is not like a typical 'Joint' such as one might see in NZ, being more the size of a large cigar, so we speak of three Cigar-sized joints per day, and in fact the highest using mother smoked 10 of these per day. We are speaking of Massive exposure here, probably on the lines of ounces of ghanja per day. This high use group was individually compared giving a high contrast with the matching 'no use' group. The most sensitive test criteria designed for evaluation of subtle effects on high-risk babies was used. Even in a small sample size this comparison would have been expected to show some results if a negative outcome was likely.
On the subject of controlling for confounding factors, firstly this is difficult in such a small study population, and secondly the author has described the incidence of these confounding factors very well to demonstrate how significant or not these may be.
The study population was all of one racial type, therefore that is not a factor: Socio-economic factors were very similar, slightly but not significantly better in the heavy use cohort: almost none of the women used tobacco or alcohol, and those that did used it at very low levels, most commonly once per week (did you know in rural Jamaica you buy cigarettes one at a time?): the parity status (whether they had previous pregnancies) was given as a percentage of first-time mothers, and deliberately selected to match between the groups, as was the incidence of previous miscarriage.
An unfortunate common impression of this study is that it claims benefits of smoking cannabis while pregnant on children's intelligence and development, which is not true … no-one ever said that. The author of the paper Melanie Dreher specifically says that the babies' improved interaction was most likely caused by the heavy-using mothers being already more independent in nature, having more control of their own financial means, and spending more one-on-one time with their baby.
The conclusion of the study was simply that in a typical 'first-world' culture we need to improve our lower socio-economic families' quality of life, family environment, early encouragement of the children's maturity and development, and lack of quality peer-group support for the mothers and families involved. That should not be a surprise to anyone. The negative effects put down to cannabis in our culture are more likely from a generally terrible environment the same people are exposed to, and the whole cannabis scare was kind of a red herring distracting us from more important issues we should have fixed long ago.
Unfortunately since the Jamaican study lost it's funds, the research was not able to be continued at the 10 year follow up. So we have no comparison in that culture to the later results reached in the other two studies. Those showed possible links to behavioural problems like ADHD, and some specific reductions in certain aspects of executive function, as measured by a new test that was devised especially for showing a negative effect of cannabis, because none could be found on the standard tests.
So we have no cross-cultural reference studies to determine for certain whether prenatal cannabis exposure could cause problems that may only show up at or after 10 years of age or so. Until better studies are available, lets take a look at what issues could feasibly arise.
The studies, confounded as they are, have shown no links between prenatal cannabis exposure and schizophrenia or similar disorders, no lowering in IQ, but have suggested that concentration, attention, peer relation problems and ADHD are areas that need further investigation. So what could, theoretically be influencing these aspects?
Lets take a look at another common factor in these disorders. I'm sure anyone interested enough in the subject to have read this far already knows what folic acid is, at least in the general way that “It's something pregnant women should take to prevent things going wrong with the baby”.
True. Basic, but undeniably true. Folic acid, aka Folate, Vitamin B9 is involved in DNA and RNA synthesis and in the methylation of nucleic acids (epiGenetic tagging). Extra folates are required in times of rapid growth such as foetal development, and taking folic acid during pregnancy has been shown to reduce neural tube defects by 20-85% in varying study parameters. The list of other disorders that folate deficiency has been suggested to cause include all the attention and learning disorders named above and more.
Yet, no studies I have seen in relation to cannabis use during pregnancy have controlled for folate supplementation (or lack of it) by the same mothers, none have tested their folate levels during pregnancy or the folate levels of the cord blood at birth, and that could have been a revelatory addition to the criteria.
Not only do the women most likely to be taking cannabis during pregnancy not as commonly take folic acid, but two in vitro studies have suggested that THC could actually restrict the transfer of folates across the placenta by about 30% (alcohol does too, new evidence indicates foetal alcohol syndrome is equally comparable to folate deficiency, caused by the alcohol restricting the supply.)
The exact mechanism of this interference and how much of the potential effect of cannabis on the foetus is due to this folate restriction has not yet been studied. Even the transfer of folate across the placenta is still not completely understood, much less how and why THC could interfere with it.
No studies have been done to determine if a higher rate of folic acid supplementation prevents this problem, and to what degree. Studies on foetal alcohol syndrome have suggested that additional folic acid protected the foetus from the apoptotic effects of alcohol. This would suggest a good possibility similar measures could be effective in the instance of cannabis as well, should use of cannabis prove to cause folate restriction in vivo as well as in vitro.
For some high risk people (about 40% of the population who have a mutation on a gene called the methylenetetrahydrofolate reductase gene, or “MTHFR”) folic acid won't help a lot as they have up to 90% reduced utilisation of folic acid. These people are already at higher than normal risk of disorders like ADHD and Schizophrenia, which are directly linked to folate deficiency in some studies.
These individuals need to take Methyl Folate (the version everyone's cells actually use anyway) instead of Folic acid for the same purpose. These individuals, who are often already verging on folate deficiency, have trouble meeting the folate requirements of a growing foetus. None of the studies on cannabis exposure in utero have checked to see if the individuals who do have ADHD and other similar disorders have the MTHFR gene mutation, or whether their mothers do. This could contribute significantly to the likelihood of issues relating to folate absorption.
So in conclusion, the evidence shows us that: