Cannabis and Pregnancy - Weighing the Risks

As featured in 1000 Watts Magazine – a bright idea for patients by patients –

GreenNurses on Cannabis and Pregnancy

Photography; Mark Fratoni

A Discussion of the Challenges Pregnant Women Face When Deciding to Use Medications While They’re Caring for Two

Precluding pregnant women from clinical drug research presents risks

According to the Centers for Disease Control and Prevention, 9 out of 10 women take medicine during pregnancy, 7 out of 10 report take at least one pharmaceutical medication. For many pregnant women, choosing to take medications during pregnancy is a difficult decision. The risks associated with taking most medications during pregnancy is largely unknown, mainly due to the long-held standard that it is unethical to include pregnant and breastfeeding women in clinical trials and other research studies to determine drug safety and efficacy. The health risks to the developing fetus are too great, and therefore, this population gets left out of necessary research. Pregnant women are still women with health conditions and illnesses that require treatment, so very often, women are left having to weigh the risk versus benefits for taking medications during pregnancy. The same risk versus benefit analysis is also necessary in the breastfeeding period. In this regard, women typically find themselves having to consider the potentially negative impacts for their babies should they choose to use a medication, or the potentially negative impacts that they could face should they choose not to take the medication in question. In both cases, the decision is profoundly difficult.

How do pregnant women decide whether or not to use a medication, with or without the oversight of their obstetrician or midwife?

The U.S. Food and Drug Administration (FDA) has a convenient list of categories that many women turn to when they are trying to determine if a medication is safe to consume during the perinatal period or not. These risk categories were developed because an estimated 10 percent or more of birth defects result from maternal drug exposure, therefore health practitioners and women needed a simple way to review risks for the purpose of making informed decisions. (These categories have been revamped in recent years to include lactation risks, but for the purpose of this article, we’ll stick with the original category list.)

Unfortunately, due to the fact that women who are pregnant and breastfeeding are largely precluded from drug clinical trials and research studies, some of the FDA risk categories carry a common and less than reassuring theme. Category A drugs tend to be considered relatively safe throughout all trimesters, for example — levothyroxine (Synthroid) can be found in this category. Categories B and C were developed on results from animal reproduction studies which may or may not transfer well to clinical use in human beings. Both categories carry the statement “there are no adequate and well-controlled studies in pregnant women.” Category B lis