Should a patient at 19 weeks gestation be treated with medical marijuana?

Medical Marijuana Use at 19 Weeks Gestation

No, a patient at 19 weeks gestation should not be on medical marijuana and should be strongly advised to discontinue all cannabis use immediately. The American College of Obstetricians and Gynecologists explicitly recommends that pregnant individuals abstain from using cannabis due to documented risks to both maternal and fetal health 1, 2, 3.

Primary Recommendation

Advise complete and immediate cessation of all cannabis products, regardless of whether they are prescribed for medical purposes. 1, 2, 3

• Obstetrician-gynecologists should be discouraged from prescribing or suggesting marijuana for medicinal purposes during pregnancy 2, 3
• Pregnant women should discontinue marijuana for medicinal purposes in favor of alternative therapies with better pregnancy-specific safety data 2, 3

Documented Pregnancy Risks

Cannabis use during pregnancy carries multiple established risks:

• Low birth weight and fetal growth restriction: Cannabis smoking during pregnancy is definitively associated with reduced fetal growth 1, 4
• Neurodevelopmental impairments: Fetal exposure may cause subtle but persistent cognitive dysfunction and behavioral difficulties in offspring 1, 4, 5
• Placental dysfunction and other serious pregnancy complications: Cannabis increases risks of adverse pregnancy outcomes 1
• Increased miscarriage risk: While tobacco smoking definitively increases miscarriage risk, cannabis may compound this risk 1

Critical Clinical Context

The risks are intensifying over time:

• Cannabis potency has dramatically increased, with THC concentrations nearly doubling from 9% in 2008 to 17% in 2017, intensifying all health risks 1
• THC readily crosses the placenta, and cannabinoid receptors have been identified in fetal brain and placenta 4
• Much existing research was performed when THC quantities were lower, meaning current products may pose even greater risks 4

Alternative Management Strategies

For conditions the patient may be treating with medical marijuana:

• For pain: NSAIDs and acetaminophen should be first-line for pregnant women requiring pain management 6
• For nausea: Despite social media claims, marijuana should not be used for pregnancy-related nausea 5
• Identify the specific indication for medical marijuana and provide evidence-based alternatives with established pregnancy safety profiles 2, 3

Common Pitfalls to Avoid

• Do not suggest "reducing" cannabis use - complete cessation is the goal 1, 2, 3
• Do not prescribe or recommend medical marijuana for any indication during pregnancy 2, 3
• Do not assume lower doses are safe - no amount of marijuana use in pregnancy has been established as safe 7
• Do not delay counseling - advise cessation at the first prenatal visit, which at 19 weeks may already represent delayed care

Breastfeeding Counseling

Provide anticipatory guidance that cannabis use is also contraindicated during breastfeeding due to potential adverse neonatal outcomes from cannabinoid exposure through breast milk 1, 2, 3.

Documentation and Follow-up

• Screen and document current cannabis use patterns, including frequency and method of consumption 8
• Provide clear documentation of counseling regarding cessation 2, 3
• Assess for cannabis use disorder if the patient reports difficulty stopping 8
• Consider referral to addiction medicine or behavioral health if cessation proves difficult 8