Reality check: Is it safe to use marijuana during pregnancy?

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Cutting out illicit substances like alcohol, cigarettes and drugs is a no-brainer for most women when they learn that they’re pregnant (or are trying to get pregnant). But for a small subset of moms-to-be, one illicit substance in particular has been touted as a lifesaver: marijuana.

It was for Melissa, a Boston-area mom of two who had hyperemesis gravidarum, the same severe morning sickness that Kate Middleton experienced. Although pot wasn’t her first solution — her obstetrician prescribed medications that didn’t end up working — it was the only thing that could stop her from “constantly” vomiting, she told Yahoo Beauty.

“I talked to my friend’s neighbour, who is a midwife, and she said that [marijuana] was the only thing that got her through her first trimester,” Melissa said. “So I smoked a little bit of weed. I coughed, and the coughing made me throw up. But after that, the symptoms just disappeared. It was amazing.”

Eventually, Melissa turned to edibles (she baked small amounts of pot into brownies), and she said it “saved my pregnancy, basically.”

She isn’t alone in her unconventional choice of recreational activity. In a report published in JAMA in January, researchers at Columbia University found that 3.9 per cent of American women who are pregnant report marijuana use, while another recent U.S. study conducted by the National Institute on Drug Abuse found that teen girls are twice as likely to smoke pot if they’re pregnant. Overall, six per cent of pregnant females aged 12 to 44 reported using marijuana in their first trimester.

Things don’t look too innocent in Canada, either. A 2015 publication by the Canadian Centre on Substance Abuse (CCSA) quoted a Canadian Perinatal Health Report (2008) that said five per cent of women used illicit drugs during pregnancy (although it didn’t specify how many used cannabis). But cohort studies suggest that number is considerably off, and state that 10 to 16 per cent of middle-class women and 23 to 30 per cent of inner-city dwellers consume marijuana during pregnancy.

“The 2013 Canadian Tobacco, Alcohol and Drugs Survey found that 22 per cent of women of childbearing age (15 to 44) reported using cannabis in the past year, which shows the potential number of women who are using it during pregnancy,” says Dr. Amy Porath, director of research and policy at CCSA. “And we know the negative impacts of prenatal marijuana use on the fetus continue into late adolescence and early adulthood.”

The impacts include neurocognitive effects as well as behavioural ones, and start to display themselves as early as 18 months. Porath says girls born to mothers who consumed marijuana prenatally show aggressive behaviours and attention problems at 18 months, while all kids show deficits in memory and verbal skills at age three. By the time they turn six, they display impaired verbal performance, quantitative reasoning, and short-term memory, and at nine, there are deficits in reading, spelling and academic performance.

Once they get to their late teens and early 20s, these neurocognitive impairments persist. Behaviourally, they display hyperactivity, impulsivity, delinquency, and even anxiety and depression throughout their lifetime.

“There’s growing research in this area and as more studies come out, they come to the same conclusions, strengthening what we already know,” Porath says. “There’s definitely a reason to be concerned.”

In the case of hyperemesis, Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada, says that any claims that marijuana helps are purely anecdotal and misleading.

“The problem with severe nausea and vomiting is that it gets better eventually,” she says. “In most women, it devolves over time, so even if someone tells you that she took it and felt better, you don’t really know what made her feel better.”

Supporters of marijuana use in pregnancy often turn to a surprising study conducted in Jamaica in 1994. It found that babies whose mothers consumed the drug during gestation had better physiological stability, were more alert and less irritable at one month compared to babies who weren’t exposed to marijuana.

However, experts are quick to point out that the study was small (only 24 marijuana users and 20 non-users were monitored), and it’s difficult to know with certainty who’s telling the truth. As Blake says, it’s hard to get a full picture when you’re asking people to report on something that’s illegal.

There’s another factor to consider when pondering the use of marijuana during pregnancy: you never really know what you’re getting.

