Docs discuss this significant pregnancy risk often overlooked, despite how common it is among patients
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“Just because it is legal doesn't mean it is safe or should be continued during pregnancy, similar to alcohol." — Ilina Pluym, MD, OB/GYN and assistant clinical professor at David Geffen School of Medicine, UCLA
“Don't be judgmental. Just give the information that you have readily available.” — G. Thomas Ruiz, MD, board-certified OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA
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“Just because it is legal doesn't mean it is safe or should be continued during pregnancy, similar to alcohol,” Ilina Pluym, MD, an OB/GYN and assistant clinical professor David Geffen School of Medicine at UCLA, tells MDLinx.
Given the known health risks of marijuana use in pregnancy, MDLinx asked physicians to weigh in on how to effectively counsel pregnant patients about their use. Here’s what they had to say.
Outlining the risks
“Marijuana use during pregnancy is associated with risks to mother and baby. Studies have shown that prenatal cannabis exposure is linked to an increased risk of preterm birth, low birth weight, and small-for-gestational-age infants,” says Dr. Pluym.
“Additionally, there is evidence suggesting that in utero exposure to marijuana can have significant and lasting impacts on a child's neurodevelopment and behavior, including higher risks of attention-deficit/hyperactivity disorder, and autism spectrum disorder.”
"Overall, the consensus in the medical literature strongly discourages the use of marijuana during pregnancy."
— Ilina Pluym, MD
The CDC notes that more research is necessary to properly understand how use of cannabis can impact mother and baby during pregnancy. But the agency recommends that pregnant people don’t use cannabis.[]
Dr. Pluym says that for some pregnant people, cannabis may be used in self-treatment for anxiety or nausea. If that is the case, she suggests providing alternative treatments.
Asking the right questions, in the right way
Taking the time to build trust and rapport with patients, Dr. Pluym argues, is a good place to start when having a conversation about marijuana and other substances.
“Emphasize that the goal is to provide good care for mom and baby, not to punish. It’s helpful to normalize the topic by saying something like ‘We ask all of our patients about substance use in pregnancy, including marijuana.’ You can use open-ended questions such as ‘Can you tell me about any substances or medications you're using’ instead of ‘Do you use marijuana?’" she tells MDlinx.
“You can follow up with ‘What have you read about marijuana use in pregnancy?’ or ‘Are you using it for a particular symptoms like nausea or anxiety?’ Then present the facts about effects on fetal development and growth and child behavior without sounding alarmist," Dr. Pluym continues. "It may be helpful to acknowledge the limit of medicine and that these are all associations, not necessary causations.”
Respectful language is key
When having a discussion with pregnant patients about marijuana use, Dr. Pluym says it’s important to be respectful.
"Avoid legal or punitive language. Reassure the patient that your goal is a healthy mom and healthy baby and not to report to the authorities. Ultimately you want to respect patient autonomy, and should the patient continue to use this after your discussion, support her choices and remain available to continue the conversation and answer questions as they come up,” she says.
G. Thomas Ruiz, MD, board-certified OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, says the key is to provide information needed in a non-judgmental way.
“Just give the information that you have readily available. You want to try and encourage the patient to have a relationship so that they'll follow your advice. You don't want to be in a confrontational relationship,” he tells MDLinx.
“The most important thing is making patients aware that there may be increased risk. So if they want to minimize that risk, there are certain things that they can do. [In] that short-term period when you're trying to have a healthy baby, there are certain sacrifices that you may want to make, and our job is just to give them that information so they can make the best decision.”
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