Can You Take CBD Oil While Pregnant?

CBD Oil Pregnancy

If you are a regular CBD user and have discovered that you will be welcoming a new member into your family, then congratulations!  You may be wondering though, can you take CBD oil while pregnant? A few women have been reported to use CBD when pregnant, in order to lessen the undesirable side effects related to pregnancy, such as nausea and vomiting (1).

Although CBD may take the edge off some of the pregnancy related symptoms, should it still be used?  The red flag here is that although it may provide some short term relief, what are the other effects it may have specifically when it comes to the babies development during pregnancy.  Just in case you want the TL;DR, the FDA advises against using CBD oil while pregnant, purely for the reason that it has some similarities to THC, where there is evidence which suggests it should not be used during pregnancy and breastfeeding. 

Using CBD When Pregnant

The stance the FDA has on using CBD oil while pregnant is based on research with THC alone, or whole plant cannabis (which typically contains some CBD). It’s worth bearing in mind that these precautions around CBD and pregnancy are justified based on studies using cannabis in general.  

The best we can do currently, is take a conservative approach, since there are no studies that directly examine the effects of CBD during pregnancy in humans.  What we do have though, are studies which demonstrate cannabis-related adverse foetal effects. So although its slight speculation, as CBD isn’t cannabis per se, but it’s still a good guideline. 

Cannabis contains phytocannabinoids, of which CBD is one. THC, CBN and CBG are a few others. The concern with phytocannabinoids is that they can cross the placenta, and permeate the blood-brain barrier of a foetus. 

This is a concern because the mothers own internal endocannabinoids play a key role in promoting the natural development of the brain through neuronal growth.  When phytocannabinoids are introduced during pregnancy, there is a risk that they interfere with the role that endocannabinoids play in properly shaping brain development.  

This is why we see that after cannabis exposure in pregnancy, its use is often associated with abnormal changes in dopamine receptors in the children, which can lead to behavioural abnormalities such as hyperactivity, poor cognitive function, and neurological impairment (2). .Cannabis use throughout pregnancy has also been associated with other negative traits in children such as anxiety, anencephaly and hyperactivity. 

When we look at CBD specifically, we are limited to research in specific cells, baby rats and mice. 

CBD has been found to be anti-angiogenic to human umbilical vein endothelial cells, which decreases angiogenesis (the process of forming new blood vessels) (3). This may arise to pregnancy complications, including placental insufficiency and pre-eclampsia.

There are also concerns that CBD may modulate the immune system by altering cytokine levels, affecting apoptosis which may ultimately deregulate a foetus developing immune system and pre-expose them to cancers and infections in their later life.

A single exposure of both THC and CBD in pregnant mice (administered at week 3/4 of pregnancy in humans) resulted in disruptions in embryonic brain and facial developments in the pups (4). These effects are similar to ones that have been shown when mothers are exposed to alcohol during pregnancy.  The study author had this to say about the results: “We know that there is no safe period to drink alcohol during a pregnancy, and I think this research shows the same is likely true of marijuana use”. 

The only problem with this study is it used both THC and CBD. We have no indication as to the degree to which one is mostly or partially responsible for the observed effects. But given the ability of CBD to interact with the Endocannabinoid System (ECS), it could theoretically play a role. 

An unexpected effect of CBD was found in another study, examining gastroschisis. (Gastroschisis is a congenital malformation of the wall of the abdomen).  After CBD had been given to pregnant mothers, gastroschisis was analysed by measuring specific markers of inflammation in the rat pups. Interestingly, the markers showed a beneficial effect of CBD on gastroschisis, due to lower levels of inflammation (5).

The key takeaway from this study however, was that CBD given to a mother can indeed have an impact on the baby.  Despite a positive effect for gastroschisis, there could at the same time be negative effects for neurological outcomes when CBD is used during pregnancy.  

I would have liked to have seen the study also measure the impact on brain development of the rat pups, to discriminate between the impact of THC vs CBD seen in the whole plant cannabis studies. 

We need to see a study using CBD alone and measuring neurological outcomes before we can start to truly understand the influence of CBD. Also population studies following mothers who choose to take CBD when pregnant will be useful to assess the impact on children. 

FDA Position On CBD When Pregnant

Due to the lack of robust research studies that examine the impact of CBD on a pregnant mother, developing child and breastfed baby, the FDA stance is that it advises against CBD use in pregnancy.  This is currently based on the fact that despite being distinct from THC in many ways, CBD as a cannabinoid is in other ways similar to THC, which may mean it poses similar risks to children that have been established in the research with THC (6). 