“The research we have is based on what we know about cannabis, but the problem is people never really know what they’re purchasing,” Blake says. “They’ve found fentanyl contaminants in samples purchased from dispensaries — there’s organized crime in the supply chain there. More effort needs to be put in the situation.”

And yet, some women swear they couldn’t have made it through their pregnancies and tolerated their extreme nausea if they hadn’t turned to pot. Carly, a Kawartha region mom, had hyperemesis in both her pregnancies — in her first pregnancy, extreme nausea and vomiting caused her to lose 30 pounds, in her second, she lost 20. So, she smoked just enough marijuana to curb her nausea and allow her to eat. She smoked up until her 17th week of pregnancy, and in both cases gave birth to healthy babies.

“I wish more women would turn to this amazing, natural plant medicine during pregnancy and the stigma behind it vanish, because it can help so many, naturally,” she says.

Lianne Phillipson, a registered nutritionist and founder of Sprout Right, hasn’t had any clients come to her seeking advice on tempering hyperemesis with cannabis, but she says “I don’t know how I would have handled that kind of situation if I were in their shoes, especially understanding the need of nutrition for a growing fetus.”

However, she says, there are ways to circumvent morning sickness naturally — and not in the “natural” way some women do. She advises her clients to take B6 and ginger and to eat protein.

“Eat as large a quantity as you can of protein, whether it’s meat, eggs, soy or dairy, as it helps clear the hormones that are building up in your liver, which is often the cause of nausea,” she says. “Eat often and don’t let yourself get hungry. If you need to eat dry toast or a cracker to get over the nausea, do that and then eat some protein. Grab any opportunity you have to eat something healthy.”

She also says that “the human body can do amazing things,” and many women have experienced severe morning sickness without turning to marijuana. And they, too, had healthy babies.

Blake sums it up simply by pointing out, “when you’re pregnant, you’re making choices that your baby has no say in. These are critical developmental moments for your baby. It’s the time to do the very best that you can.”

Retrieved from: http://globalnews.ca/news/3389327/reality-check-is-it-safe-to-use-marijuana-during-pregnancy/

The importance of dads

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The father’s role in producing a healthy baby doesn’t begin and end with conception.

Evidence is now pointing to an important link between the father’s health pre-conception and the health of their child over their lifetime.

“There’s this phenomenon called the developmental origins of health and disease where influences during early life, during pregnancy, during the early post-natal period change your metabolic set up for the rest of your life,” Dr Scott White, WA spokesman for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said.

“Babies born after a period of inter-uterine hostility — where they are a bit smaller than they want to be, their placenta is not fantastic, they are a bit growth restricted — are at significantly increased risk for diabetes and heart disease and some cancers and all sorts of ‘badness’ in later life.

“Traditionally the effect of that was looked at from the maternal point of view and the fathers were pretty much ignored but more recent studies looking at the paternal contribution suggest there is a significant role for the health of the father prior to pregnancy and the health of the offspring.”

Perhaps the clearest association between a dad’s health and that of his offspring is seen in obesity, where it has been shown that paternal BMI is linked with the birth weight of baby boys and a correlation between a father’s “fatness” with a daughter’s increase in body fat from age five to nine has been identified.

Sperm carry not just DNA, but also signals known as non-coding RNA which can influence how development proceeds, according to scientists from the Robinson Research Institute, writing for The Conversation. These non-coding RNA are different in the sperm of obese men than in men of a healthy weight and, in some research in mice, have been shown to make their offspring fatter.

“There are significant epigenetic changes in the sperm of obese men so we know the healthier the father is, the better quality the sperm is, the better-quality embryo you make and that seems to have important lifelong impacts,” Dr White, who also provides preconception counselling at King Edward Memorial Hospital, said.

Alcohol, too, can be a catalyst for epigenetic changes that either switch on or off, or turn up or down, the expression of different genes that are carried both in the sperm and the egg, influencing the long-term health of offspring.

