With the rise in popularity of cannabis derived products, we reviewed the evidence to answer the question: is CBD and weed safe in pregnancy or breastfeeding?

Fall is here, Halloween is on its way, and the season of the pumpkin spice latte is in full swing. But this year, the month of October is a whole new source of excitement for some Canadians. Today, Canada legalizes marijuana. Of course, with the legalization of weed and cannabis-derived products comes a whole bunch of questions about its safety, particularly for certain groups. One product in particular is generating a lot of interest: CBD oil. Heck, even Coca-Cola is looking into the possibility of making a drink containing the “medicinal” compound!! So, let’s take a look at the research on CBD oil, and in particular, what pregnant or breastfeeding moms should know about the stuff before they consider using it. We’ll also get some insights from Dr. Jennifer Hirsch, a Pregnancy and Post-Partum Psychiatrist at Mount Sinai Hospital in Toronto!

Cannabis 101

To get things going, let’s lay out some cannabis-related terms! For a start, the word “cannabis” is the scientific name for the genus of plant used as hemp fibre for fabrics and construction materials, edible hemp seed (a good source of healthy fats and protein), and, of course, as a psychoactive drug. During the 1930s in the US, there was a push from the government to crack down on the use of cannabis as a recreational drug. The Mexican term “marijuana” was adopted in anti-drug literature as a sneaky and possibly racist way to link cannabis with migrant workers. Alas, it’s stuck around, so we’ll use “cannabis” in this post. There are over 70 active compounds in cannabis, known as cannabinoids, but the two biggies are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the part of the pot that gets you giggling while staring at your toes, or having deep philosophical revelations, only to forget them two minutes later. Not that I know anything about that, of course! But CBD is different: it’s not psychoactive, but it does have certain interesting and therapeutic effects on the body.

Therapeutic Benefits of CBD Oil

To start with, CBD has antioxidant and anti-inflammatory effects, and is considered neuroprotective. In other words, it may help guard the cells of the brain from damage. In the early literature, CBD has been investigated for its possible effects in reducing anxiety and symptoms of social phobia and post-traumatic stress disorder, and one exploratory 2012 study found that it was as effective in treating schizophrenia as standard anti-psychotic medications! CBD has been used in natural circles to treat all kinds of things, from Tourette’s syndrome to Crohn’s disease to fibromyalgia and pain associated with multiple sclerosis. Lastly, CBD oil is often used by patients undergoing treatment for cancer, as it’s thought to help reduce the nausea associated with chemotherapy.

Now, let’s back it all up for a hot minute here. Before you like light up a dube (I don’t think I’ve written that word since high school), it’s important not to jump the gun. There is still very little research on CBD, and much of the existing research out there was done in animals rather than humans. In other words, it’s not solid stuff. In terms of official statements, Health Canada provides a hefty list of potential therapeutic uses for cannabis, but points to the limited number of studies demonstrating the safety and efficacy of cannabis products to address any specific illness. The word “potential” is key here: a lot more research will be needed (particularly studies in humans rather than animals) looking at different products and different doses, before any real claims can be made.

Is Weed Safe During Pregnancy?

Why might mothers in particular want to use weed or cannabis products while pregnant or breastfeeding? Well, Dr. Hirsch had this to say: “Increasingly in my practice, women are informing me that they are already using various forms of cannabis during their pregnancy or while breastfeeding. Although there is no high-quality research on its effectiveness, many pregnant and breastfeeding women believe it may be helping their nausea, anxiety or insomnia.” During pregnancy, it seems some mothers use cannabis to help with morning sickness, and after birth, women may use cannabis products to address postpartum depression. But Dr. Hirsch is quick to mention that cannabis can interfere with antidepressant medications, and can cause anxiety, paranoia and hallucinations – not a great situation for new parents! TRUST ME.

But just how many moms are turning to CBD and other cannabis products? According to a 2012 study that looked at 25,000 women who gave birth at a hospital in Australia, 2.6% of them reported using cannabis while pregnant. That was, admittedly, a long time ago, so it’s very possible that number is much higher now. The study also controlled for confounding factors like smoking, alcohol consumption and other illicit substances, however there could have been other factors that were not controlled for and these were self reports which can be a limitation since some people under report their drug use.  What is maybe more relevant here is that these mothers were twice as likely to have babies who were small for their gestational age, and their babies were twice as likely to be admitted to neonatal intensive care. Even more alarming was that it would seem cannabis use during pregnancy can disrupt the developing neurotransmitter systems in the baby’s brain, and in particular, may impact the neurotransmitter dopamine. Dopamine imbalance has been shown to increase the risk of depression, schizophrenia and drug addiction, so at this time, most doctors would not see it as worth the risk. When asked about the risk of cannabis use during pregnancy, Dr. Hirsch brings up the Ottawa Prenatal Prospective Study, which began in 1978 with pregnant women and followed their 180 children for a number of years, to examine the effects of cannabis use during pregnancy on children. “After age 4, there were differences in behavioral problems and decreased performance on visual perception tasks as well as language comprehension and sustained attention and memory difficulties in exposed children,” says Dr. Hirsch. She also provided this juicy piece of info: THC content in today’s cannabis is around 10 times higher than it was during the 1970s, when the study started! That’s a bit of a scary thought.

