Cannabis and Pregnancy - Weighing the Risks

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

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 lists many over the counter medications including Tylenol and Benadryl, considered very safe by most perinatal and obstetric health providers. And then there are Categories D and X where there is “positive evidence of human fetal risk” determined mainly by adverse reaction reports.

The challenge of treating mental illness during pregnancy

Category C is arguably the most disconcerting because this is the category where most commonly prescribed antidepressants fall. Herein lies a significant issue — women in the childbearing years are at increased risk for developing depressive and anxiety disorders. As a result, antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) are the most frequently used class of prescribed drug by pregnant and breastfeeding women. But the use of these medications is not without risk, especially during the first trimester in which there is an increased risk of miscarriage with the use of some SSRIs. All psychotropic medications cross the placenta and risks to the developing child do exist. These medications may alter brain development in the exposed fetus which may lead to increased rates of depression later in life.

Category D is where anti-anxiety medications tend to fall. Klonopin, ativan, and xanax and other benzodiazepenes comprise this category. These drugs are not prescribed to to pregnant women as regularly as SSRIs, but the use of these medications is prevalent enough to note. These drugs also cross the placenta. Newborns exposed to benzodiazepenes inutero may struggle with decreased muscle tone, breathing challenges, and increased sedation which may be dis