James Fitzpatrick, head of alcohol and pregnancy and FASD research at Telethon Kids Institute, said while Fetal Alcohol Spectrum Disorder could only be diagnosed if there had been direct exposure to the foetus by the woman’s drinking, some studies linked behavioural problems in children and adolescents with changes in the genetic expression of male sperm that are associated with alcohol exposure.

“It is not as hard and fast as the direct toxic effects of alcohol if the woman drinks, but there is the possibility these epigenetic effects that are passed on before the point of conception can modify later behavioural and indeed health outcomes,” Dr Fitzpatrick said.

It takes three months to make a mature sperm so any changes required to ensure a father is in peak condition for conception must be made well in advance, Dr White recommends. Just like prospective mothers, dads are advised to adopt a healthy lifestyle in the lead up to trying to conceive by maintaining a healthy weight, limiting alcohol intake to safe levels and not smoking or using illicit drugs.

Factors such as obesity and alcohol could reduce the number and quality of sperm, making it harder to get pregnant in the first place.

There’s also a role for dad’s-to-be to support their partner in staying on a healthy path during the nine months of pregnancy and beyond.

One of the biggest drivers of a woman drinking in pregnancy is her male partner drinking in pregnancy, according to Dr Fitzpatrick.

“That’s why it is very important that men support their partners not to drink in pregnancy and ideally that would be through taking a pregnant pause themselves or having the nine months off with their partner to support her during pregnancy.”

Retrieved from: The West Australian

Warning labels about drinking while pregnant are working

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A random encounter with a warning sign at a north Eugene grocery store put Gulcan Cilon the trail of research toward her UO doctoral degree and, now, a newly published paper.

The paper, published in the Journal of Health Economics, took a deep dive into extensive federal data to probe behavioral changes that likely resulted from point-of-sale warning signs urging women who are pregnant to avoid alcohol.

In states requiring the signage, drinking by pregnant women is down 11 percent, Cil found. She also found evidence of fewer premature births coming with less than 32 weeks gestation and fewer births of babies weighing less than 3.5 pounds. The biggest effects were among women 30 and older.

Cil, now a visiting instructor in the UO Department of Economics and postdoctoral fellow in the Mikesell Environmental and Resource Economics Research Lab, recalled how her research began.

New to Eugene in 2010, she said, she wasn’t pregnant, had no plans to be and didn’t have any friends who were. But that grocery store sign that depicted a woman with a baby inside and holding a cocktail glass and topped with the words “Pregnancy & Alcohol DO NOT MIX” captivated her.

“Every time I walked in the store I saw the sign at the front door and again at the register, and I was like: What is this? I saw it enough times, I guess, that I kind of knew that you’re not supposed to drink alcohol while pregnant, but that was like a confirmation to me,” she said. “I found it very educational, and I was interested in policy behind it.”

Cil was born and raised in Turkey, where such warnings are not used because, she said, drinking by pregnant women is not considered a public health concern.

With a background in environmental economics, Cil had chosen to pursue health economics as a doctoral student. She soon learned that 23 U.S. states and Washington, D.C., required such signs at all retail stores that sell alcohol.

“So I looked in the literature to see if they actually worked,” she said. “I found that the issue had never been studied and evaluated as a public education program or public awareness program.”

Cil mined two national databases — the National Vital Statistics Natality Detail Files and the Behavioral Risk Factor Surveillance System — for clues. Her focus was on information gathered between 1985 and 2010.

Using complex analytic techniques on data related to drinking by women, she compared signage-adopting states with a group of nonadopting states. Her control group included women who had lived in nonadopting states and women who lived in adopting states before signage requirements began.

Her approach allowed her to identify the direct relationship between drinking while pregnant and birth outcomes, while also reducing the likelihood that other factors such as cigarette smoking, drug abuse, nutritional deficiencies and other risky life choices were at play in any behavioral changes.

The study, she said, suggests a likely causal relationship, which had not previously been documented in relation to signage policies, between drinking while pregnant and birth outcomes.

