Pot Smoking

Pot Smoking Pregnant Moms Likely Use Other Drugs

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A quarter of mothers and their newborns who tested positive for marijuana use had evidence of other illegal drugs, according to a small retrospective study of mother/newborn pairs.

Based on data collected from an urban non-profit teaching hospital, 26.1% of mother/newborn pairs tested positive for tetrahydrocanabis (THC) in urine-meconium screenings, 11.6% tested positive for opioids, followed by amphetamines (10.8%) and cocaine (6.5%), reported Shirley Chen, MD, of Creighton University in Omaha, and Edith P Allen, MD, of St. Joseph’s Hospital and Medical Center and Phoenix Children’s Hospital in Phoenix.

Of the 491 mother newborn/pairs testing positive for marijuana, only 22.4% picked up marijuana use in both mother and newborn. More than three-quarters (77.6%) of these tests came back positive for one party only, though it was more common in newborns compared with mothers (42.4% versus 35.2%), they stated in a poster presentation at theAmerican Academy of Pediatrics (AAP) annual meeting.

While not involved with the study, Sharon Levy, MD, MPH, director of adolescent substance abuse program and assistant professor of pediatrics at Children’s Hospital in Boston, said she thought the latter data was the most interesting “nugget of information” from the results.

“Fetal samples were much more likely to be positive for marijuana than maternal samples, underscoring that fat soluble THC crosses the placenta and is concentrated in the fetus,” she told MedPage Today via email. “When mothers use marijuana, their fetuses are actually getting a higher dose than they are themselves.”

The authors also screened mothers and newborns separately, and found that the most common illicit substance in THC-positive newborns was amphetamines (8.8%), while the most common among THC-positive mothers was opioids (16.3%). Levy added that these results showed that by collecting both maternal and newborn samples, the authors were able to get more information about drug exposure.

Urine and meconium tests were used to screen drug exposure in infants and a large majority (78.6%) of infants only had positive meconium tests to identify THC exposure. The authors noted that there was no exposure in newborns that urine picked up and meconium did not.

Co-author Allen told MedPage Today that even though mothers are usually open to saying they use marijuana, the meconium of the baby might be the most important piece of information to tell about the history of drug use in the mom.

The retrospective study was done using data from 2006 to 2010. The authors examined data from an urban teaching hospital that averaged 5,000 births a year. About 10% of the sample tested positive for THC/marijuana use.

Screenings for both mothers and newborns were done per Arizona state’s guidelines. Criteria for drug screening included history of previous or current substance use by the mother, noncompliance with prenatal care, symptoms of withdrawal in the mother and signs of neonatal abstinence syndrome, low birth weight, and other adverse outcomes, such as necrotizing enterocolitis.

Mark Hudak, MD, of the University of Florida at Jacksonville and former member of the AAP committee on drugs, told MedPage Today that examining past marijuana use was a new point of view in light of the legalization of medical marijuana in some states.

“Arizona is one of those states that has made a change allowing medical use of marijuana, and I think that was the genesis of going back and looking at their population,” he said. “I think the message they were trying to convey is if you have a mother or baby where you find marijuana, you have to think about other substances and whether those substances may contribute to newborn issues.”

One obvious potential issue would be whether or not to allow a mother testing positive for drugs to breastfeed, and Allen said that was something to be aware of, particularly in states where marijuana is legal for medical or recreational purposes.

“I think it’s our responsibility as pediatricians to really be more objective and more cautious about the decisions that we take about the care of those babies,” she said. “We have to be careful about when we allow this baby to breastfeed if there is a problem with other drug consumption during pregnancy by the mother.”

Hudak said that clinicians need to be aware of the situation and to make sure there is good follow-up on the babies. He added that the pediatrics field is currently working through the conflicting recommendations about breastfeeding in mothers with substance abuse.

“Whether breastfeeding is a good thing or maybe contraindicated in some of these mothers [is] another topic under very active debate,” he concluded. “I don’t think that issue is settled yet.”

Heavy Pot Smoking Linked With Stunted Growth

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Boys who smoked marijuana heavily were significantly smaller than their peers by the end of their adolescent growth phase, according to a study conducted in Pakistan.

Study participants who were described as “marijuana addicts” during boyhood were on average 4.6 inches shorter and 4 kg lighter at age 20 than nonsmokers, reported lead investigator Syed Shakeel Raza Rizvi, PhD, and colleagues at the PMAS-Arid Agriculture University Rawalpindi, in a presentation at the European Congress of Endocrinology in Dublin.

The investigators compared height; weight; and levels of luteinizing hormone, testosterone, growth hormone, and cortisol in 220 marijuana-addicted and 217 nonpot-smoking boys.

Plasma concentrations of luteinizing hormone, testosterone, and cortisol were significantly higher in the marijuana addicted boys, but levels of growth hormone were significantly lower.

Chronic pot smoking may trigger a stress response that stimulates the onset of puberty but lowers growth hormone levels, the researchers suggested, on the basis of a separate set of laboratory experiments.

To determine the acute effect of smoking marijuana on cortisol levels, the researchers measured salivary cortisol in 10 “drug addict volunteers” of unstated age before, during, and after smoking a 0.25 g marijuana cigarette. “Acute administration of marijuana induced significant increases in the salivary concentrations of cortisol,” the researchers reported.

“The mechanism underlying the stimulation of reproductive function by marijuana in pubertal boys needs to be examined in detail. Furthermore, the suppressive effect of cortisol on growth directly through inhibition of growth at the cellular level by depletion of nutrients or indirectly through inhibition of growth hormone secretion needs to be further studied,” Rizvi said via email to MedPage Today.

“In addition, it is to be ascertained whether cortisol itself or some other factor like nutritional status is attributable to decline in growth rate in pubertal marijuana addicted boys. We are examining these aspects currently,” Rizvi said.

In the U.S., marijuana is the most popular drug among young people, with 11.7% of 8thgraders and 35.1% of 12th graders reporting having used it within the past year, according to a 2014 survey from the National Institute on Drug Abuse (NIDA).

More than 6% of 8th graders and 21% of 12th graders reported using marijuana within the past month, the survey found, and about 1% and 6% of 8th and 12th graders, respectively, said they used the drug daily.