As we’ve discussed above, there is a need for numerous and comprehensive studies examining the interaction of CBD specifically on pregnant mothers and outcomes in children.  It may be that sufficient evidence suggests that CBD is either harmless, or beneficial, but that is yet to be proven or disproven.  Just based on the biological mechanisms of cannabinoids alone, It could be that any alteration of the ECS during pregnancy, whether its CBD or THC, could pose a risk to a developing child, since the cannabinoids are similar. 

CBD Oil, Conception & Fertility

We could speculate here, as to the effect that CBD may have on the processes surrounding getting pregnant. I’ll cover below just why there is justification to speculate.  Since the ECS plays a leading role in the steps that lead to pregnancy, such as fertilisation, implantation and parturition, there is a chance that CBD may (or may not) modify these in some way, given its ability to ‘talk’ to the ECS around the process of conception.  We can get an idea as to how CBD may relate to fertility, by looking at the mechanisms driving the process. As an example, levels of anandamide (an endocannabinoid) that peak around ovulation are correlated with a successful conception (7).

On the other hand, insufficiency of anandamide may be correlated with difficulty conceiving due to its role in ovulation.  You may be thinking, where is he going with this anandamide stuff? Well, this is where CBD comes in, because of its ability to modulate levels of anandamide in the body. 

CBD encourages higher levels of circulating anandamide, as it is able to discourage its breakdown. In theory, this would be in support of a positive effect on fertility and conception, although this is conjecture at this point, until clinical research can confirm this.  Additionally, it may not be CBD that’s the answer, simply because it is something that simply attempts to alleviate underlying imbalance in the ECS, and does not address the root cause (of why an ECS may be imbalanced in the first place. 

For example, stress can affect fertility, which will manifest itself in an ECS imbalance. So the root cause is really stress. This is a big one, as a successful conception depends on a synchronous dance of hormones, which may be thrown off by excessive stress hormones. Plus the signal of stress hormones literally tells the body that an environment is stressful, where it is not suitable or safe for a child to be born into.  Although CBD can reduce levels of stress hormones (8), and bring back some sort of balance, if the underlying stressor is still there it’s still likely to be more difficult to conceive. 

This again is all theoretical, and there is no evidence for CBD to support a role in conception. Anyone using it to try and conceive does so at their own risk, and managing their own expectations appropriately.  When it comes to other cannabinoids like THC, there’s also some interesting research on its use before conception, in both parents. 

THC can modify the way genes are expressed (what ones are turned on/off, up-regulated/ down-regulated) in parents before a child has been conceived (9). These changes in gene expression are particularly relevant when it comes to a mothers eggs, and a fathers sperm, where the genetic information (and instructions on how to express it) comes together to be passed on. 

Epigenetic (changes in how genes are ‘read’) have been found in kids whose parents used cannabis heavily before conception. Here’s one you may not have seen coming, but alcohol and cannabis use in dads translated to epigenetic changes in their kids, as a result of being passed through the sperm (10).

CBD Oil While Breastfeeding 

As well as playing a role in foetal brain development during pregnancy, Endocannabinoids also continue to do so throughout the breastfeeding process.  They are passed to the child from the mother through breastmilk, which is another significant benefit of breastfeeding in addition to the provision of key probiotic bacteria for a healthy immune system.  As we know, CBD can interact with the body's ECS, and modify levels of endocannabinoids. 

As is the case during pregnancy, there is a chance that CBD may interfere with the developmental instructions (endocannabinoids) that are passed through a mothers milk.  Even after having a successful pregnancy, it still might not yet be time to get back on the CBD. This is because cannabinoids like THC and CBD can be detected in breast milk after they have been consumed, meaning that the child gets a second hand dose.  Again the concern here is how exposure will affect a child's immune and neurological developments (11).

There are no human studies investigating CBD use in mothers on infant development. However, mouse pups who were given anandamide shortly after birth, grew up to be overweight, insulin resistant and had increased body fat. They also had increased appetites (12).

The endocannabinoid 2-AG plays a key  role in promoting the suckling response in a child's brain so it can learn to latch and take on nutrients from breast milk (13). Theoretically a 2-AG deficiency may mean a child does not take on enough nutrients to be suitably nourished.  From conception, all the way to raising a mature infant, there is a delicate balance of factors at play with regards to the body's ECS. Quite how CBD impacts this balance is still yet unknown, although we have attempted to speculate as to what its impact may be. 

This will be facilitated once measurements of an individual's ECS are more standardised and well understood.  Then there may be a case to promote or limit the use of cannabinoids like CBD at various points during the process of conception through to breastfeeding, based on an individual mothers needs and her ECS. 

Summary 

Based on how early it is with CBD research, and the little we know about how it affects child development, its best to stop using it when pregnant and breastfeeding. 

It may be that sufficient research emerges that shows it's safe, but it's best to be cautious. Based on the negative impact of THC and other cannabinoids on child development, it is right to be cautious and steer clear for now.