Abstract
Objective
To provide health care providers with the best evidence on cannabis use and women’s
health. Areas of focus include screening, dependence, and withdrawal; communication
and documentation; pregnancy (including maternal and fetal outcomes); maternal pain
control; postpartum care (including second-hand smoking and parenting); and breastfeeding.
Target Population
The target population includes women who are planning a pregnancy, pregnant, or breastfeeding.
Benefits, Harms, and Costs
Discussing cannabis use with women who are planning a pregnancy, pregnant, or breastfeeding
allows them to make informed choices about their cannabis use. Based on the limited
evidence, cannabis use in pregnancy or while breastfeeding should be avoided, or reduced
as much as possible if abstaining is not feasible, given the absence of safety and
long-term follow up data on cannabis-exposed pregnancies and infants.
Evidence
PubMed and Cochrane Library databases were searched for articles relevant to cannabis
use during pregnancy and breastfeeding published between January 1, 2018, and February
5, 2021. The search terms were developed using the MeSH terms and keywords and their
variants, including cannabis, cannabinoids, cannabidiol, CBD, THC, marijuana, edible,
pregnancy, pregnant, prenatal, perinatal, postnatal, breastfeed, breastfed, lactation,
nursing, fetus, fetal, neonatal, newborn, and child. In terms of publication type,
all clinical trials, observational studies, reviews (including systematic reviews
and meta-analyses), guidelines, and conference consensus statements were included.
The main inclusion criteria were pregnant and breastfeeding women as the target population,
and exposure to cannabis as the intervention of interest.
Validation Methods
The authors rated the quality of evidence and strength of recommendations using the
Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations
of strong and weak recommendations).
Intended Audience
All health care providers who care for women of reproductive age.
SUMMARY STATEMENTS
- 1.Screening, brief intervention, and referral for treatment can be used to identify and treat cannabis use in women during pregnancy (low).
- 2.The effectiveness of cannabis for treatment of nausea and vomiting in pregnancy is unclear (very low).
- 3.Prenatal cannabis exposure is associated with mild fetal growth restriction (low).
- 4.The effects of prenatal cannabis exposure on long-term outcomes through to childhood, adolescence, and adulthood have not been conclusively defined, but recent data suggest that there are persistent neurocognitive effects into adulthood (moderate).
- 5.Although cannabis is commonly used to treat pain, there is no evidence for its use in alleviating pain during pregnancy, intrapartum and/or postpartum periods (very low).
- 6.There is little data available to inform decisions about cannabis use during breastfeeding (low).
- 7.Given the evidence, the safest option is to avoid cannabis use during pregnancy and breastfeeding (moderate).
- 8.In cases where women are unable to abstain, given the apparent dose–response relationship between prenatal cannabis exposure and persistent neurocognitive effects on the fetus and/or neonate, decreasing cannabis use during pregnancy and breastfeeding can mitigate the adverse effects (moderate).
RECOMMENDATIONS
- 1.All women should be screened for cannabis use, including during pregnancy, using a validated screening tool (strong, low).
- 2.Women with at-risk cannabis use or cannabis use disorder should be offered brief intervention, and, if appropriate, referral for treatment (strong, low).
- 3.If possible, health care providers should document cannabis use in pregnancy, both in the prenatal record and in the infant’s medical record (strong, low).
- 4.Cannabis should not be used during pregnancy because prenatal exposure can increase the risk of neurobehavioural abnormalities in the child (strong, moderate).
- 5.Health care providers should monitor women who regularly (near daily or more than twice weekly) use cannabis during pregnancy for potential intrapartum and/or postpartum withdrawal (or cannabis withdrawal syndrome) (strong, moderate).
- 6.Health care providers should recommend that women abstain from cannabis use during breastfeeding (strong, low).
Keywords
Abbreviations:
CBD (cannabidiol), CBT (cognitive behavioural therapy), CUDIT-R (Cannabis Use Disorder Identification Test Revised), MET (motivational enhancement therapy), NICU (neonatal intensive care unit), SBIRT (screening, brief intervention, and referral for treatment), SIDS (sudden infant death syndrome), SSRI (selective serotonin reuptake inhibitor), THC (tetrahydrocannabinol)To read this article in full you will need to make a payment
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Article info
Publication history
No. 425b, April 2022
Footnotes
This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that health care providers provide patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and inclusivity: While the SOGC as a rule uses gendered language, in respect for our mission to advance women’s health, there are contexts in which it is important to use gender neutral language, and to be fully inclusive. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person’s needs.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
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- Guideline No. 425a: Cannabis Use Throughout Women’s Lifespans – Part 1: Fertility, Contraception, Menopause, and Pelvic PainJournal of Obstetrics and Gynaecology Canada Vol. 44Issue 4
- PreviewTo provide health care providers with the best evidence on cannabis use with respect to women’s health. Areas of focus include general patterns of cannabis use as well as safety of use; care for women who use cannabis; stigma; screening, brief intervention, and referral to treatment; impact on hormonal regulation; reproductive health, including contraception and fertility; sexual function; effects on perimenopausal and menopausal symptoms; and use in chronic pelvic pain syndromes.
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