Cil was not able to sufficiently probe effects related to heavy drinking, which is associated with fetal alcohol spectrum disorders. The lack of statistical significance for behavioral change related to these disorders may reflect the fact that they are rarely diagnosed at birth and reported on birth certificates, she said.

Point-of-sale warning signs, she said, are an effective, low-cost approach to protecting the health of pregnant women and the babies they carry.

The signs used by states that require warnings all contain similar language. A future study, Cil said, might explore whether variations in signage — the graphics, fonts, colors and language used — may best be effective.

—By Jim Barlow, University Communications

Retrieved from: http://around.uoregon.edu/content/warning-labels-about-drinking-while-pregnant-are-working

Challenging the conversation around FASD

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Changing perceptions and challenging the conversation, Dr. Peter Choate and Dr. Jacqueline Pei spoke at the 2017 FASD Network event.

 

“My mind is like a filing cabinet but no one alphabetized the [darn] thing” is a phrase that welcomes you to the complex world of Fetal Alcohol Spectrum Disorder (FASD). 

The FASD Network hosted their first annual 2017 FASD session: Challenging the conversation.

Shana Mohr, Training coordinator at FASD Network, said there is still a lot of misinformation about FASD.

“The racial problem in the view of FASD in this country is still prevalent,” Mohr said.

Peter Choate, a registered social worker and member of the Clinical Registry, stated there is an urgency to get away from race based FASD because if we stay on race as the topic, we will target community where we think race is the issue. “Race is not the issue”.

“There is a bias that FASD most influences the Aboriginal population, but research actually indicates, it is young university women. Women who engage in social drinking,” Choate said.

Choate said the perpetuation of stigma rests solely on the mother, while the perpetuators of FASD are actually the males, but they are given an out.

Choate asks, why are the men being excluded from this conversation? Go to a man and have a conversation about casual sex, whose sperm is coming into the equation.

 “Denial is huge, when it comes to educating young university women and men about alcohol,” Choate said.

He said there needs to be a conversation with these people and there is a general ineffectiveness of success in preventing FASD, because we are not reaching the right people.

Facts tell us that FASD does not discriminate, people discriminate.

“I have seen the enemy and it is us [referring to the front line workers],” Choate said, noting we are the ones most in need of changing the conversation.

“We need to expand the conversation to authority figures, judges, police, frontline workers, doctors, nurses, and teachers,” Choate said.

Choate said young men need to be shown what respect for a woman looks like.

He also said poverty and addiction play a big part in the world creating people living with FASD.

“We need to help them as humans who seek support without shame, stigma, or condemnation.”

Choate said, structurally the system creates relapse. There is a need to get away from deficit-based assessments, and the need to get away from external language.

He said that frontline workers need to build relationships before and after rehab, or it just won’t work; there will be relapses because rehabilitation is a step in recovery, not a solution.  

“What front line workers need to do is to build relationships with the people that need that help,” Choate said.

Choate strongly suggested to challenge policy makers who act as barriers to support.

He said that people living with addiction need to have a purpose and for front line workers to help find that in their lives, or else there’s no reason to be sober.

“My challenge, my hope is for you to have a conversation with somebody who would not normally have that conversation.”

Retrieved from: http://www.eaglefeathernews.com/health/index.php?detail=2709

Let’s Talk About Alcohol Abuse

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Alcohol is a depressant drug that slows down your body’s central nervous system.

While a small amount of alcohol may provide health benefits, drinking excessively can cause serious health issues.

About alcohol abuse

Abusing alcohol can affect your concentration, speech, balance, vision, coordination, judgement, and overall health.

Exactly how it affects you depends on several factors:

  • the amount you drink
  • your gender and age
  • your body size
  • how quickly you drink
  • your mood
  • the amount and type of food you have eaten
  • your past experiences with drinking
  • medications you are taking that may interact with alcohol
  • your overall health

Health effects of short-term alcohol abuse

Drinking too much alcohol can cause:

  • drowsiness
  • dizziness
  • slurred speech
  • reduced inhibition
  • loss of coordination skills
  • inability to think and judge clearly
  • inability to estimate distances
  • decreased reaction times
  • confusion or memory loss
  • blackouts
  • negative mood states (depression)
  • violence
  • suicide
  • vomiting and choking
  • irregular heart beat
  • respiratory depression, coma, or death

Health effects of long-term alcohol abuse

Over time, heavy drinking can lead to more serious health problems such as:

  • brain damage (dementia, difficulties with coordination, and motor control
  • depression
  • increased risk of suicide
  • increased risk of high blood pressure
  • increased risk of stroke
  • increased risk of heart disease
  • liver damage
  • stomach ulcers
  • blood vessel disorders
  • impotency in men
  • menstrual irregularities in women
  • some types of cancer
  • addiction
  • death

Long-term alcohol abuse can also lead to professional, personal, financial, and legal problems, any of which can affect your health.

Did you know?

Drinking while pregnant puts your baby at risk of being born with Fetal Alcohol Spectrum Disorder. If you are pregnant or planning to become pregnant, the safest choice is to drink no alcohol at all.

Reduce your risk

Responsible drinking saves lives.

  • Limit the amount of alcohol you drink. Your risk of injury increases with every drink.
  • Don’t drink alcohol on an empty stomach. Eat before–and while–you drink.
  • Alternate alcoholic beverages with caffeine and alcohol-free drinks to limit the amount you drink in any three-hour period.
  • Drink only if you want. Don’t feel pressured into accepting a drink.
  • Don’t drive. Take a taxi or public transportation, walk, or decide who will be the designated driver before you start drinking.
  • Use Canada’s Low-Risk Alcohol Drinking Guidelines to help you decide when, where, and how to drink.

Did you know?

About 40% of car crashes in Canada are caused by alcohol.

Responsible hosting can help keep you and your guests safe.

  • Limit how much you drink so you can stay in control of the party.
  • Before the party, ask a friend or family member to help you if problems arise during the event.
  • Provide guests with plenty of alcohol-free drinks like coffee, tea, pop, fruit punch, and juice.
  • Mix and serve drinks yourself or appoint someone responsible as bartender. People tend to drink more when they serve themselves.
  • Serve food, but avoid salty and greasy snacks because they’ll make your guests thirstier.
  • Stop serving alcohol at least an hour before the party ends.
  • Don’t rely on coffee to sober up guests. It only makes them more alert, not sober.
  • Encourage guests to use designated drivers, leave their cars at home, take taxis or public transport, or walk. Keep cash and taxi numbers handy.
  • Be prepared for overnight guests by having blankets, sleeping bags, and pillows on hand.
  • Never serve alcohol to minors.

Retrieved from: https://www.canada.ca/en/health-canada/services/substance-abuse/alcohol-abuse.html

 

Study compares alcohol consumption during pregnancy across European countries

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A study among over 7000 women in 11 European countries shows the proportion of women in Europe who drink alcohol when they know they are pregnant is lowest in Norway and highest in the UK. The countries with the highest proportion of women who reported alcohol consumption during pregnancy were the UK (28.5 %), Russia (26.5 %) and Switzerland (20.9 %).

This is the first study that compares alcohol consumption during pregnancy across 11 European countries. The study uses the same method for collecting data, thereby making the results comparable between the countries.

Results
On average, 16% of women in the 11 European countries reported that they drank alcohol after they knew that they were pregnant.

  • The countries with the highest proportion of women who reported alcohol consumption during pregnancy were the UK (28.5 %), Russia (26.5 %) and Switzerland (20.9 %).
  • The countries with the lowest proportion of women who reported  alcohol consumption were Norway (4.1 %), Sweden (7.2 %) and Poland (9.7 %).
  • Women who reported alcohol consumption during pregnancy were more likely to be older, more highly educated, in employment, and had smoked before pregnancy than women who did not report this consumption.

Why do so few women in Norway drink during pregnancy compared to the UK?

