Unexplainable - Expecting: Weed and pregnancy

Episode Date: May 24, 2023

Many states have extremely punitive policies around cannabis and pregnancy. But researchers don't actually have great data on cannabis's harms. For more, go to http://vox.com/unexplainable It’s a great place to view show transcripts and read more about the topics on our show. Also, email us! [e-mail] We read every email. Support Unexplainable by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Karen Landman is it a great person to come to with questions. And a few months ago, a friend of mine asked me if it was okay for her to continue smoking pot while she was pregnant. Karen is such a great person to ask this kind of question because she's a physician and she's also a health and science reporter here at Vox. So she started digging around for answers for her friend, trying to figure out, you know, is weed safe to use during pregnancy? and she found out that her friend was not alone. A lot of people have this question. In my research, I ran across a website and a podcast called Blunt Blowin Mama by this woman named Chinatria Anthony. And it's all about giving mom's advice about how to safely use weed.

And so I reached out to talk to her. I spoke into, I want to say at this point, hundreds of women, they're asking for understanding. They're asking for guidance. They're asking for support. These parents asking Shinitria for guidance and support, they often didn't feel safe going to their doctors for advice. Telling a medical provider can flag, they can flag you, and that can cause problems. Each state is different, but even if you're in a legal state, you can face consequences. Big consequences, like having your kid taken away or getting locked up.

It's scary, and I always tell people that the biggest fear and risk for a problem, person who decides to use cannabis during pregnancy is the legal ramifications that may follow if someone finds out. So I always tell them, you know, don't tell anyone. Don't tell anyone. But Karen found that these laws and these consequences, they don't really square with the science. Honestly, we really don't know all that much about how weed affects a fetus. I mean, there's a ton of data out there, lots and lots of studies for decades. People have been studying this, but the science is still pretty inconclusive. There are a lot of unknowns, and yet the policies on this are incredibly harsh, especially because, you know, cannabis is legal in more than 20 states, and yet we still include it

among drugs for which we will really, really severely punish parents for using them while they're pregnant. It just didn't line up for me. This is Unexplainable. I'm Bird Pinkerton, and this is the final episode of our series, Expecting, about how scientific mysteries about pregnancy affect parents. In this series, we have looked at how a fetus can change a parent's cells and how a child can change a parent's brain. But on today's show, we're looking at one question, this question of how much weed a person

can or should use during pregnancy, to understand an even broader problem. When we lack answers about pregnancy, what is the impact on parents? What is the impact on their bodies, on their lives, and even on their freedom? So Karen Landman, first of all, I feel like there are a bunch of different terms for weed. But like, what is the difference between, like, cannabis and weed and CBD oil and what, like, all the sort of products that are out there? Now, gosh. Well, basically, when we say marijuana and weed and pot and grass and hash, we generally mean the same thing. We mean the flower of the cannabis plant. And products that include the psychoactive chemicals that that flower contains. And the most important one for these purposes is Delta 9 and tetrahydro-canabinol, which we usually abbreviate as THC. Okay. So if we just use the term like weed as an umbrella term throughout, we can just assume we're referring to like THC specifically, the thing that kind of like gets you high within weed. Yeah.

Okay. So why are pregnant parents using weed to begin with? So most of them use it for nausea and vomiting. I saw a study where like 70% of the people who use cannabis while. were pregnant, we're using it for morning sickness or similar related symptoms. But people use it for lots of different things. In addition to morning sickness, people use it to treat pain and to help stimulate appetite, to help them sleep, to deal with anxiety and depression. A lot of people are using it for symptom management. And they haven't actually been told by a doctor to use it for that, but they just know that it works for that. I talked to Katrina Marks. She's an OBGYN, an addiction medicine specialist who works in Baltimore.

So I'm dual board certified in both OBGYN and addiction medicine. And she said that the biggest questions that she gets is how safe is cannabis during pregnancy or what are the risks of cannabis during pregnancy? And, you know, if you pick up a pack of cigarettes or a bottle of alcohol, there's messaging on there from the surgeon general about risks in pregnancy, but that doesn't exist with cannabis. Is it super common to use it? Like, are a lot of people doing this or is this a small? A ton of people are doing it.

Really? Yeah. So I saw studies where, you know, in states where it's legal, like 7% of pregnant people use cannabis while they're pregnant. Oh, okay. Yeah, it's a lot, right? And that number is even higher if you look at communities where the norms might be a little bit different.

You know, I saw some data suggesting that anywhere between like 15 and almost 30% of young urban women use cannabis while they're pregnant. So if I'm pregnant, um, I'm not. But, you know, let's say I had a fetus. What's going on in there? Like, how is my consumption of, say, food or weed or whatever than getting down to the fetus? So everything that's in a parent's bloodstream basically gets kind of run through or run past the placenta before it hits the baby. And can THC get through? Like, can weed get through? It can. We don't know exactly. how much does. But yeah, so weed or its metabolites, which is a fancy way of saying, like, all the

little things that weed gets broken down to, that THD gets broken down to inside the adult's body, all of that can pass through the placenta and into the fetus's bloodstream. But there's a filtering process, right? Less of it ends up in the fetus's bloodstream than is in the parent's bloodstream. We have some older observational studies that suggest a fraction of the THC that's in the parent actually ends up in the fetus, maybe around three to seven times less. Is the fetus? This is such a dumb question. Is the fetus getting high?

Great question. It's not a dumb question. We have no idea. We really don't know. Yeah. I mean, yeah, how do you even measure? Right? So what do we know here?

Not just about like fetus is getting high or not getting high, but like, so what do we know? about how weed is potentially affecting these fetuses. Well, okay, so we know that there are receptors both in the placenta and in the developing fetuses' brain that are nerve cells that can be seen and attached to by THC. But like Katrina Marks told me, we really don't know a whole lot about what that means. We know that it gets to the fetus. And then there's just a lot of biological plausibility there that as the brain is developing and you're developing all of these different receptors that being exposed

to a substance like this would affect those areas of the brain and development. We also have a lot of information about birth weight and about head circumference, which are a little bit more concrete, but that doesn't really give us the kind of information we want. That's not actually what we care about, right? We don't care about the birth weight. We care about it's the long-term effects on that human being as they grew up. If you were to observe and compare groups of parents who did and did not use cannabis during pregnancy and then follow their kids out for years, you would find that there are some small

differences in attention, in behavior, and in learning that are detrimental. So negative effects in these areas for the kids of the folks who smoked cannabis, or used cannabis, I should say. What kind of detrimental? There's deficits in being able to pay attention. Deficits in, there's some studies that found that there's a little bit more aggression at certain ages and oddly skewed toward girls born to folks who used cannabis compared with those who didn't. How intense are these effects?

They're measurable differences, but they're still within the range of normal, which makes, you know, you can imagine that makes it kind of complicated. And you were saying before these are, they're observing this, it sounds like, like these are like observational studies, which is very different from like a randomized control trial or something, right? Yeah. So that randomized control trial is kind of the gold standard of medical drug testing. It's where you basically take two groups of people and one group takes the medicine or takes the drug and the other group doesn't. And you try to get people from the same racial ethic background, the same financial background, all kinds of similar. so that you're basically comparing only one thing, which is whether they're using the drug or not. You can't do that in pregnant folks very easily, period, but you especially cannot do it with a drug that is illegal and that we suspect has some detrimental effects. So we don't have that kind of data in pregnant folks. What we have are data where we just follow the kids of folks who are in each one of

these groups to see if they're different. And that means we have a really hard time separating out all the other things that might go along with using cannabis while you're pregnant, like having, I mean, this is on the extreme man, but like having unmedicated anxiety or depression, or, you know, living in a low-income setting. Those kinds of things, we know those are associated with all kinds of neurobehavioral problems in kids. And we have a really hard time separating those out from the actual cannabis effects when we don't have a randomized trial.

So it sounds like what you're saying is we have sort of this weak effect that we've seen in these studies that are not our like gold standard kinds of studies. They're just kind of our like, we looked around and we're seeing what was happening. And here's what we found. How does this compare to the things that we know about like alcohol or smoking, for example, and the effect that it has on a fetus? So I think that what makes it different for alcohol and smoking is that they cause some physical deficits that are. a lot more concrete and easier for doctors like Katrina Marks to measure. Something like fetal alcohol syndrome. You can very clearly point to alcohol and say this is the thing that it causes, where with cannabis, it's much more nebulous. And we don't have an exact

thing to say, if you smoke cannabis in your second trimester, when you're five years old, you'll be diagnosed with ADHD. We don't have that direct causality. So it sounds like there's like a lot of uncertainties here in terms of there's no like huge neon sign saying like, hey, weeds definitely bad. Right. When people ask if it's safe to use cannabis and pregnancy, you know, what they're usually asking is, is this going to have effects on my fetus? But what they're not asking is, you know, compared to what? Like, what is the alternative to using cannabis and pregnancy? Particularly with things like nausea and vomiting, which is one of the reason that a lot of people say that they use it, we kind of fail as medical community.

Like, we don't have great treatments for all of these things. For people who are pregnant and who use cannabis, not using cannabis generally means, you know, one of three alternatives. One is that whatever symptoms they're managing with cannabis are just going to be really severe and untreated. So, like, if they're using cannabis to treat chronic pain or if they're using it to treat morning sickness, they might just have to deal. with the chronic pain or the morning sickness. And I'm not sure if you've heard much about pregnancy,

but it sounds like it's pretty rough on the body. So that's not a great alternative, right? For some folks who use cannabis and pregnancy, the alternative might be a different illicit substance. So they may, instead of using cannabis to manage pain, they might use an opioid to manage pain. We know that opioids have harmful effects on a pregnancy. So that's not a great alternative either. And then, you know, a third alternative is a drug that was developed by the pharmaceutical industry to treat whatever their symptoms are. And those come with their own risks. You know, there's a lot that we don't know. I mean, we just don't know how a whole lot of drugs, both legal and illegal, affect pregnancy.

Is we like a huge outlier here? Or is it kind of representative of actually like a bunch of drugs, like legal or illegal, in terms of what we actually know about how they affect pregnancy? I think for most drugs, it's like weed. About 90% of drugs, we're talking here about FDA-approved drugs. We don't really know what they do in pregnancy, good or bad. 90%? Yeah, it's just, it's hard to study.

It's hard to study drugs in pregnant folks. They're kind of a protected class in research. So there are a lot of restrictions on conducting research in pregnant folks. this is an issue. This is an issue people are trying to do something about because it means that we have a lot fewer options to treat various conditions in pregnant folks because we just don't know what they do. So a lot of what we do know about drug safety and pregnant folks is from observational studies like what we have for cannabis. And that's obviously not ideal. What's the impact of that lack of knowledge on families in the doctor's office? So, you know, parents don't want to hear we don't have options for you. And because there's an absence of knowledge, we have an absence of options. And so people just have to kind of find their own sources, find their own information, do their own personal experiments on what works and doesn't work.

And then we penalize or judge people that find their own ways to treat these symptoms. After the break, it's not just that we don't have answers for parents. It's also that we penalize these unknowns. We only buy we've. So Karen Landman, health and science reporter at Vox, you started investigating the effects of weed on pregnancy when your friend asked you to look into it. And then you found that even though we don't know a ton about how weed could impact a pregnancy or a child, there are actually a lot of potential legal consequences for parents to navigate, right? So what are some of the policies that states have in place? Yeah.

So 24 states have laws that say that drug use during pregnancy and that includes cannabis, because cannabis again is federally illegal, is equivalent to child abuse. What? Yep. That includes some states where recreational use is legal. We start tonight with an investigation into mothers facing jail time for using prescribed medical marijuana. Some of these women are facing life in prison. Life imprisonment. Women being charged with felony child neglect.

after their newborns tested positive for medical marijuana. Child Protective Services was called. I wonder, is this the day that someone's coming to take my baby? So to be completely clear, we have no particularly excellent science indicating that weed has, like, strong, measurable, life-changing effects on a baby and smoking it in almost half the states. constitutes child abuse.

Hennie, in Colorado, substance abuse in pregnancy is considered child abuse. Yes, I mean, it's without, yes, sorry. It's very, you see why it's confusing? That's not where it ends. Three states make it possible for pregnant people to be jailed for using drugs during pregnancy. Are you serious? Which states? Alabama, South Carolina, and Tennessee.

