Taking both marijuana and alcohol during early pregnancy may disrupt fetal development

Dr KK Aggarwal

New preclinical research has shown in animal models that exposure to cannabinoids (CBs), which includes cannabidiol (CBD) and tetrahydrocannabinol (THC), during early pregnancy can cause malformations in the developing embryo. The research also demonstrated that co-exposure to CBs and alcohol increased the likelihood of birth defects involving the face and brain. The study, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, was published in Scientific Reports. The compounds are present in Marijuana and in India the Ayurvedic formulations containing marijuana are Jatiphaladi Churna and Madanananda Modaka.

Its therapeutic uses in Indian Ayurveda are for:

• Agnimandya (in which food is not properly digested due to the diminished power of Jaṭharagni)
• Atisara (acute diarrhea)
• Grahaniroga (irritable bowel syndrome)
• Klaibya (erectile dysfunction)
• Anidra (insomnia)

As of August 2018, thirty-one US states, the District of Columbia, Puerto Rico, and Guam authorize medical use of cannabis.

An additional 15 states have limited programs that authorize use of high cannabidiol/low delta-9-tetrahydrocannabinol (THC) cannabis formulations for treatment of childhood epilepsy, especially refractory seizures.

A cannabis extract with equal proportions of THC and cannabidiol is approved for medical use in 27 countries (including Canada), but not in the United States, for treatment of pain and muscle spasticity due to multiple sclerosis.

A cannabis extract containing only cannabidiol was approved by the US Food and Drug Administration for the treatment of intractable childhood epilepsy.

Smoked and inhaled cannabis have a rapid onset of effect (typically minutes) and relatively short duration of action (typically 2 to 4 hours).Oral cannabis has a slow onset of effect (typically half to one hour) and long duration of action (typically 4 to 12 hours). This may lead to inadvertent overdosing; when patients don’t experience effects as soon as they expect, they may take another dose, resulting in a cumulative overdose.Drug interactions: THC is a substrate for the CYP2C9 and CYP3A4 drug-metabolizing enzymes; so may interact pharmacokinetically with other substances metabolized by these enzymes, such as tricyclic antidepressants, protease inhibitors, or sildenafilTHC potentiates the sedative effects of other central nervous system depressants such as alcohol and benzodiazepines.Based on known adverse effects of recreational cannabis use, it seems prudent to avoid recommending medical cannabis to individuals with a history of schizophrenia, a recent acute myocardial infarction or episode of cardiac tachyarrhythmia, or who must drive or operate heavy machinery.

Taking both marijuana and alcohol during early pregnancy may disrupt fetal development.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA