Effects of Marijuana in Reproduction + Postpartum

Sorry, they’re not good.

In the wake of marijuana becoming legal both medically and recreationally, its use and safety within different populations is coming to the forefront. With many populations, cannabis can be safe and really great. Marijuana and pregnancy? Not so much. For a woman who is trying to conceive, is pregnant, is postpartum and/or breastfeeding, the use of the cannabis plants can have significant consequences for both the mother and the child. This is a multifactorial issue: there’s the matters of agricultural pollutants used in growing marijuana, the metabolites in marijuana itself (ex THC or CBD), and its effects on the more vulnerable the population at hand.

I will be covering the basics of specific marijuana metabolites, their pathways, how it is grown, and its misuse in both the reproductive health and the postpartum period. This talk is to educate and empower practitioners and patients alike on how to educate on the use of marijuana. I am going to discuss the effects on infant brain development, perinatal mood disorders that may be amplified with marijuana use, the passage of the marijuana components in breastmilk and the effects it has on continuing the growing family, its effects on the reproductive system in general, and its effects on postpartum depression and psychosis etc.

For everyone’s knowledge, this topic is a crossover of all of my fields of study. I began working on organic farms at age 17 up until I attended medical school. After college I began studying midwifery and assisting home-births, and continued in that field for 13 years. Now, I am an naturopathic physician that focuses on the reproductive period specializing in fertility and postpartum health and perinatal mood disorders. Not to mention, I love the Grateful Dead. I am not anti-cannabis. I think it’s great for a million reasons. But with anything that has a positive effect, there is a negative side always. You can eat too much celery and it will give you diarrhea right?

Marijuana is now the number one most abused substance in pregnancy: 40-60% of people who used it prior to pregnancy continue throughout. Marijuana cultivation is NOT what is has been historically. The art of cultivation has become its own science and with that a stronger more powerful plant. This is not the “lids” your parents were messing with in the 80s.

Weed is different now. Currently we have 33 states that have medical marijuana and 10 states that have recreational marijuana. More research is being gathered due to the less severe restrictions, and also willing moms to solicit information.

First, let’s talk about the plant itself…..

Hemp and marijuana are both the same species of plant, but they are different.

In the USA Marijuana is defined as any Cannabis Sativa plant that has a >0.3% THC content (tetrahydrocannabinol). There is a weird crossover here. The FDA (the Food and Drug Administration) refers to the plant as CBD, but the same exact plant is referred to as hemp by the USDA. It’s the same plant, with the same regulation. It’s the same plant with the same regulation. Gross? Yes! The same agricultural rules are used on what is meant for paper and fabric products, as for the “CBD” supplements at the grocery store.

The FDA regulates food and medicines, things for consumption. The USDA regulates pesticides, seeds, etc. It’s rare that you find a commodity in this cross section, and the negative publicity results from FDA being for medicine, yet the regulations are not there. In complete disarray from the federal government, no one knows how to regulate the plant. Regulations are a bittersweet thing, it’s a process, it will take years and rarely designed to help people, because it is created for commodity.

The other consideration is the state vs federal legality contradiction, which to put it simply, hemp is federally legal and state run, but the fungicides used in it are regulated by the state as well. The whole thing is in complete disarray from the federal government, no one knows how to regulate the plant. Regulations can venture down different paths, and if states go “recreational” marijuana regulations will be much like alcohol and tobacco – not regulations used by medicine – and funding for research for uses such as cancer, low appetite, chronic pain, etc., will be tossed to the wayside.

Back to plant basics:

There are male and female versions of both species: the female is what produces flower, and for medicinal purposes that is what is used for medicine extraction in both plants. With hemp, whole plants can be used for paper, fibers, etc. Industrial hemp mainly uses stalks.

There are about 700 active constituents in marijuana, THC being the most popular one, because it’s the one that gets you high (others do as well). THC has psychoactive properties and is distributed to the brain and adipose tissue (1). Meaning it gets stored in the fat (the brain is VERY fatty). Depending upon your adipose density, distribution, metabolism or level of activity, this is stored in for a minimum of 30 days but more like 60-90 for a more sedentary person.