Although the British population in general drink more than Norwegians (ref: Report: Drugs in Norway in 2016, FIG. 2.6.2, p. 30), the study found that countries with a comparable drinking culture to the UK – like Poland and France – had relatively low proportions of women drinking during pregnancy.  Therefore, the drinking culture in the overall population may not necessarily apply to those who are pregnant.

“Differences in pregnant women’s drinking behaviour between countries can have many explanations besides variations in willingness of women to provide information about their alcohol consumption during pregnancy. There could be differences in national guidelines or educational campaigns about drinking during pregnancy, differences in prenatal care and attitudes towards alcohol use in pregnancy, or a combination of all these factors,” saysProfessor Hedvig Nordeng from the Norwegian Institute of Public Health, who is the principal investigator of the study in Norway.

Who drinks most?

Of those women who said they drank alcohol during pregnancy, 39 % consumed at least one unit of alcohol per month. Those who drank most frequently (more than one to two units per week) were in Italy (7.8 % of the women said they drank during pregnancy) and the UK (2.8 %).

Those who drank the least (1-2 units during the whole pregnancy) were in Norway and Sweden (over 80 % of the women who said they drank during pregnancy) and France, Poland, Finland and Russia (70-80 %).

Therefore, even though a larger proportion of Russian women continue to drink during pregnancy, compared to the other countries they do not actually drink that much. The women who drink during pregnancy in Italy seem to drink a lot more than the women in the other countries. Again, this may be due to a combination of factors.

Post doc Angela Lupattelli from the University of Oslo, who coordinated the study in Norway and Italy, explains:

“We can speculate that both social and cultural factors play a role. Women’s attitudes on the one hand, and national alcohol-related guidelines and policies on the other, may influence women’s drinking behaviour during pregnancy,” saysLupattelli.

Smokers and highly educated women drink most
The association between smoking before pregnancy and alcohol use during pregnancy has been observed in earlier research. A plausible explanation for this association is the underlying risk-taking health behaviour among these women.

It seems like a paradox that older and more highly educated women were more likely to drink during pregnancy, which also confirms prior research on the topic.

This study did not look at the relationship between education and the amount or frequency of drinking during pregnancy.

The study authors speculate whether older, more educated women might be more critical towards guidelines that recommend complete abstinence from alcohol during pregnancy. The authors wonder whether older women are less exposed than younger women to the health campaigns that warn against alcohol use during pregnancy, especially if they drank a little during previous pregnancies and had healthy children.

The study authors believe it is important for national campaigns to target all women of childbearing age:

“There is no defined safe minimum amount of alcohol to drink during pregnancy. We therefore recommend that all pregnant women should adhere to the guidelines for total alcohol abstinence during pregnancy,” says Nordeng.

Data
The study consisted of 7905 women, 53 % were pregnant, and 46 % were new mothers (with a child up to one-year-old).

The countries included were Croatia, Finland, France, Italy, Norway, Poland, Russia, Serbia, Sweden, Switzerland and the UK.

The women completed an anonymous online questionnaire, which was available on selected websites intended for pregnant women in the respective countries. Since the questionnaire was anonymous, the authors believe that underreporting was minimal.

Retrieved from: http://www.news-medical.net/news/20170411/Study-compares-alcohol-consumption-during-pregnancy-across-European-countries.aspx

FASD Language Guide

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Click to download the Language Guide

The language guide provides dignity-promoting alternatives to stigma-inducing words or phrases commonly used in society. The Looking After Each Other project proposes the language within the guide be used in an effort to promote the dignity of those with FASD and their families.

The guide is intended to be a living document that will change over time as the Looking After Each Other project continues to reflect on the use of language as a tool to promote dignity for everyone impacted by FASD.

The guide was produced by the Manitoba FASD Coalition. The Coalition is a province-wide collaborative network of individuals and organizations from across all sectors committed to supporting prevention, education, research, and intervention activities in the area of fetal alcohol spectrum disorder. We share ideas, information, resources, challenges and successes.

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