There is growing evidence that there is an increased use of Marijuana (cannabis) during the perinatal period. This review summarizes pertinent legislation (past and present) and the physiology and pathophysiology of cannabis use during pregnancy. The literature which involves issues concerning cannabis and pregnancy is expanding but at present has many gaps and unanswered questions. The effects on the newborn are significant and treatment recommendations including breastfeeding are presented. Also included is a description of developmental delay during the first 2 years of life in infants exposed to prenatal marijuana. In addition, this commentary discusses the increase use of the newer “synthetic” cannabinoids which have greater psychotropic activity and can cause significant harm.
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Marijuana Tax Act of 1937, Pub. L. 75-238, 50 Stat. 551, enacted August 2, 1937 was a United States Act that placed a tax on sale of cannabis.
Controlled Susbstance Act (CSA). Pub L. 91-513, 84 Stat. 1236, enacted October 27, 1970, codified at 21 U.S.C. 801 et. seq. is the statute establishing federal U.S. drug policy underwhich the manufacture, importation, posseon, use and distrubution of certain substances is regulated.
Compassionate Use Act of 1966 or Proposition 215, California Health and Safety Code, Section 11362.5 is a California law permitting the use of medical cannabis dispite lack of the normal Food and Drug Administration testing for safety and efficacy.
Grigsby TM, Hoffman LM, Moss MJ. Marijuana use and potential implications of marijuana legalization. Pediatr Rev. 2020;41:61–72.
National Institute on Drug Abuse; National Institutes of Health: U.S. Department of Health and Human Services. The science of drug abuse and addiction. Marijuana 2017:1–55.
Roche M, Finn DP. Brain CB2 receptors: Implications for neuro psychiatric disorders. Pharmaceuticals. 2010;3:2517–33.
Bloomfeld MA, Ashok AH, Volkow ND. The effects of delta-9-tetrahydrocannabinol on the dopamine system. Nature. 2016;539:369–77.
Field T, Diego M, Hernandez-Reif M, Figueiredo B, Deeds O, Ascencio A, et al. Prenatal dopamine and neonatal behavior and biochemistry. Infant Behav Dev. 2008;31:590–2.
Sosinsky AZ. The effects of marijuana on embroyo development. Essential Reads, Psychiatric Disorders During Pregnancy. March 29, 2017. Describes cannabinoid signaling necessary for pre-implementation development, uterine receptivity during implantation, and fallopian tube function.
Friedrich J, Khatib D, Parsa K, Santopietro A, Gallicano GI. The grass isn’t always greener. The effects of cannabis on embryological development. BMC Pharmacol Toxicol. 2016;17:45.
Aizpurua-Olaizola O, Elezgarai I, Rico-Barrio I, Zarandona I, Etxebarria N, Usobiaga A. Targeting the endocannabinoid system: future therapeutic strategies. 2016. http://www.sceincedirect.com/science/article/pii/S1259644616302926.
Howlett AC. The cannabinoid receptors. Prostaglandins Other Lipid Mediat. 2002;68–69:619–31.
Salas-Quiroga, A, Díaz-Alonso J, García-Rincón D, Remmers F, Vega D, Gómez-Cañas M, et al. Prenatal exposure to cannabinoids evokes long-lasting functional alterations by targeting CB-1 receptors on developing cortical neurons. PNAS. 2015;112:13693–8.
Fride E. The endocannabinoid-CB receptor system: Importance for development and in pediatric disease. Neuro Endocrinol Lett. 2004;25:24–30.
Deshpande LS. Prolonged cannabinoid exposure alters GABA-A receptor mediated synaptic function in cultured hippocampal neurons. Exp Neurol. 2011;229:264–73.
Pacher P, Mechoulam R. Is lipid signaling through cannabinoid 2 receptors part of a protective system. Prog Lipid Res. 2011;50:193–211.
Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4:1770–804.
Schou J, Prockop LD, Dahlstrom G, Rohde C. Penetration of delta-9-tetrahydrocannabinol and 11-OH-delta-9-tetrahydrocannabinol through the blood-brain barrier. Acta Pharmacol Toxicol. 2009;41:33–8.
