Marijuana is the most commonly used illicit drug in the United States, with over 42% of Americans reporting past year use. The effects of marijuana on reproductive health are still unclear, but research suggests that it may have negative impacts on fertility and pregnancy outcomes.
The delta 8 and female fertility is a study that was conducted to see how marijuana use affects the reproductive health of women. Results showed that delta 8, which is a chemical found in weed, can decrease the amount of eggs in ovaries.
In the United States, marijuana is the most often used illegal substance among females of reproductive age and during pregnancy. 1,2 This popularity is mainly due to marijuana’s recent state-level legalization, which has increased its availability as well as its perceived safety.
Jamie O. Lo, MD, works at the Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, and the Department of Obstetrics and Gynecology, School of Medicine, Oregon Health & Science University, Portland.
Because marijuana’s primary active component, -9-tetrahydrocannabinol (THC), may cross the placenta3,4 and is detected in breast milk5, there is additional worry regarding damage to the developing fetus and children, according to current studies.
Carol B. Hanna, PhD, works at the Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, in the Division of Reproductive & Developmental Sciences.
Those who are trying to conceive, pregnant, or breastfeeding should avoid smoking marijuana, according to public health efforts. Many women, however, continue to consume marijuana during pregnancy despite the lack of accessible safety data and literature.
This is concerning, given that marijuana’s strength has risen dramatically in the last decade. 6 THC concentrations in dispensary goods may vary from 17.7% to 23.2 percent, with a maximum of 75.9%. 7
Furthermore, just 17 percent to 31% of THC concentration in goods supplied via state-licensed and online dispensaries is properly labeled. 8,9 With the public’s acceptance of marijuana’s potential advantages increasing, it’s more essential than ever for health care professionals to properly advise patients about the drug’s impact on fertility and future children.
MARIJUANA NUMBER ONE
What exactly is marijuana?
Marijuana is derived from the Cannabis sativa plant, which includes over 600 chemicals and is characterized by cannabinoids, which have therapeutic and psychotropic effects. 4 THC is the primary psychoactive component, a tiny, highly lipophilic molecule that is processed by the liver and has a half-life ranging from 20 to 36 hours in infrequent users to 4 to 5 days in heavy users, with full elimination taking up to 30 days.4
Marijuana is used in a variety of ways.
Marijuana may be delivered in a variety of ways (Table 1). Inhalation, which includes smoking, vaporizing, and dabbing, is the fastest way for THC to reach the body and has the lowest risk of overdose. Smoking has traditionally been the most popular technique, since it produces symptoms quickly (within 1-3 minutes) and for a short time (between 1-3 hours).
Oral absorption may take up to 20 minutes for drops, tinctures, sprays, lollipops, or breath strips to take effect, with effects lasting 1 to 3 hours. GI absorption, on the other hand, comprises sweets, candies, beverages, snacks, and pills that need digestion before experiencing an impact, which may take anywhere from 30 to 90 minutes and last anywhere from 6 to 8 hours.
Edibles are popular, particularly during pregnancy, since they are tasty and unobtrusive, with long-lasting benefits. Because the onset of effects is delayed, these techniques are more likely to lead to overconsumption. There are also alternative techniques, such as topicals, transdermals, and suppositories, for skin absorption.
FERTILITY AND REPRODUCTIVE HEALTH AFFECTS OF MARIJUANA USE
Menstrual cyclicity and ovulation
In general, the research suggests that marijuana usage has some impact on ovulation and menstrual cyclicity. Acute and chronic exposure to high amounts of THC has been demonstrated in preclinical investigations to alter sex hormones (e.g., follicle-stimulating hormone, luteinizing hormone), interrupt ovulation, and cause monthly abnormalities, including amenorrhea. 10-12
Females, on the other hand, have a mixed bag of evidence, ranging from no impact or extended cycle duration only when marijuana was used more than three times in the previous three months to potentially increased anovulation and decreased reproductive hormone levels. 13,14
Marijuana usage has not been shown to have a substantial impact on fecundity. After adjusting for confounders, a large prospective observational research focusing on North American couples trying to conceive revealed no significant relationship between female and male marijuana usage with fecundity. 14
Similarly, a retrospective observational research based on cross-sectional survey data found that marijuana usage, regardless of frequency, did not increase the time it takes to conceive. 15 The possible hazards of preconception marijuana use on fecundity among women with a history of pregnancy loss were recently emphasized in a research (NCT00467363). 16
IVF stands for in vitro fertilization.
