Dec. 18, 2024 – There’s a lot of information out there about what to expect when you’re expecting, but there aren’t so many resources on what to expect when quitting cannabis for pregnancy.
Research continues to show that cannabis use during pregnancy is linked to risks for both mom and baby during pregnancy, at birth, and throughout a child’s development. The American College of Obstetricians and Gynecologists says pregnant people should quit, but as many as 7 of every 100 pregnant people report using cannabis during pregnancy.
It turns out that quitting cannabis can trigger what are known as “rebound symptoms” that often mirror common pregnancy symptoms like nausea, insomnia, and anxiety.
“If you just found out you're pregnant, and now you can't sleep and you're anxious, you may think that you're doing yourself a favor by treating these symptoms with cannabis, but really when you stop this drug, your symptoms are going to be worse,” said Alta DeRoo, MD, MBA, an addiction specialist and practicing obstetrician-gynecologist in Minnesota. She is the chief medical officer for the Hazelden Betty Ford Foundation, which operates a nationwide network of addiction and mental health treatment centers.
Substance use experts have received requests from obstetric and gynecologist colleagues asking for tip sheets on the topic, and a Yale expert called the available evidence-based approaches to quitting cannabis for pregnant and postpartum people “lacking.”
So if you’re considering quitting cannabis or maybe just cutting back, either ahead of pregnancy or perhaps a pregnancy test just revealed the news, here are some options.
What Will Quitting Be Like?
There may be withdrawal, especially for heavy users.
“It's not going to be like your traditional withdrawal that you would expect from withdrawing from opioids or alcohol, where this is a huge uncomfortable physiologic response,” DeRoo said.
Cannabis withdrawal can feel like a type of anxiety that is sometimes described as a stuck accelerator or taking your foot off the brake pedal of a car. People who use cannabis to help with sleep may have rebound insomnia.
“That could be very disturbing to a person who was previously enjoying some of those systemic effects that cannabis was providing throughout their body,” said DeRoo.
Withdrawal symptoms usually subside in one to two weeks, and your OB/GYN wants you to reach out for help managing the symptoms.
Also, you might slip up.
“It's OK. It happens. It's part of the process,” said Ariadna Forray, MD, a reproductive psychiatrist at Yale Medical School who focuses on clinical research to develop treatments and interventions for pregnant and postpartum people with substance use disorders.
A slip could be a sign to ask for help. She would ask her patient to think about what their next step is.
“I would ask, ‘How can we help you continue to go on the path that you want?’ Which, for most pregnant patients, they don't want to use. They want what's best for the pregnancy. They want what's best for their baby,” Forray said.
How Do I Bring Up the Subject With My Provider?
Some pregnant people may be worried that disclosing their use may trigger a child welfare investigation. Some states do have reporting requirements for cannabis use.
Forray said she can understand those concerns.
“The best thing that folks can do is sometimes just be aware of what the rules and the regulations and the policies are in their state around this,” she said. “One way to approach it, if someone is in a state where there's concerns around that, is just to talk about the symptoms they're experiencing and maybe what alternative treatments there might be.”
DeRoo noted that patients also have a right to decline a urine drug screen, and it’s OK to ask, “How are you going to use my urine when I give you a sample?”
“This might be important because perhaps you gave up smoking marijuana two weeks ago; however, that marijuana is going to stay in your system for a good 30 days, so maybe you don't want this urine drug screen showing that it has marijuana,” she said.
All of the experts interviewed for this article said providers want to talk openly with their patients about cannabis use, because they want to help, and they can. They also said that child welfare investigations around cannabis use among people who only use that drug are rare in the states where they practice, but wouldn’t rule out they could happen in some places.
I Need Help Quitting – What Are My Options?
Talking to your provider about quitting has been shown to increase the likelihood that you’ll be successful, says Kelly Young-Wolff, PhD, MPH, a licensed clinical psychologist who studies cannabis use during pregnancy at Kaiser Permanente in California.
