Benefits, Harms, and Costs
- 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).
- 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).
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)
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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.