According to the research, marijuana usage before conception has a detrimental impact on the success of in vitro fertilization (IVF). Females who used marijuana during the previous year before IVF and gamete intrafallopian transfer had 25% fewer oocytes recovered and 28% fewer fertile eggs. 17
Furthermore, those who smoked marijuana at the time of study enrollment had twice the adjusted probability of pregnancy loss as those who were former marijuana smokers or had never used (54 percent vs 26 percent; P =.0003), according to a recent prospective study of females using assisted reproductive technology. 18
PREGNANCY AND LACTATION USE
Approximately half of females who use marijuana before to conception continue to use it throughout pregnancy, owing to its antiemetic effects, especially in the first trimester, when development is most susceptible.
Prenatal marijuana usage is estimated to be 2 percent to 5 percent in most studies, with up to 30 percent in young, urban, and socioeconomically disadvantaged girls. 1,19 They are more likely to be younger, to use numerous drugs, to have nausea and/or vomiting during pregnancy, to have other life stresses or mental health issues, and to have limited or interrupted prenatal care.
Smoking is the most common method of marijuana delivery during pregnancy, followed by edibles and then vaping, with most women utilizing just one route of marijuana administration. 20
The research on prenatal marijuana exposure that are available are mostly observational or retrospective, complicated by polysubstance use and small sample sizes, and rely on self-report. 19 This is problematic since studies have shown that toxicological screens reveal more females who have used marijuana than self-reported usage. 21
However, current data suggests that maternal marijuana use has certain negative effects, including as intrauterine growth restriction, fetal neurological implications, neonatal intensive care unit hospitalization, and children with poor cognitive development. 19,22
The US surgeon general,23 the American College of Obstetricians and Gynecologists (ACOG),4 and the American Academy of Pediatrics24 all advise pregnant and lactating patients to avoid marijuana use based on the existing data. All agree, however, that more study is required to fully comprehend THC’s effects on the developing brain and children. 4,23,24
Benefits that are believed to exist
The claimed advantages of marijuana usage during pregnancy are the most frequent reason given, particularly for self-treatment of nausea or hyperemesis. Marijuana’s impact on nausea and vomiting during pregnancy is yet unclear. Marijuana is also used to treat melancholy, anxiety, insomnia, tension, and discomfort during pregnancy. All of these diseases have alternate therapies that are better defined in the context of pregnancy.
