Prenatal and Neonatal Complications Of Cannabis. Marla D. Kushner, DO, FASAM, FSAHM

Transcription

1 Prenatal and Neonatal Complications Of Cannabis Marla D. Kushner, DO, FASAM, FSAHM

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3 What is Cannabis? Tetrahydrocannabinol (THC) is the major psychoactive ingredient in marijuana. Cannabinoids refers to all compounds that are structurally related to THC Marijuana is the nations most commonly used illicit drug Classified as a schedule I narcotic in the U.S.

4 Who is Using Cannabis? 44% of males and 35% of females studied have used marijuana at least once in their lifetime. In teenagers use has been rising and 6.6% of high school seniors are daily users. Annual rate of about 38% Approximately 11% of pregnant women ages in a study measuring serum metabolites. 5-30% of mothers reported marijuana use during pregnancy

5 Other Names for Cannabis Afghan Dro Jane Nug Spliff Bhang Dry High Jive Otis Tea Black Rock Bobby Brown Broccoli Buddha Grass Bush Dope Draw Dubby Gage Ganja Gangster Giggleweed Grass Hemp Herb Joint Kabizzle Kryptonite Kiff Kush Loco Weed Mary Mexican Green Panama Red Pot Puff Reefer Resin Roach Sativa Smoke Texas Tea Thai Sticks Weed Pot Grass 420

6 Most Common Forms Marijuana Hashish Hash Oil Synthetic Marijuana

7 Marijuana Prepared from the dried flowering tops and leaves of the harvested plant THC concentrations of leaves range from 0.5%-5% THC concentrations from unfertalized flowering plants range from 7%-14%

8 Hashish Dried cannabis resin and compressed flowers THC content of 2%-8%

9 Hash Oil Obtained by extracting THC from hashish (or marijuana) with an organic solvent THC concentration between 15% and 50%

10 Synthetic Marijuana High Potency Up to 600 times more potent than marijuana s THC.

11 How Is Cannabis Used? Smoking as a joint containing grams of cannabis Bong or water pipe. Increases absorption of THC by the lungs. Orally via food products. Slows the onset of effects

12 Cannabis THC is absorbed from the gastrointestinal tract and lungs rapidly distributed to: Brain (being highly lipophilic) Fat tissue Extensively bound to plasma proteins (97%)

13 How Is Cannabis Metabolized? THC is metabolized in the liver to the active metabolite, 11-OH_THC, which is rapidly converted to 11-nor-9-carboxy-THC, which is inactive but is the urinary marker for cannabis. THC is lipid soluble and can be deposited in the fatty tissue. So half-life could be as long as 4 days Urine may be positive for weeks to months after THC use has stopped.

14 Psychological effects of marijuana include: euphoria, relaxation, slowed thinking and reaction time, altered perception, impaired coordination impaired motor performance, poor short-term memory, impaired attention and judgment panic attacks, anxiety, dizziness difficulty expressing thoughts in words.

15 Physiological effects of marijuana include: increased heart rate reddened eyes dizziness dry mouth increased appetite, nausea respiratory disorder immune system dysfunction.

16 Other Effects of Cannabis amotivational symptoms (cont.) Lower educational acheivment, lower income, impaired cognitive function, social life and health in heavy users. Quitting high school Increased job turnover.

17 Prenatal Marijuana Use

18 Prenatal Use Up to 30% of mothers Unclear due to use of multiple drugs including alcohol, tobacco, stimulants, and opiates. Harm caused by a toxic agent is a function of Genetic makeup Fetal and post natal environment Dose Developmental stage of the fetus at time of exposure

19 Prenatal Use Often other characteristics of these mothers may have an effect High stress Lack of prenatal care Sexually transmitted infections High risk behaviors

20 Prenatal Use Metabolites of marijuana enter the fetal blood stream Active metabolites can penetrate the fetal blood-brain barrier and interfere with early neuronal cell development or cause neuronal death. Indirect affect: marijuana causes vasoconstriction that restricts the fetal oxygen supply.

21 Prenatal Marijuana Use

22 Perinatal Use Rapid transit to the fats in breast milk

23 Is it safe to breastfeed? Lactating mothers should refrain from consuming cannabinoids. Advise mothers to discontinue breastfeeding if they cannot stop using cannabinoids; incorporate the known risks of formula feeding. Cannabinoid exposure through milk has no appropriate studies of. In every case, nursing babies should be closely monitored.

24 Passage of THC into breast milk Perez-Reyes et al (1982) suggested THC is excreted into human breast milk in moderate amounts. Based on their findings, 0.8% of the weight-adjusted maternal intake of one joint would be ingested by an infant in one feeding (ie, the baby would receive 0.8% of its mother s dose/kg). Heavy user milk-to-plasma ratio (ie, levels in milk vs levels in maternal blood) was as high as 8:1.

25 Lactation & THC Animal studies suggest that marijuana can decrease the amount of milk produced Suppressing prolactin production Through a direct effect on the mammary glands

26 THC in breast milk Astley and Little (1990) suggested that exposure to THC through breast milk in the first month of life could result in decreased motor development at 1 year old. No studies have adequately addressed the effects on long-term neurodevelopment.

27 THC in the neonate Lethargy Less frequent feeding Shorter feeding times are other observations reported after babies exposure to THC through breast milk. A mother s ability to nurse and care for her child might be compromised because marijuana can affect mood and judgment.

28 Breastfeeding and THC A baby s brain is still forming, THC could theoretically affect brain development. It is also important to avoid environmental exposure to maternal marijuana smoke. Nursing mothers who are using marijuana should be referred to appropriate services for counseling.

29 Studies Ottawa Prenatal Prospective Study One week shorter gestation period and true ocular hypertelorism (wide spaced eyes) and severe epicanthus (skin folds at the corners of the upper eye lids Mothers who smoked >5 joints a week Maternal Health Practices and Child Development >1 joint a day during first trimesters showed deficits in school achievement, reading and spelling. Mild withdrawal symptoms and poor autonomic control, particularly of state regulation(ability to adjust level of alertness required for a task)

30 Developmental Problems Higher order thinking Problem solving Memory Planning Impulsivity Attention

31 AGE 10 Exposure during first and third trimester More depressive symptoms

32 Ages Doubled the risk of tobacco and marijuana use 1.3 times more likely to be high frequency users, even after extensive control for other factors known to increase use.

33 Ages MRI study showed altered neuronal functioning during a psychological test that involves remembering the placement of images on a screen

34 Prevention Raising awareness among pregnant women Legislation for synthetic marijuana

35 Treatment CBT Motivational enhancement CM therapies

36 Contact information: Phone:

37 Thank you!