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October 19, 2019
10/19/2019 3:00:00 PM - 10/19/2019 4:30:00 PM
Room W312AB
Cannabidiol in Pregnancy: Attitudes of Obstetric-related Healthcare Providers and Women 18-44 years-old in California
Sydney Selzer, M.D., Gillian Morrison, M.D., Brian M. Bensadigh, M.D., Katherine Gelber, M.D., Andrew W. Geller, M.D., Mark I. Zakowski, M.D.
Cedars-Sinai, Los Angeles, California , United States
Disclosures: S. Selzer: None.G. Morrison: None.B.M. Bensadigh: None.K. Gelber: None.A.W. Geller: None.M.I. Zakowski: None.
Introduction: With increasing legalization of marijuana, use in pregnancy increased to 7.1% in 2016 in CA.i Women believe regular marijuana use has no risks.ii While THC is the most widely known cannabinoid in cannabis, cannabidiol (CBD) has gained attention due to its lack of intoxicating properties and potential therapeutic roles. This is the first study to examine attitudes of obstetric-related healthcare providers and reproduction-aged women in California towards CBD in pregnancy.

Methods: Anesthesiologists, certified nurse midwives (CNM), doulas and reproductive aged women (18-44 y.o.) in California completed a survey focused on attitudes regarding safety of CBD, marijuana and alcohol in pregnancy. The primary aim was to determine attitudes toward CBD use during pregnancy, labor and postpartum period and differences in these attitudes between groups. All groups’ answers to each question were compared using Chi Square Contingency table, p<0.05 significant.

Results: Responses include 113 anesthesiologists, 9 CNMs, 48 doulas, and 315 women. While two thirds of women have seen CBD for purchase, over 50% of anesthesiologists never ask about CBD use. Only 9% of women believe 1 drink alcohol/week is safe, but 29% thought CBD topical use during pregnancy was safe. About 20% of Anesthesiologists and CNM rated topical CBD as safe in pregnancy, but significantly more (70%) doulas rate as safe (p<.001). Anesthesiologists were significantly less likely (7-13%) to consider CBD to reduce nausea, anxiety or pain in the pregnant or laboring woman P<.01. Conversely, 20-30% of women would use CBD for nausea, anxiety or pain during pregnancy and labor. Attitudes towards CBD use for nausea and pain were similar to those for anxiety, shown in Figure 1.

Conclusion: Given the abundance of CBD containing products in the marketplace and the fact that 20-30% of women have a positive attitude to CBD use during pregnancy for nausea, anxiety or pain, anesthesiologists should ask about CBD usage in their pregnant patients. CBD’s therapeutic properties stem from its ability to bind to the widely distributed cannabinoid receptors as well as serotonin (5-HT1A) and transient receptor potential villanoid type 1, producing analgesic, anti-emetic and anxiolytic effects.iii,iv Interestingly, repeated low-dose CBD treatment for a week increased 5-HT firing activity through desensitization of 5-HT1A autoreceptors, a similar mechanism seen with selective serotonin reuptake inhibitors (ssRIs).iv These findings indicate that CBD has potential to interact with commonly used anesthetics. Further, although in its pure state has been deemed safe with little abuse potential, CBD has little regulation and oversight therefore many products have mislabeled strength, THC content and may contain harmful contaminants.iii,v

While further research and regulation may reveal therapeutic potential and safety for CBD in pregnancy, this survey suggests anesthesiologists should be vigilant and ask patients about CBD use.

References: i. JAMA 2017;318:2490, ii. AJOG 2017;217:705 iii.The health effects of cannabis and cannabinoids NAP 2017, iv. Pain 2019:160:136 v.CBD Critical Review Report WHO 2018$$graphic_{D6E0EEB8-2614-4CAC-ABA1-C532F80631B6}$$
Figure 1

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