Open to trying therapy? Ask about approaches called “cognitive behavioral therapy” (CBT) and “motivational interviewing.” During those therapy sessions, you will explore your motivations for quitting and come up with ways to manage cravings and thwart triggers.
A real key to success for pregnant people is often finding other ways to manage nausea, stress, and anxiety.
DeRoo says these are some options for common symptoms:
- Nausea: Doxylamine and vitamin B6, and if those don’t work, your provider can prescribe a steroid.
- Insomnia: Melatonin, sleep hygiene, and therapy called CBT for insomnia is available through apps or online modules if in-person therapy isn’t an option.
- Anxiety: Coming up with ways to cope, like exercise, journaling, and talking with a trusted person; therapy and medications like Zoloft or Wellbutrin are also options.
Cutting back is also an option, said DeRoo, but she stressed that the goal should be to quit all cannabis use during pregnancy.
“Anything that you can do to decrease your THC use is a step in the right direction,” said DeRoo, referring to tetrahydrocannabinol, the active ingredient in marijuana that can cross the placenta to the fetus.
DeRoo would then tell her patient, “And I can meet you where you are with that. As long as we agree, I meet you there, but then I carry you along on the pathway to not having to use any drugs or alcohol.”
Is the Smoke the Problem? Can I Vape and Use Edibles?
There is no evidence that vaping or using edibles is safer, said Young-Wolff, noting that so far, research on cannabis use during pregnancy hasn’t asked people what form they use.
“Our team has also received a substantial grant from the National Institute on Drug Abuse to study how different methods of cannabis consumption may impact maternal health outcomes during pregnancy,” she said. “Insights from our focus groups reveal that pregnant patients are eager for evidence-based information about whether certain modes of cannabis use are more harmful than others.”
I Know People Who Didn’t Stop Cannabis During Pregnancy, So Why Should I?
Listen to your doctor, not friends or other “experts.”
You’re going to encounter people who tell you using cannabis during pregnancy is safe. One study out of Colorado even showed that 70% of dispensaries contacted by a mystery caller stating she was eight weeks pregnant recommended treating her morning sickness symptoms with cannabis products.
“Many have heard that there are risks associated with use, but they have also seen friends and family use cannabis without any obvious adverse outcomes,” Young-Wolff said of testimony shared during focus groups.
A really important part of quitting cannabis during pregnancy is to make plans to not be around the drug. That means asking your partner to quit with you, and asking friends and family not to use around you.
One of the newest studies on cannabis use during pregnancy came from Young-Wolff’s team, which found that living near cannabis retailers in California was linked to higher rates of using the drug during early pregnancy.
What Do I Do When Quitting Gets Hard?
A circumstance you might not see coming is when you think you’ve quit and find yourself reaching for cannabis during pregnancy. For alcohol and opioids, medicines are available during pregnancy to reduce cravings, but there are no such drugs for people who are quitting cannabis, noted Maria Muzik, MD, MSc, a perinatal psychiatrist at Michigan Medicine and a professor in both the departments of Psychiatry and Obstetrics & Gynecology.
“When do you relapse? Not when you are at your best. It’s when you feel weakened, when you are stressed about other things, as well. When maybe there is a relational issue, or you feel physically sick. When all of this comes together, that's where you are most likely to relapse,” she said.
Ask for help. It’s worth keeping you and your baby safe.
Trying to quit cannabis before or during pregnancy could also reveal that you were using the drug to try to treat a mental health condition like anxiety or depression. Finding an alternative and evidence-based treatment for that during this time will have long-term benefits for your child, said Ran Barzilay, MD, PhD, a child and adolescent psychiatrist at Children’s Hospital of Philadelphia and an assistant professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine.
“Opening another side of the discussion, untreated mental health conditions and disorders are also a potential risk factor for not just the mother, but for the child over time, for the next generation,” he said. “So these are things that we would want mothers and pregnant people to treat.”