CBD: is cannabidiol. Cannabidiol produces many effects through multiple molecular pathways. The scientific literature has identified more than 65 molecular targets of CBD. CBD directly activates the 5-HT1A (hydroxytryptamine) serotonin receptor, thereby creating an anti-anxiety effect. The G-coupled protein receptor is implicated in a range of biological and neurological processes, including (but not limited to) anxiety, addiction, appetite, sleep, pain perception, nausea and vomiting. The CBD oil you are finding in your grocery store or local coffee shop is made exclusively from the hemp plant. This product is a joke and largely placebo pending the quality of the product, (I will get into why in a minute) this is mostly industrial hemp oil.

Full Spectrum CBD oil (also referred to as isolate or broad spectrum) contains other phytonutrients besides CBD

High resin producing cannabis plants (which are largely marijuana plants) have up-regulated genes for cannabinoid synthesis with greater diversity in constituents adding more therapeutic and also potentially dangerous aspects of the plant.

CBD needs the presence of THC to work effectively! They are synergistic, best friends!

Endocannabioid system: what is it and what is it used for?

The ECS is an endogenous LIPID (meaning fat) based system of neurotransmitters than bind to cannabinoid receptors that got through the Central nervous system and Peripheral nervous system, which involve psychological and cognitive processes, including fertility, pre and post-natal development, and activate the immune system. Its primary goal is to cause homeostasis, meaning, if something is off, it picks up the slack and creates balance. There are 2 primary cannabinoid receptors CB1 (brain and nervous system), and CB2 which are mostly in the peripheral tissues of the immune system, spleen, tonsils and thymus gland, and regulate cytokines (monocytes, macrophages, b cells, and T cells, aka specific immune system fighters). They are also found in the brain (hippocampus) and the GI system in which they are responsible for regulating the inflammatory response, and reducing gut motility.

Ok I am going to get a little scientific so try to follow. The CB1 Receptor which is found on the neurons and glial cells in the brain (think the antennas or signal receivers in the brain) – when there is THC PRESENT it binds to CB1 directly and creates euphoric effects. CBD has 100 times less affinity to CB2 Receptors than THC. However, delta 9 tetrahydrocannabinol breaks off of THC to help CBD bind to CBD2 receptors to ignite the endocannabinoid pathway to work. 3% of THC is necessary for this to happen, otherwise there is no real biding and no system is truly activated. Thus THC is still present and necessary.

Are you still with me?

Sorry, it’s a lot. But to understand the process, you need to understand the plant and how it works.

And remember, currently the average THC content of a flower sold in a dispensary is around 24% and can be higher. Back in your Moms’ day, it was likely around 7%. Very different.

CBD: Hemp Looking at USDA

Most cannabis studies are usually referring to the synthesized form of cannabinoids, pharmaceutical (marinol, etc.). Read the FDA’s memo on the government perspective through the lens on double blind studies . However, looking at full spectrum oils that aren’t using nanotechnologies; it’s a completely different world, and dangerous. In terms of the plant cultivation, the much preferred organic regiment via terpene isn’t actually always organic, and again this is regulated by the USDA.

Hemp pesticides are listed on the CDA website and the hempMED website for medical approved uses. This is a cool resource and also terrifying if you have any clue on pesticide effects.

So in each state, the Department of Agriculture is who regulates the cannabis industry.

So here is where we start seeing the hormonal cascade begin. Environmental toxins are often endocrine disruptors. One of the biggest things in cannabis is that its hormonal (ethylene blockers) are used to feminized seeds. Who cares? Well, the female stress response does. Ethylene blockers are responsible for stimulating and inhibiting growth within the plant world and also (2) in the human body. Ethylene blockers are considered one of the top 12 endocrine disruptors along with popular compounds like lead and fire retardants (yikes!).

With various sprays in the field as they are concentrated at extraction (ethanol), you will have a concentration in insecticides, nematodes, and miticides. Looking at these guys at first glance, with no agriculture background, you may think that they seem natural enough. However, they are not and are very toxic!

The compounds themselves have a really long half- life, therefore it’s safe to assume their presence in breastmilk also being at a higher concentration for longer. Once you get pregnant, you aren’t “detoxing” as much/in the same way and you store fat easier. Ultimately this is to hold on so you have energy stored for the baby in case you need it during gestation, and in addition so your milk is super dense with fat and fat soluble nutrients.

Now, many of the pesticides are lipophilic, meaning they get sucked up by your fat cells and get stored there. So with breastfeeding, you will then be giving that pesticide directly to the baby. Let’s look at a couple of the common pesticides used in cannabis cultivation and their side effects:

Azadirachtin (neem): Exposures can vomiting, seizures, metabolic acidosis, and toxic encephalopathy.

Copper octanoate: inhalation of this substance blocks zinc absorption and downregulates/changes Th1 and Th2 immune responses: triggering AI disease, upregulated pro inflammatory cytokines etc.

Pyrethrins: associated with infant thyroid issues, language receptivity, physical motor skills and feeding dysregulation, social relationships with children.

Eagle 20: converts to cyanide, which prolonged exposure is linked to spontaneous degenerative diseases, pernicious anemia, optic neuropathy, Parkinson’s, cognitive development, diabetes and pancreatic issues.

Glyphosate is allowed to be sprayed in fallow field which are fields next for year or soy or corn farms Glyphosate is not allowed to be spayed directly on the marijuana plant directlysed to kill Aphids, russet mites, and caterpillars, but is very known for its endocrine disrupting and carcinogenic effect, and increased non-Hodgkin’s lymphoma in children, (3) especially recently with their use on oats. Other side effects of glyphosate exposure is miscarriage, autoimmune disease, mental and chronic illness.

This is the other piece of the puzzle that brings it all in. In cannabis, cultivation is geared towards feminization, because a male plant or hermaphrodited plant will produce seeds and not be as potent. At the end of a female cannabis’s plant’s life or when she is really stressed/feeling threatening, she can hermaphrodite and produce seeds. Cannabis cultivation does not want this to happen and therefore the stabilization of the feminine plant is phyto-estrogen driven within the nutrients that are used during the stages of cultivation (it’s rare to just grow the plant in soil that is not modified or fed consistently)

Also in cultivation, there is a term called “flushing”, when you rid the plants or all of the potential pesticides, etc. at the end of its life cycle. This is a practice of both ethics and quality, but often not performed. When this is not performed, the pesticides and nutrient feed particles are then stored in the plant and thus ingested. There are no regulations stating that they need to be flushed appropriately or ways of testing the plant to ensure that process what done successfully. There is no mold testing in most states for recreational cannabis, however it is often that there is in testing for medicinal! Meaning you could very likely be smoking/ingesting mold!

Mold is SUPER common in cannabis due to the nature of the flower and its density. There is no standardized testing facilities for recreational cannabis, thus the products are unregulated. Medical cannabis does have standards in some states but with the push of the market to be more recreational, the drive for money to be invested into cannabis as medicine is getting slimmer by the day.

In Oregon there is less recreational testing, in Colorado there is more. Again, every state will vary in the way they handle products, except CBD which again, is under federal law and falls under the USDA’s regulation for cultivation. With that said, Hemp is not tested really at all and not third party tested. Thus with that knowledge, no immune compromised, pregnant or breastfeeding person should be consuming off the shelf CBD. As it is regulated as a commodity, not a medical product, and is regulated by the USDA. If you want to check me right now and argue that most herbal products are also under this same rule and regulation then I would absolutely agree.

Many herbal companies, tinctures and dried herbal extracts are not great with their practices. But there are some that ARE and have very stringent practices with their cultivation. Any of my patients will tell you I am very particular on what herb comes from where and how the medicinal component is extracted. It’s a quality issue. But, people aren’t taking red clover or Maca to get high, so the drive behind many of those products is driven by the medicinal effect, not the euphoric factor.

But, there are many herbs in general that are dangerous for certain populations, and interact with different drugs, and it can definitely be a problem with the level of access and lack of education from consumer and practitioner. Herbalism shouldn’t be taken lightly, and it can have serious and at times fatal interactions.

Many marijuana companies that have great reputations don’t have vertical supply over their chains. On the recreational side of things is a completely commercial system that is designed for transaction, not for healing. The whole thing is structured for taxes, so it’s going to be a commercial system. The overall prediction is that recreational eventually will be run by the ATF (alcohol tobacco and firearms). Anything medical will go through the pharmaceutical industry and be isolated as synthetic.

Oregon is a total T state, which means hemp is defined under .3% delta 9, plus thc, plus derivatives. But this is considered a “final interim rule” which is a standing law that the USDA is projected to take 2+ years to deem rule (this was pre COVID so who knows when now!)

