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A Review of How THC and CBD Cross the Placenta and May Affect Fetal Development Through Placental Receptors

ReviewModerate evidence
The takeaway

Both THC and CBD cross the placenta and can affect the fetus directly, but cannabinoid receptors throughout the placenta mean these substances can also impair placental development and function, contributing to growth restriction and other adverse outcomes.

Obstetricians, maternal-fetal medicine specialists, pregnant cannabis users, reproductive researchers.

Both THC and CBD cross the placenta and affect placental receptor signaling

What the researchers found

Cannabinoid receptors are expressed throughout the human and murine placenta. Both THC and CBD cross the placenta. Prenatal cannabinoid exposure is linked to small for gestational age and fetal growth restriction. Studies including placental analysis identified changes in placental vasculature and function. In vitro studies show cannabinoid effects on cell proliferation, angiogenesis, and migration in placental cells.

Why it matters

Cannabis use during pregnancy is increasing as pregnant women use it for morning sickness and anxiety. This review highlights that the risk is not just from direct fetal exposure but also from cannabis disrupting the placenta itself, which could impair nutrient delivery and fetal growth.

The numbers in context

Cannabis concentrations have increased dramatically over 20 years. Cannabinoid receptors found throughout placenta. Prenatal exposure linked to growth restriction. Placental vasculature and function changes documented in exposed pregnancies.

How the study worked

Narrative review summarizing clinical, animal model, and in vitro evidence on how phytocannabinoids affect placental development and function, with focus on receptor distribution and signaling pathways.

What this study cannot tell us

Narrative review without systematic methodology. Much evidence is from in vitro or animal models. Clinical studies with placental analysis are few. Cannabis product composition varies widely. Timing and dose of exposure likely matter but are poorly characterized.

How to read the evidence

Narrative review integrating clinical, animal, and in vitro evidence. Mechanistic plausibility is strong but clinical evidence is limited.

When this study was published

Published in 2023.

The bigger picture

Most prenatal cannabis research focuses on the developing brain, but the placenta is the first point of contact. If cannabinoids impair placental blood vessel development or nutrient transport, the downstream effects on the fetus could extend well beyond direct cannabinoid exposure.

Questions still open

  • At which gestational stage is the placenta most vulnerable to cannabinoid disruption?
  • Do different cannabinoids (THC vs. CBD vs. isolated compounds) have different placental effects?

Common questions

Does cannabis affect the placenta?
Yes. Cannabinoid receptors are found throughout the placenta, and both THC and CBD cross it. Studies show cannabis exposure can change placental blood vessels and function, which may contribute to fetal growth restriction.
Is CBD safe during pregnancy?
This review found that CBD, like THC, crosses the placenta and can affect placental cell function. The assumption that CBD is safe during pregnancy because it is non-psychoactive is not supported by the available evidence.

Read the original research

Cannabinoids and the placenta: Receptors, signaling and outcomes.

Placenta, 135, 51-61

Citation

Rokeby, Abbey C E; Natale, Bryony V; Natale, David R C. (2023). Cannabinoids and the placenta: Receptors, signaling and outcomes.. Placenta, 135, 51-61. https://doi.org/10.1016/j.placenta.2023.03.002

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