Premature birth is when a baby is born too soon
The evidence is conflicting, but it seems that marijuana usage increases the chance of premature delivery. Only females who used marijuana at least weekly throughout pregnancy had a substantially higher risk of preterm birth, according to a previous comprehensive review and meta-analysis adjusted for concurrent cigarette use. 25
When only pooled adjusted estimates from individual studies that had been adjusted for confounders were included, no relationship was observed. More recently, a large population-based retrospective cohort research (N= 661,617) in Ontario, Canada, found that maternal marijuana use was linked to an increased risk of premature delivery (RR 1.41; 95 percent CI, 1.36-1.47). 26
Low birth weight and fetal growth restriction
The link between prenatal marijuana use and fetal growth restriction or low birth weight is one of the most researched subjects. Multiple systematic reviews, meta-analyses, and retrospective and prospective investigations have all shown a link between the two, ranging from an 84-gram difference to a 256-gram difference. 19,25,27,28
However, several research failed to account for confounders such as nicotine usage. After correcting for cigarette smoking, a more recent comprehensive systematic review showed a substantially higher risk of low birth weight in females who used marijuana more than weekly, but this trend was not detected when just estimates from individual studies that accounted for all variables were included. 25
Anomalies in fetal structure
Studies have looked at the function of marijuana and its link to structural fetal anatomical abnormalities. 27,29-33 Anomalies of the cardiac, genitourinary, gastrointestinal, and central neurological systems, as well as craniofacial abnormalities such cleft lip and palate, have been previously reported. 29-31,33 Cardiac abnormalities, particularly ventricular septal defects, were the most often observed. 31,33
However, the majority of research found no consistent link between periconceptional marijuana usage and congenital malformations. 27,32
Loss of pregnancy
Prenatal marijuana usage does not seem to be linked to an increased risk of miscarriage or stillbirth, according to the current evidence. 16,19,34 However, the research is inconsistent, in part because studies that show a link are muddled by polysubstance usage, particularly cigarette use, or are too small to establish a genuine connection.
There was no link between preconception marijuana usage and miscarriage in a recent research (NCT00467363) of women who had previously had a first-trimester loss. 16 A prior research that looked at the effects of illegal drug use and smoking on stillbirth found a substantial link between marijuana use and stillbirth, although this effect was reduced when tobacco usage was taken into account. 34
Other issues to consider
There are no links between in utero cannabis exposure and fetal distress, maternal diabetes, ruptured membranes, abruption, hypertension, maternal weight gain, bleeding, or length of maternal hospital stay. 19,27
Neurodevelopment and behavioral consequences in offspring
Currently, there is no significant evidence linking prenatal marijuana exposure to long-term child outcomes such as sudden infant death syndrome, cognition, or academic performance. 19
Prenatal or postnatal marijuana exposure has been shown to have an effect on offspring neurological development, including trembling and a high-pitched cry in babies, decreased fine motor skills and abnormal social behavior in infants, decreased problem-solving skills and memory, depression and anxiety symptoms, decreased attention span in school-aged children, and a predisposition toward delinquent behavior and drug addiction, according to existing studies. 19,27
Most recently, a big retrospective Canadian research discovered a link between mother marijuana usage during pregnancy and the offspring’s risk of autistic spectrum disorder (ASD). 22 In children who had been exposed to marijuana while still in the womb, the incidence of ASD diagnosis was 2.2 percent. Children exposed to cannabis had an ASD diagnosis rate of 4.00 per 1000 person-years (95 percent confidence interval: 3.65-4.38), compared to 2.42 (95 percent confidence interval: 2.39-2.44) among children who were not exposed to cannabis. 22
By the age of ten years, children exposed to marijuana prenatally had a higher prevalence of intellectual impairment and learning problems, but this was less statistically robust, presumably due to residual confounding not accounted for. 22 The researchers were unable to investigate the link between THC exposure during pregnancy and observed childhood health outcomes.
Prenatal THC exposure has been shown to raise the likelihood of subsequent drug use, delinquency, heightened heroin-seeking characteristics, and changed regions of the brain known to influence behavioral responses to different environmental cues linked with reward behaviors in humans and animals. 19,35,36
During pregnancy, you should be monitored.
Prenatal marijuana exposure seems to have a potentially detrimental impact on children, including reduced fetal weight or low birth weight, according to the current data. 19,27 Furthermore, although most studies did not consistently show a link between periconceptional marijuana use and structural anatomic anomalies, Fetal Alcohol Syndrome Disorder has been linked to both fetal congenital malformations and dysmorphic characteristics. 27,29-33
In pregnancies complicated by maternal marijuana use, a thorough fetal anatomic assessment and serial growth ultrasounds should be explored, particularly if the maternal pattern of use is persistent and/or heavy.