Bailey JR, Cunny HC, Paule MG, Slikker W Jr. Fetal disposition of delta-9—tetrahydrocannabinol (THC) during late pregnancy in the rhesus monkey. Toxicol Appl Pharmacol. 1987;90:315–21.
Araujo JR, Goncalves P, Martel F. Effect of cannabinoids upon the uptake of folic acid Be Wo cells. Pharmacology. 2009;83:170–6.
Blazquez C, Gonzalez-feria L, Alvarez L, Haro A, Casanova ML, Guzman M. Cannabinoid inhibit the vascular endothelial growth factor pathway in gliomas. Cancer Res. 2004;64:5617–23.
Carmeliet P. Angiogenesis in health and disease. Nat Med. 2003;9:653–60.
Compagnucci C, Siena SD, Bustamante MB, Giacomo DD, Tommaso MD, Maccarrone M, et al. Type-1(CB1) cannabinoid receptor promotes neuronal differentiation and maturation of neural stem cells. PLoS ONE. 2013;8:e54271.
Tortoriello G, Morris CV, Alpar A, Fuzik J, Shirran SL, Calvigioni D, et al. Miswiring the brain: delta-9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33:668–85.
Rueda D, Navarro B, Martinez-Serrano A, Guzman Ml, Galve-Roperh I. The endocannabinoid anandamide inhibits neuronal progenitor cell differentiation through attenuation of the Rap1/b-Raf/ERK pathway. J Biol Chem. 2002;277:4665–50.
Nadeau V, Charron J. Essential role of the ERK/MAPK pathway in blood-placenta barrier formation. Development. 2014;141:2825–37.
Corson LB, Yamanaka Y, Lai Ka-Man VL, Rossant J. Spatial and temporal patterns of ERK signaling during mouse embryogenesis. Development. 2003;130:4527–37.
Ryan SA, Ammerman SD, Mary EO, et al. Use and prevention; section on breastfeeding. Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes. Committee on Substance Abuse and Prevention and Section on Breastfeeding. Pediatrics. 2018;142:e20181889.
ACOG. Committee opinion #722. Marijuana use during pregnancy and lactation. Ostetrics and Gynecology 2017;130:e205–9.
Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana use by breast feeding mothers and cannabinoid concentrations in breast milk. Pediatrics. 2018;142:e20181076.
Ana V. Gutierrez Alvarez, David Rubin, Paulo Pina, Michael Sorto Velasquez. Neurodevelopment outcomes and prenatal exposure to marijuana. Pediatrics. 2018;142:(Meeting abstract) 787.
Scheyer A. Prenatal exposure to cannabis effects the developing brain. The Scientist Magazine. 2019:1–10.
Morris CV. Molecular mechanisms of maternal cannabis and cigarette use on human neurodevelopment. Eur J Neurosci. 2011;34:1574–83.
Marroun HE, Brown QL, Lund IO, Coleman-Cowger VH, Loree AM, Chawla D, et al. An epidemiological, developmental and clinical overview of cannabis use during pregnancy. Prev Med. 2018;116:1–5.
The Health Effects of Cannabis and Cannabinoids. The current state of evidence and recommendations for research. National Academies of Sciences, Engineering, Medicine. The National Academies Press, Washington DC; 2017. Chapter 10–4.
Klonoff-Cohen H, Lam-Kruglick P. Maternal and paternal recreational drug use and sudden infant death syndrome. Arch Pediatr Adolesc Med 2001;155:765–70. https://doi.org/10.1001/archpedi.155.7.765.
Marroun HE, Tiemeier H, Steegers EAP, Jaddoe VWV, Hofman A, Verhulst FC, et al. Intrauterine cannabis exposure affects fetal growth trajectories: the generation R study. J Am Acad Child Adolesc Psychiatry. 2009;48:1173–81.
Conflict of interest
The author declares that he has no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Martin, G.I. Marijuana: the effects on pregnancy, the fetus, and the newborn. J Perinatol 40, 1470–1476 (2020). https://doi.org/10.1038/s41372-020-0708-z