Okay. And in another three, parents can be involuntarily committed to rehab or jail for using cannabis during pregnancy. Before you ask, that's Minnesota, South Dakota, and Wisconsin. So if you're in one of these states with these really, really strict laws, like, say, Alabama or South Dakota, if an expecting parent goes in, what happens if they test positive for weed in a drug test in those states? They don't even have to test positive. They just have to tell the wrong person in the wrong place at the wrong time that they smoked weed while they were pregnant. So there are some really, really horrifying cases pretty recent from Alabama that illustrate this. One is of a woman who was jailed after admitting to cops that she'd smoked pot the day she learned she was pregnant.

And the county where she was detained wouldn't let her leave jail unless she went to drug rehab. But the drug rehab refused her because they said, She's not addicted. She's just a casual marijuana user. So she was stuck in jail pregnant for three months. Oh, my God. Because the county's laws wouldn't let her leave without a rehab plan. I mean, she eventually was let out.

But, I mean, there are other cases. An Arizona woman is getting national attention after using medical marijuana legally during her pregnancy. In Arizona, a woman who actually worked for child protective services had a script for using cannabis to treat morning sickness. and was charged with child abuse and neglect, put on a child abuse registry. DCS said Regelton neglected the child by exposing him prenatally to cannabis. I think the state Supreme Court has ordered that charge reversed and ordered her removed from that registry. But, I mean, she had, you know, a doctor's approval, a doctor's instruction even to use cannabis to manage her symptoms. And that, even that did not protect her from these laws.

What? Part of this is because cannabis is still illegal. under federal law. And so there's a federal policy called CARA. That's the Comprehensive Addiction and Recovery Act. And it applies to cannabis use as well as other drugs. And it was passed in 2016, so relatively recently. And what it does is require states to address the needs of newborns who were exposed to substances in utero. And even though you can't test a pregnant person for drugs without their consent. Babies can be tested without the parents' consent. And under Cara, if a baby tests positive for a substance, then whatever the state's policy around that substance

use and pregnancy gets applied. Hospitals get to make their own policies about whether they test newborns for drugs. But states make the policies about what hospitals have to do with that information once they get it. And so while some states don't have punitive policies around it, others do. And so it's just incredibly, incredibly confusing. So these policies are not being made in response to science, it sounds like, because there's this vacuum. These policies are being made in response to weed being illegal on a federal level. And so it sort of like trickles down into these punitive laws. Right. If these kinds of policies were being made based on science, then we would have them related to tobacco. We don't have these policies around tobacco. So to be totally clear,

like, we do have very good data on tobacco having like measurable negative effects in babies, but we don't punish those things. Instead, we punish consuming a thing that does not seem to create measurable differences in babies. Yep. That's the decision we made. That's basically right. And I think part of that is that tobacco is legal in this country. And the existence of these policies is arguably itself very harmful. It causes a lot of stigma.

It causes, like I said, a lot of confusion. And that stigma, that confusion that these punitive policies cause could likely cause a lot more harm to fetuses than the actual drug use itself does. Yeah. Yeah, like, what does this mean for the care both of the parents and the fetuses? So to many parents, this thicket of policies and the stories that keep coming out about the people who are on the business end of these policies make them feel like prenatal care and like delivering in a hospital are just a trap. And that's especially true for parents of color. For example, black newborn babies are a lot more likely to be drug tested than white newborns. In one study, you know, clinicians ordered drug tests for seven-ish percent of black newborns compared with about two percent of white newborns.

So that just means you're going to be applying these punitive policies disproportionately to people who already distrust health care because it makes them feel like health care providers are an extension of law enforcement. The space between a health care provider and a patient should be a place of trust. but it introduces an immense amount of distrust into that space. The laws don't make any sense, and I think they really stand in the way of people accessing appropriate medical care. For providers like Katrina Marks, this has a huge impact on the relationships she has with her patients. I dream of a day where all I have to talk to people about

is the actual health impacts of things and not the legal aspects of it. And it also has a huge impact on moms like Shinitra Anthony. So I just wish in a world, like, we could go to these care providers and they can provide a support on how to care for ourselves. Yes, pregnancy is a blessing and it's all about the baby, but it's about mom, too. Yeah. It's really hard to come out and be the one that's, like, viewed as pro-drugs, right? Which, like, I'm not pro-drugs.

