Pregnancy is a difficult time. Your body becomes covered in stretch marks and splotches, your calves double in size overnight, and you can’t sit through so much as a PowerPoint presentation without getting up to pee at least thrice. (And don’t get me started on the men who won’t give up their seats on the train. I see you, Brett. Take off your Air Pods, turn off Chapo Trap House, and help a bitch out.) But all of these physical changes pale in comparison to the constant level of judgment and policing from total strangers, to the degree that you can’t so much as order a decaf at Starbucks without feeling like you need to hire a team of attorneys. Defensiveness, not physical discomfort, is the perpetual state of the pregnant individual.
On Thursday, in a joint conference with other top Trump administration officials, Dr. Jerome Adams, the surgeon general of the United States, joined the chorus of mommy-shamers when he issued an edict urging pregnant women and new mothers not to use cannabis, in part due to THC levels dramatically increasing in recent years. “The scary truth is that the actual potential for harm has increased,” Adams said during the conference. “This ain’t your mother’s marijuana.” The secretary of health and human services, Alex M. Azar II, concurred, referring to marijuana as a “dangerous drug” and saying that “no amount of marijuana” has been proven safe during pregnancy.
The edict comes amidst a growing — and increasingly successful — campaign to legalize marijuana on the state level, with 33 states and Washington, D.C. passing laws that mandate some level of legalization, and 11 states (plus D.C.) fully legalizing the plant for adult use. It’s also worth noting that there is data to suggest that cannabis use is on the rise among pregnant women, with dispensaries marketing products to treat hyperemesis, or morning sickness: one study in California (one of the few states to screen for marijuana use during pregnancy) found that cannabis use among pregnant women almost doubled between 2009 and 2016, though notably, these numbers were still quite small (increasing from 4 to 7 percent, according to the data). During his press conference, Dr. Adams noted this rise, attributing it to the widespread normalization of cannabis thanks to legalization.
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To be clear, Dr. Adams is far from alone in expressing concern about the dangers of marijuana for pregnant women. Indeed, it is firmly in line with that of the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), both of which have issued statements outlining that there is no amount of marijuana that has been proven safe for use during pregnancy. His statement is, in fact, supported by research; though the studies on pregnancy and cannabis use are limited (in part due to the fact that marijuana is illegal on a federal level), there is persuasive data to indicate that there’s a strong correlation between marijuana use during pregnancy and low birth weight, as well as one comprehensive study from earlier this year indicating that maternal marijuana use increased the risk of preterm birth. In light of the absence of sufficient data on the health effects of cannabis on developing fetuses, the medical establishment has urged women to abstain entirely.
All of this makes it pretty safe to say that while we don’t know much about the effects of marijuana on developing fetuses — much like brie or chardonnay or antidepressants or charcuterie or any of the other myriad substances women are forbidden to partake in whilst gestating — cannabis comes with risks, and women should weigh these risks against potential benefits before deciding to use it. But this is not the same as saying that marijuana is, unequivocally and without a doubt, a “dangerous drug” for all pregnant women, nor is it the same thing as saying that legalization has normalized marijuana use among pregnant women to the degree that they are totally unaware of its dangers. And despite the best intentions of the surgeon general, both of these statements could ultimately do more harm than good.
In many crucial respects, the conversation surrounding marijuana use during pregnancy is similar to the ongoing debate over prenatal alcohol use. While the consensus among health professionals is that alcohol consumption during pregnancy has been linked to an increased risk of babies developing fetal alcohol syndrome, which is linked to brain damage and low birth weight, it’s still an open question as to just how much alcohol increases the risk, which has led the AAP to recommend total abstinence during pregnancy. In recent years, some medical professionals have questioned these guidelines, urging patients to adopt a more common-sense approach toward alcohol consumption, saying it’s OK to have a celebratory glass of champagne every once in a while. But the AAP has stuck firm to its guidelines, as has the CDC, which even at one point suggested that all women who were not on birth control should abstain from alcohol on the off-chance that they might, possibly, at one point, get pregnant. (Women, unsurprisingly, didn’t take too kindly to this suggestion, leading the CDC to walk back a bit).
These guidelines have shaped public policy to a large degree, with 23 states classifying drinking while pregnant as a form of child abuse. And perhaps unsurprisingly, these policies disproportionately end up affecting women of color and poor women in particular, who are more likely to be reported to the authorities after a positive drug test screening than white women.
Regardless of what the AAP and CDC think women should do, however, the fact remains that some women are drinking during pregnancy (11.5 percent, according to one paper, though the actual number is likely higher) — and the culture of fear, judgment, and paranoia swirling around this issue could have some extremely troubling consequences. One recent paper found that states that had adopted punitive measures for pregnant women who consumed alcohol actually saw an increase of preterm births, and had higher rates of pregnant women drinking alcohol than states that did not. The authors of the study concluded that far from curbing alcohol consumption during pregnancy, laws that punished women for drinking alcohol drove such behavior into the closet and made them less likely to seek out prenatal care, for fear of having their children taken away by Child Protective Services if they were found to have consumed alcohol. The criminalization of pregnant women drinking, combined with the tremendous amount of stigma and shame associated with the behavior, ironically further endangers at-risk women and their babies by discouraging them from getting care.
As the conversation over federal legalization continues, one could easily predict a similar dynamic unfolding in relation to cannabis use during pregnancy. In fact, we kinda know this is exactly what would happen; according to one 2017 study, while the majority of women supported mandatory prenatal drug testing, 14% said that such a policy would deter them from seeking prenatal care. (It is telling that the subjects were neither pregnant nor current drug users, two factors that would likely have contributed to that percentage being much higher.) We also already know that existing cannabis laws disproportionately target poor people and people of color in general, so it is not inconceivable to imagine that increasingly stringent guidelines about cannabis use during pregnancy would similarly target women of color as well — the demographic that is currently most in dire need of access to high-quality maternal health care.
None of this is to say that cannabis use during pregnancy is unequivocally 100% safe (though one could argue that pretty much nothing you put in your body during pregnancy is), nor is it to say that Dr. Adams’ statement was not well-intentioned. It is to say, however, that the medical establishment taking a paternalistic, finger-wagging approach to pregnant women and alcohol use has largely failed. There is little to suggest that taking a similar approach to marijuana wouldn’t fail, too.