In places where marijuana is legal, approximately 5% of nursing females use the drug. 5 THC is extremely lipid soluble and is transported into breast milk, where it is retained in lipid-rich tissues such as the offspring’s brain, possibly affecting neurodevelopmental processes.
THC levels in breast milk peak one hour after inhalation and remain detectable for six days following usage, according to research. 5,37 Exclusively breastfed babies consume 2.5 percent of their mothers’ THC dosage.
Previous research has shown that children exposed to marijuana in utero and during nursing had worse motor development at one year of age than those who were not. 38
Lethargy, less frequent feeding, and shorter feeding periods have also been documented in the literature in babies exposed to THC via breast milk. 39 At this time, no research have properly examined the long-term neurodevelopment consequences of marijuana exposure during nursing.
Hyperemesis caused by cannabinoids
This disease is difficult to detect during pregnancy and is characterized by paradoxical cyclic vomiting in individuals who have used cannabis for a long time. 40 Severe nausea, persistent vomiting, stomach discomfort, and strange, obsessive bathing habits are common symptoms.
Agitation, diaphoresis, tachycardia, postural hypotension, subjective fevers/chills, and weight loss are some of the other symptoms. It’s also resistant to antiemetics, and bouts typically last 24 to 48 hours, but they’ll come back if you keep smoking marijuana. Marijuana abstinence for two weeks is considered long-term treatment. 40
Serum (detects usage in the past 2-3 days), urine (detects use in the past 2-3 days in occasional users or the past few weeks in chronic users), and hair (detects use in the past 2-3 days in occasional users or the past few weeks in chronic users) are all options for maternal testing (detects use up to 90 days prior).
False positives on drug tests have been recorded due to medications such nonsteroidal anti-inflammatory medicines or proton-pump inhibitors, and testing may be influenced by body mass index, frequency of usage, when marijuana was last used, and the delivery vehicle of marijuana utilized.
Synthetic or designer cannabinoids are currently undetectable in standard urine drug tests.
Umbilical cord homogenate and meconium are two neonatal testing techniques. Because THC accumulates uniformly throughout the length of the chord, the location of the section of cord delivered is unimportant. Umbilical cord homogenate is simpler to collect than meconium.
Although meconium testing is more sensitive than cord homogenate testing, it is only accessible after around 24 weeks of pregnancy, is typically passed within 48 hours after delivery, and sometimes requires a concerted effort to collect.
The landscape of marijuana usage is changing, and health care professionals must be flexible in their approach to patients who are trying to conceive, pregnant, or breastfeeding who use marijuana.
- Marijuana usage among females of reproductive age is on the increase, as is the strength of THC in accessible products, and there is enough data to suggest abstention for women who are trying to conceive, pregnant, or nursing.
- Marijuana usage may have a negative impact on fertility by disrupting sex hormones, ovulation, and menstrual cyclicity.
- There is no link between marijuana usage before to conception or during pregnancy and loss or stillbirth.
- Prenatal marijuana usage has been linked to fetal growth restriction, low birth weight, preterm delivery, and admission to the neonatal critical care unit.
- Marijuana usage during pregnancy is not linked to birth abnormalities in any way.
- Marijuana use during pregnancy and nursing has been linked to a child’s cognitive development being hampered.
As the number of states that have legalized marijuana grows, so will the sense of safety. This is worrisome since marijuana’s potency is constantly increasing, implying that our present knowledge of the dangers associated with marijuana usage may soon be obsolete.
There is now enough evidence of damage to advise against using it when trying to conceive, pregnant, or breastfeeding. The American College of Obstetricians and Gynecologists (ACOG) recommends that all patients be screened for marijuana and drug use before conception and during the first trimester of pregnancy (Figure), that accurate information be made available, that counseling be provided, and that treatment referrals be made. 4
The smoking during pregnancy was linked to which of the following in newborns? is a question about the effects of marijuana use on female reproductive health and pregnancy.
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