I'm pro-medical care and accurate information. I feel very strongly that punitive action. and legal policies are not the solution here. You know, we see this in the literature that punitive policies really have a strong effect on whether pregnant folks seek prenatal care, and that we know has an effect on child health. When people come to prenatal care, their outcomes are much better, even if they continue to use drugs. And so this system that we've set up, that people are afraid to come to care because there are

these reporting laws that they may or may not understand, the provider may not understand, it really sets up, again, this mutual distrust. And so then people don't come to care. And then that causes negative impacts on their pregnancy. Is the solution here to learn more about the effect of the sort of range of drugs on pregnancy? Or is it to change the policy? Like, what should the future look like here? You really have to look at this and ask, what are we, like we meaning public health and

policymakers and health care more broadly, what are we trying to do here? And what are we actually doing? And what is the gulf between those things? I think, you know, we're never going to get the kind of study that lets us definitively say how much cannabis is safe during pregnancy, when it's safe to use, what forms are safest to use. But we know a lot about the negative impacts of the policies that we've made already. And experts I talked to said that one of the biggest ways to, reduce the negative effects of these policies is to federally legalize cannabis. That would make a big difference. It wouldn't fix the problems that result from punitive policies around other drug use in pregnancy, but it would at least remove cannabis from the list of substances that could trigger those

policies. It just feels like it is hard enough to have a living thing inside of your body growing and changing. And then you throw in all these mysteries, the sort of like policy landscape we've built up around weed. Yeah, I mean, even in some states where weed is legal, they have laws on the books that equate using it during pregnancy with child abuse.

So it's like it's the pregnancy state that makes you a criminal, right? Not the use. It's the fact that you're doing it while pregnant that makes it criminal. And so you have to wonder, where is that coming from? Why are we doing this? Why do we think it makes sense to, as a society, suddenly consider a pregnant person's body a publicly owned and publicly regulated piece of property where different rules apply?

What do providers do? patients do in this situation. It's, these are really hard questions. Throughout the series on pregnancy, I've been looking at the ways that having a kid or being pregnant shapes a parent, like how pregnancy shapes parents' brains and their bodies. Coming into this conversation with Karen, though, I actually thought we would flip that script a little, like that we'd be talking more about how a parent shapes their kid or about the effects of weed on a fetus in the womb, how that shapes the child that comes out. So I was surprised to realize that, actually, this did still wind up being a conversation

about parents, like about how mysteries and unknowns around weed and pregnancy can make this already very difficult process of pregnancy much harder, like how it can shape parents' lives both in the doctor's office and also in the court system. And then, Shinitria told Karen something that made me think of this whole episode beyond just the questions of weed. You're sent home with this baby. You're sent home with your new body, your new reality, your new life. And that's it. I thought that if I asked for help, then I didn't look like a good mom or I didn't look like I was doing it right.

And it's not fair. In pregnancy, it feels like there are a lot of questions with no good answers. and a lot of parents like Shinitria, trying to figure out how to do the best job taking care of their baby and themselves. And we'll never have all the answers to all the questions about pregnancy to give these parents.

But we can make choices about the policies we enact and the environment that we create in doctors' offices that make parents' lives just a little bit easier instead of harder, right? That make things a little more. more fair. For more of Karen's reporting, check out her article on vox.com slash unexplainable. This episode was produced by me, Meredith Hodnott.

I also run the show. We had editing from Brian Resnick, Catherine Wells, Bird Pinkerton, and Noam Hassanfeld. We had sound design and mixing from Christian Ayala, music from Noam. The facts were checked by Tia Nguyen, and Mandy Nguyen is on an awe-inspiring journey. Some sad news, though, Mandy's pigeon Sunny has passed away or is maybe just flying high in the foothills of San Jose. This is a hard loss for the pigeon pants community. Sunny, you will always be the dinosaur of our hearts. Just a quick note, in the episode, Karen says that 24 states consider substance use during pregnancy to be child abuse.

That number is actually 25 states plus the District of Colleen. Thank you so much for listening to our pregnancy series. We have more articles about pregnancy unknowns, and you can check those out at Vox.com slash Unexplainable. And please leave us a review or email us your questions and thoughts at Unexplanable at Vox.com. We really love hearing from you, so please reach out. Unexplainable is part of the Vox Media Podcast Network.

We are off next week, but we will be back in your feed. in June.