You need to 1000mg of CBD, 1000mg THC: deep transudation, deep RSO made from cannabis, rice grain type pellet, and then the endocannabinoid system starts apoptosis. That is a really high dose and if you have no idea what that means we can sum it up that you can’t use hemp or recreational marijuana for healing or medicine. But the term medical marijuana is in itself illegal.

Modalities of use:

Topical

Transdermal

Suppository, both vaginally and rectally

Ingested

Smoked

Vaporized

Dabs

All of these modes of consumption have variations of effects and risks within the system, this is a whole talk within itself!

WHAT IT DOES IN THE BODY: Finally!

Fertility Complications:

So now that you understand the plant itself, you can understand where this conversation might go, and for the context of fertility, it does not have positive effects, and can make conception difficult. In men, cannabis decreases testosterone, (3) which decreases sperm count volume and effects semen morphology/quality pending the way it was administered in the body. It decreases sperm count for three months with one episode of marijuana use (4). And testosterone levels decrease by 50%! It is difficult to increase testosterone and some studies are showing that these effects are permanent.

ACOG reviewed a study stating that women whose partners use marijuana at least once per week have an average of 4 times the amount of miscarriages. (5)

Testosterone is also a driver of egg quality for women; we are like goldilocks and need a certain amount of testosterone to have a healthy viable egg to implant. Marijuana use decreases egg viability and effects egg quality and antioxidant levels within the female reproductive system.

THC stores for at least 30+ days in fat/adipose (90 days in some cases depending upon metabolism and concentration of adipose). So when you are trying to conceive, suppose you are exercising, then you are releasing those metabolites into your system and having it effect you reproductively.

Then with pregnancy, you are mostly storing fat, right? In preparation for the baby and for breastfeeding. Whenever those fat cells are mobilized that is when you are releasing the metabolites, so it’s not just about active use but about past uses as well.

It crosses the placenta! Yes! It does!

Pregnancy complications:

Maternal diabetes

Rupture of membranes
Premature onset of labor
Use of prenatal care
Duration of labor
Placental abruption
Secondary arrest of labor
Elevated blood pressure
Hyperemesis gravidarum
Maternal bleeding after 20 weeks
Antepartum or postpartum hemorrhage
Maternal weight gain
Maternal postnatal issues
Duration of maternal hospital stay
Hormone concentrations

Evidence of miscarriage, stillbirth, intrauterine growth restriction and low birth weight, five-fold increase in dysmorphic features associated with Fetal alcohol syndrome, impaired fetal neurodevelopment, childhood attention, and learning disorders. (6)

Fetal brain growth: What we are concerned about is its effects on hormones and cognitive development, and pathway establishment and a recent huge study was released stating that marijuana use during pregnancy has links to increase chances that the child will develop autism. (7) Studies on rats have shown alterations in neurotransmitters signaling, which again, neurotransmitters are the messenger system between your nerves and your cells.

Neuroimaging of habitual marijuana use in teens have noted smaller cortical and subcortical volume, so it is safe to assume that early exposure will have much more extreme effects.

Lactation: increased tremor, poor sucking reflex, decreased feeding time, slow weight gain, changes in visual responses and delay of motor development. So with the knowledge that the prefrontal cortex isn’t developed until the age of 25, you can understand the impacts on use.

This mimics fetal alcohol syndrome: Ottowa study 1978 and MHPCD study in 1982 showed behavior problems, language comprehension, ADD, memory difficulties, worse academic performance, depression, hyperactivity, anxiety

And in 2002: maternal use: more aggression and inattention at 18 months.

Postpartum:

Messes with breastfeeding: Why?

It inhibits prolactin. This is a female plant and like I mentioned before, it is hormonally driven. The more secure you can make the plant female, the stronger the oils within the plant, the stronger the effects. Estrogen inhibits prolactin, which decreases milk supply.

