A Canadian clinical guideline concluded cannabis use during pregnancy and breastfeeding should be avoided given limited safety data, while emphasizing screening, supportive communication, and harm reduction if abstaining is not feasible.
Obstetricians, midwives, and healthcare providers caring for women of reproductive age.
Recommends avoidance or maximum reduction if abstaining not feasible
What the researchers found
Based on GRADE-assessed evidence, the guideline recommends avoiding cannabis during pregnancy and breastfeeding, or reducing use as much as possible if abstaining is not feasible. Key focus areas include screening, dependence and withdrawal management, communication approaches, maternal/fetal outcomes, pain control, postpartum care including secondhand smoke, and breastfeeding considerations.
Why it matters
Cannabis use during pregnancy is increasing. Clinicians need evidence-based guidelines to counsel patients, particularly as social acceptability of cannabis grows.
The numbers in context
Literature search covered January 2018 to February 2021. Guideline addresses screening, dependence, withdrawal, communication, maternal/fetal outcomes, pain control, postpartum care, and breastfeeding.
How the study worked
Clinical practice guideline searching PubMed and Cochrane for articles published January 2018 to February 2021. Included clinical trials, observational studies, reviews, and guidelines on cannabis during pregnancy and breastfeeding. Evidence quality rated using GRADE.
What this study cannot tell us
Limited high-quality evidence available. Most studies are observational with potential confounders. Long-term follow-up data on cannabis-exposed pregnancies is sparse.
How to read the evidence
GRADE-assessed clinical guideline, but underlying evidence is largely observational with limited long-term data.
When this study was published
Published in 2022 with literature through February 2021.
The bigger picture
The guideline takes a harm reduction approach: rather than simply advising against use, it provides strategies for reducing harm when complete abstinence is not achievable.
Questions still open
- What are the specific dose-response relationships between cannabis exposure during pregnancy and fetal outcomes? Are some formulations or routes of administration less harmful?
Common questions
Should cannabis be completely avoided during pregnancy?
What about cannabis and breastfeeding?
Read the original research
Guideline No. 425b: Cannabis Use Throughout Women's Lifespans - Part 2: Pregnancy, the Postnatal Period, and Breastfeeding.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 44(4), 436-444.e1
Citation
Graves, Lisa E; Robert, Magali; Allen, Victoria M; Dama, Sumeet; Gabrys, Robert L; Tanguay, Robert L; Turner, Suzanne D; Green, Courtney R; Cook, Jocelynn L. (2022). Guideline No. 425b: Cannabis Use Throughout Women's Lifespans - Part 2: Pregnancy, the Postnatal Period, and Breastfeeding.. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 44(4), 436-444.e1. https://doi.org/10.1016/j.jogc.2022.01.013
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