After widespread legalization across the U.S., medical and recreational cannabis use is becoming much more acceptable. Thanks to the untiring efforts of biomedical scientists, the medicinal benefits of cannabis are being proven beyond a reasonable doubt. As medical marijuana use increases, so do the safety comes to for the general population as well as special groups, such as elderly people, children, and pregnant women.
While marijuana use in pregnancy is already a hot topic for scientific debate, a recent study has warned that pregnant women ought to shun cannabis to prevent complications, particularly for their unborn child. Upon reviewing several published studies, this particular study concluded that maternal cannabis use can easily improve the risk of anemia in pregnant women by 36%, while the unborn’s in utero cannabis exposure can easily improve the risk of reduced birth weight by 77% and related neonatal intensive care unit (NICU) admission two fold. As marijuana is becoming much more accessible, learning the two the benefits and adverse effects, particularly in this special population, stands as our top priority.
Just since something has actually been published in peer-reviewed scholarly journals doesn’t mean it is scientifically accurate or the last opinion of the scientific community. As an independent scientist, I’m here to critically appraise the scientific strengths, limitations, and possible/potential biases of this review study.
Limitations of the Study
Upon reviewing the study, every one of I can easily say is – the study did not come devoid of limitations. Let’s have actually a check out in detail.
- The study exclusively relied on self-reported measures of cannabis use and potentially underestimated the prevalence or history of various other drug(s) use of pregnant study subjects. various other drug(s) use might be as a result of social desirability, drug dependence, and addiction.
- As along with various other similar studies, the present study did not exclude subjects along with history of poly-substance use/abuse. Most hard drug abusers, tobacco users and alcoholics are cannabis users yet not vice versa. Hence, the exact ‘cannabis-only effect’ on pregnancy has actually not been determined by researchers. Properly designed, additional studies are called for to lure definitive conclusions.
- Certain maternal and fetal outcomes were measured using the same cut-off points in most of the reviewed studies. Furthermore, different studies reported varied outcomes that were not reported in various other studies. For example, one study has actually reported incidence of jaundice along with reduced birth weight while two various other studies reported incidences of fetal distress along with reduced birth weight and hypoglycemia along with reduced birth weight. along with varied outcomes, the study could not lure any kind of definitive conclusions.
- The meta-analyses study included 24 studies including case–regulate studies, cross-sectional, and cohort studies yet not a single randomized-controlled study, which is universally considered as a reliable clinical trial study design to reduce/eliminate study bias. This is a notable limitation of the study.
- Although, the review and meta-analyses study found prevalence of maternal anemia among cannabis users, the study cannot locate any kind of association between the incidence or prevalence of maternal anemia and cannabis use. The study authors warned that the results need to be interpreted along with caution, and recommended further studies to confirm their findings.
- Similarly, the study found an increased price of neonatal intensive care unit/hospital admissions for cannabis-exposed infants. However, a few of the necessary neonatal outcomes and growth parameters, such as head circumferences, gestational age and length were not significantly demonstrated in the present study. various other observed growth parameters remained notably inconsistent. These drawbacks call for a question concerning the viability of this study.
- The study mostly focused on Apgar score as a neonatal assessment variable among in utero cannabis exposed infants, yet the results could not demonstrate substantial association. Additionally, the effects of cannabis use on neonatal assessments including, Prechtl and NBAS, were not adequately discussed in the literature.
- The inclusion and exclusion criteria were not properly designed. The study did not strictly include the relevant studies along with subject’s maternal age of 18 years and older.
To understand and assess the effects of a drug, learning the fetal and maternal outcomes are essential. various other confounding factors, such as heavy alcoholism and tobacco use, can cause edge outcomes such as reduced birth, maternal anemia, anomaly and in utero reduced weight troubles etc. Even the researchers of this study were not sure whether the observed edge events were related to cannabis use or as a result of various other drugs use (tobacco and alcohol). Meaning, the cause-and-effect of cannabis use and these edge outcomes could not be established by the study. Hence, additional studies are warranted to eliminate the confounding factors along with utilization of right age-matched regulate groups.
Reported Results are Mixed and Conflicting
Surprisingly, the meta-analyses and review study that I’ve critically appraised is not the only study that reported inconclusive results. Here are the various other botched-up studies along with either mixed or conflicting results.
In one study, no plausible association was observed between 1 and 5 minute Apgar scores and neonatal behavioral assessment scales among in utero cannabis exposed infants. Similarly, a demographic study conducted in Jamaican and Costa Rican people (recreational cannabis use) have actually failed to prove to any kind of negative effects in cannabis-exposed unborn.
Among the 5 studies that investigated the association between the gestational age and in utero cannabis exposure, four studies observed a null association between these two factors, while one study found a substantial decrease in gestational age among in utero cannabis exposed infants. Additionally, further studies on fixed-effects models have actually failed to demonstrate substantial association between gestational age and in utero cannabis exposure.
Other independent studies have actually found no remarkable association between in utero cannabis exposure and number of hospital remain days, risk of developing jaundice, abnormal fetal resuscitation, occurrence of respiratory distress syndrome and other complications such as perinatal mortality, anomaly, abnormal fetal tests, fetal heart price of the pulmonary arteries or aorta, aortic peak systolic velocity, sepsis, hypoglycemia, spontaneous abortions, intubation necessity after delivery, abruption and fetal distress.
Despite these conflicting evidences, one study has found a notable improve in mutant lymphocytes in the blood samples of pregnant mother and the unborn. However, another study has found no increased risk of chromosomal abnormalities (spontaneous abortion karyotypes) in pregnant cannabis users.
Taken together, the study has actually shown some degree of correlation between cannabis use and NICU/ICU admission. along with these limitations, the study results do not appear to be conclusive and further assessment of these results in a homogenous population is required.
A scientifically-sound study along with conclusive results could benefit pregnant women to advice them much better already know the pros and cons of cannabis use, and additionally to make informed decisions.
Looking in to the Reality
Forget concerning the reported adverse effects of this study, if we check out the various other studies and historical evidence, cannabis appears to be practical to treat various gynecological and obstetrical problems. Self-reporting and anecdotal evidence has actually shown that weed can easily advice pregnant women to treat morning sickness. The American Medical Association has actually called for warning labels for marijuana (the two medical and recreational use) concerning the feasible risk throughout pregnancy yet it has actually not been imposed. It appears most pregnant women are not concerned by these study results. They tend to use marijuana to relieve morning sickness, labor pain, and additionally for quicker labor.
As endocannabinoids may influence the modulation of parturition and pregnancy, cannabinoids might mediate a direct role in myometrial contraction via CB1 receptor action. This benefit may be valuable to induce labor, nonetheless only if the potential benefits of cannabinoids outweigh feasible edge events.
If these studies have actually reported several obstetrical benefits, why are there no mentions concerning any kind of adverse effects in the unborn? Are these fears unnecessary?
I hope to leave these questions to you, the readers, yet would certainly enjoy to hear their thoughts.
Based on my review of this study, I’m not here to say marijuana is permanently safe to use throughout pregnancy.
“Nothing is a medicine, nothing is a poison – the right dose differentiates the poison and medicine.” – Paracelsus (Father of Pharmacology)
As legalization of medical cannabis is underway, it is rather difficult to initiate/conduct clinical trials right away, for every one of ailments. It might take some time. So, it is not feasible to find out the efficient dosage, adverse effects and contraindications in patient population, particularly in pregnant women and unborn. Until it happens, we have to be in wait-and-watch mode.
Better safe Compared to sorry!