Is Weed Safe WHILE BREASTFEEDING?

So what about cannabis and breastfeeding? Well, it seems that when cannabis is not isolated in the form of CBD, the THC can actually concentrate in breast milk. Only one sizable study from the University of California San Diego has examined the connection, analyzing 54 breastmilk samples from 50 mothers who used cannabis while breastfeeding. The researchers were able to detect THC in 63% of the samples analyzed up to 6 days later! The samples contained an average of 9.5 nanograms per millilitre of THC. To put that in context, the Government of Canada’s Bill C-46 proposes that any blood levels of THC higher than 5 ng/mL be considered impaired driving, so the women’s milk samples had almost double the allowable amount! On the other hand, THC has an oral bioavailability of no more than 12%, meaning that if ingested (as in breastmilk), less than 12% of it will be absorbed into the baby’s bloodstream. Would these small amounts affect a baby? It’s (unfortunately) very likely – another study found that infants exposed to THC in breastmilk had decreased motor function by the time they were one year old. Yikes.

So maybe not such great news for the babe, but what about for the mom and her breastfeeding journey? If you struggled with breastmilk supply like me, you’re going to want to listen up. Studies in both animals and humans have shown that cannabis use in lactating mothers might reduce levels of prolactin, the hormone that promotes lactation in response to suckling. The result? Cannabis may cause a decline in breastmilk production overall.

CBD vs THC in Pregnancy and Breastfeeding

Okay, okay. So you might be getting the sense that we’re not super gungho about moms or mom-to-bes smoking up on the regular. But what about CBD, the innocent (and potentially therapeutic) cannabinoid cousin of THC?

Well, at the moment, there’s pretty much zero research on the effects of CBD on infants of pregnant or breastfeeding mothers. Heck, at this point, there’s not even sufficient data on plain ole’ marijuana and breastfeeding. Of the 54 breastmilk samples analyzed at UC San Diego, only 5 of them had detectable levels of CBD. However, these samples came from mothers using cannabis, not CBD oil, so all we can determine from this study is that CBD can be found in breastmilk. What remains to be seen is how much CBD might end up in the breastmilk of a mother taking CBD oil, and what effects, if any, exposure to CBD during breastfeeding might have on infants. However, CBD is gaining traction as a potential treatment for pediatric epilepsy, and recently, a drug composed of pure CBD was approved by the US FDA for use in seizures. This fact, combined with the fact that CBD is not a psychoactive compound, has forced the US Drug Enforcement Administration to move toward reclassifying CBD from a Schedule I (addictive substances with no medicinal use) to a Schedule II or III (less restricted categories). With a more relaxed law around the use of CBD, there will likely be more research into this potentially exciting compound and, hopefully, some more hardline answers about its effects on infants.

In the meantime, there are a number of CBD oil products different ratios of CBD and THC on the market, and this can all be overwhelming or confusing, especially to first-time consumers. In advance of cannabis legalization, Health Canada has put forth proposed labeling requirements, so that consumers could theoretically better control the concentration, and ratios they’re getting. They’ve also imposed a legal limit for THC content: 30 mg/mL of THC in any cannabis oil product, and 10mg/dose of all other ingestible products. Natural health products (NPHs), such as hemp or CBD oils, will be allowed THC concentrations no higher than 10 parts per million.

But is this enough? Dr. Hirsch isn’t sure. “Cannabis strength remains highly variable even within the same dispensary and often a very different concentration than labeled. It is uncertain how legalization will impact this as much of the cannabis is already approved in Health Canada licensed facilities.” And, she points out, cannabis products can contain harmful mould or pesticides! “Some people carry a genetic variant making it difficult for their immune system to clear molds, making smoking or vaping potentially dangerous to a developing fetus, risking exposure to mycotoxins such as Aspergillus.” Honestly, so many pregnant women I speak to are worried about eating unpasteurized cheese, or sushi, or even certain teas, this seems like a much bigger risk to take.

Bottom Line on CBD and Weed Safe in Pregnancy or Breastfeeding?

 

So what to do if you’re a pregnant mom-to-be and hoping to use CBD oil while pregnant or breastfeeding? Unfortunately, at this time, there’s no straightforward answer. The most recent recommendations, from the Society of Obstetricians and Gynecologists of Canada warn pregnant and breastfeeding women against the use of cannabis, but their concerns stem from the possible effects of THC, not CBD, on babies. The SOGC acknowledge that many women (as many as 70%) see no major danger in using cannabis occasionally during pregnancy and breastfeeding. However, when it comes to THC, the research so far doesn’t support its safety during pregnancy or breastfeeding. Dr. Hirsch points to rampant misinformation, saying “Much like alcohol and tobacco, just because a cannabis is legal and natural, doesn’t guarantee it is safe for your baby.” And as for CBD, the jury’s still out. While you should definitely speak to your doctor about your options, it seems like most would agree that pregnant and breastfeeding moms abstain until we have more definitive studies.

Contribution by Adam Weinmann, RD2B