TCH/CBD are going to flood dopamine pathway, which then runs it dry and not allowing for its endogenous signals to release appropriately. And it inhibits dopamine. This is a big deal…

Dopamine, serotonin, oxytocin, and endorphins are the quartet responsible for our happiness

Dopamine is how we feel and perceive please, it’s a big part of how we formulate planning and thinking, focus and how and what we perceive to be interesting. Its directly also correlated with heart rate, blood vessel function, kidney function, lactation, sleep, mood, attention, pain processing and it controls the nausea and vomiting center

THC and CBD/potentially other endocannabinoids are also going to effect the HPA axis which will inhibit oxytocin. Oxytocin is the love hormone that encourages bonding to baby (the smell of the baby’s head for example). This is huge. Concern for moms who are already suffering from postpartum mood disorders. THC/CBD use causes a rush of dopamine, which inhibits.

It’s a dissociative, which is the opposite of what is needed, especially in incidences of trauma history or birth related hardship.

Initially with postpartum, oxytocin is needed for the uterus to shrink, risk of postpartum hemorrhage increases when that is not bioavailable or inhibited. Within the initial period of postpartum, gonadal steroid hormones have a new adaptive pathway to undergo, as the woman is no longer pregnant so that shift occurs. Levels of estradiol and progesterone drop DRASTICALLY, which often is the catalyst for initial baby blues or subsequent PPD. This is almost like a withdrawal from a drug – the effects are that jarring to the system.

Then we have the HPA axis, which is also under serious flux with the previously stated gonadal distress and increased cortisol levels (from not sleeping, being responsible for a new child, and undergoing physical and emotional exhaustion). HPA can either be hyper or hypo regulated. This then precipitates, and can be the catalyst for thyroid disorders, which as we know can be an undiagnosed reason for PPD.

Usually this is aided/softened by the presence of dopamine/oxytocin which would be decreased with CBD/THC use. The other consideration here is the presence of bromines and other micronutrients that would inhibit thyroid function that are present in both the agricultural feed and the herbicides used.

This decrease of oxytocin will interfere with bonding, inhibit lactation and the drive to breastfeed. And if the mother chooses to NOT breastfeed (which breastfeeding causes a feedback loop increasing oxytocin levels in the first 6 months) then she may struggle more with baby bonding and thus increase her risk for perinatal mood disorders.

Decrease in oxytocin can also be correlated with risks of poor care: not giving their baby the emotional and physical attention they need, not taking them to the doctors/seeking outside care, etc. We know that children of depressed mothers are at risk of a wide range of cognitive, emotional, medical and behavioral problems and the use of THC and CBD may magnify those statistics and outcome.

Oxytocin plays a major role in regulating the onset of maternal behavior, with antidepressant and anxiolytic, and found in concentrations of the placenta, which is one of the medical benefits of consuming placenta (however I do not encourage that practice to due risk in Group B strep).

It gets stored in adipose and thus can be released in breastmilk ranging from 6 days after mom’s consumption to 6 weeks. And infant will test positive for marijuana in urine for 2-5 weeks after ingestion break milk with THC depending on the mother’s ability to absorb and process THC, mainly a liver and fat cell issue. THC has a similar metabolism to alcohol in the moment; however it’s metabolites get stored differently because it is lipophilic and stays within the system longer. (8)

Risks with mental health:

Marijuana use is linked to an increased risk of psychiatric problems including anxiety, depression, schizophrenia, and post-traumatic stress disorder. Research indicates that marijuana use with these conditions at onset will worsen trajectory and an increase in ADHD, behavior issues, cognitive decline potentially at a later age, potentially not seen until puberty.

All in all, there is a balance, good and bad with everything. Just because something is “natural” does not mean it is safe, and does not mean it should be consumed. Marijuana is so great for so many things, both medicinally and recreationally. But with any good, there is bad, with any up there is down. Marijuana education and safety should be a priority with women who are considering having a baby

With the evolution of its legality in recent times, many mothers and moms-to-be view marijuana as the safe alternative to alcohol and other inebriants. Unfortunately, there’s plenty of research highlighting the range of complications that cannabis consumption can induce in both reproduction and postpartum. Here’s a link to a detailed article I wrote concerning the risks and dangers.

On a lighter note, my office has moved. I am now located at 1616 SE Ankeny St. just off east Burnside, and back to seeing patients in person! My schedule is seeing patients in person on Mondays and Fridays, and telemedicine on Mondays, Wednesdays, and Fridays. Due to the rise in covid cases I am encouraging patients to not book an in person visit unless a physical exam is necessary.

Dr. Noe King