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The MomBaby Podcast explores critical topics in maternal health through conversations with experts and lived experiences. Each episode highlights important issues like recognizing maternal warning signs, coping with pregnancy complications, and more. Whether you're expecting, a new mom, or a healthcare provider, The MomBaby Podcast offers valuable information to help ensure healthier outcomes for mothers and babies.
Erin McClain: [00:00:00] All right, well, hi. Welcome to the Mom Baby podcast. I'm Erin McClain. I'm the Assistant Director and research associate at the UNC Collaborative for Maternal and Infant Health. I have Megan Williams here with me today from You Quit, Two Quit. Can you tell us about yourself and what You Quit, Two Quit does?
Megan Williams: Yeah. Hi Erin. My name's Megan Williams. I'm a research associate with the UNC Collaborative for Maternal and Infant Health, and we provide training and technical assistance around perinatal tobacco screening and cessation. So we're talking with providers around the state often, and one topic that keeps coming up lately is the use of cannabis in pregnancy. And so we wanted to talk about that today in our podcast.
Erin McClain: Awesome. So when you say cannabis, what do you mean?
Megan Williams: That's a very good question. There's a lot of different words that all mean sort of the same thing under this umbrella that we're talking about, but cannabis refers to THC, which [00:01:00] is known as quote unquote marijuana, as well as CBD, which is sort of the non-psychoactive component that's in cannabis. And so when we say cannabis, it's really an umbrella term that includes both of those, both the THC, which would be, in North Carolina, not legal, and the CBD, which is what you can, purchase in stores all over the place in North Carolina.
Erin McClain: So is that why I see lots of like dispensaries and advertising popping up in North Carolina? So we do have some legal cannabis here?
Megan Williams: Yeah, so it's a, it's a really confusing landscape right now because in some states, THC, otherwise known as marijuana is legalized and it's fully legal, recreational use. In North Carolina, we only have legalized cannabis, I mean legalized CBD. So, and not all changed with the Farm Bill of 2018.
So prior to 2018, it was all illegal, but at the federal level. But, with the [00:02:00] implementation of the Farm Bill, they actually legalized a form of cannabis plant that could have up to 0.3% of THC contained within it. And typically, just for comparison's sake, the type of plant grown for THC marijuana use is usually 10 to 12% of THC concentration.
So what manufacturers are doing, since it's the plant that determines legality and not the product, is they're legally growing this hemp plant, which contains only 0.3% Delta 9 THC. Also known as marijuana. Then processing the CBD that's also present in these plants, and creating various other forms of THC that are currently legal in North Carolina.
Delta 9, THC being the only type that's illegal in this state at this point. You may see these advertised as Delta 8, THC, Delta 10 THC, and THCA. Those other types of THC have effects on the user that are similar to Delta 9, but they're [00:03:00] not illegal in North Carolina because of the plant that they came from.
Erin McClain: Okay. So is there anywhere in North Carolina that you can find legal? Delta 9.
Megan Williams: Yeah, that's a really good question. So in North Carolina it's, it's, not legal statewide except for, on the Qualla boundary. So the Qualla boundary, as of last year, they had originally legalized medical marijuana and then in the last, I think it was maybe about six months ago, they went ahead and just legalized all THC marijuana for all uses, so for recreational use. So what that means is that on the reservation itself, it's legal to sell it, but that doesn't, so that means that, you know, if, if other North Carolinians are, are to purchase it there, they cannot legally use or legally sell it or resell it in the rest of North Carolina but on the reservation itself, it's still, it's considered legal at this point.
Erin McClain: And they can do that because the Eastern Band of Cherokee are a sovereign nation, basically. So they. [00:04:00] That's why that area. Okay, what about kind of oversight? So we've got all of these products out here, what do we know about them?
Megan Williams: Well, you know, what's, what's interesting is that when a state decides to legalize Delta 9 THC, what they also do is they provide oversight to the sale and, you know, manufacturing of those products. And in North Carolina, since we don't have a legal market, we have this kind of gray area where there's all these products that are not, they don't really get overseen by the FDA.There's not, I mean, there's technically within the industry, there's, they're, you, kind of overseeing the products for quality and, and whatnot but there's no body that's responsible for making sure that the labeling is correct, that there's no contaminants contained in these products. And so, what we're concerned about just as health professionals is that, you know, folks might be getting exposed to all sorts of [00:05:00] things that they're not realizing that they're getting with these products. For example, there was a study that sampled, I think 30 different products that, you know, from 10 different manufacturers, and every single one of them had something in them that was not on the label.
It was everything from THC, Delta 9 THC, so it says CBD or you know, Delta 8 THC or whatever, you know, thinking that you're getting that version of it, but maybe it actually has Delta 9 in it. Some of the products had lead contaminants in them, and some of the products had mold. You know, there's all sorts of things that can kind of sneak into the manufacturing process, which is why it's really important to have oversight.
And so we're in this, this time right now where it's really fuzzy and there's not, you know, there's industries that are taking off really quick, and because it's a profit driven industry, they're not bothering so much with, with the oversight, or at least there's not a [00:06:00] third party that's necessarily making sure that they're accurate in their labeling and careful with their manufacturing.
Erin McClain: Thanks. That's really helpful to understand. I think it seems like such a complicated, situation in our state, so it's, it's nice to understand kind of where are things legal, where are things kind of in a gray zone and, and what does that look like in North Carolina? So can you tell me what these products look like when we talk about, THC. 'Cause I see lots of different things on the market, but can you tell me what we're, what we're talking about here?
Megan Williams: Yeah, so there's so many choices for how folks can get CBD products and THC products. There's blunts like a joint kind of thing like you would traditionally think of.
So there's combustible things that they can use. There's also vape products and so, you know, folks that are using vaping devices for tobacco can also use them for CBD products and THC [00:07:00] products. We also see gummies and other types of edibles and if you walk into a vape store, there's so many options.
Like that's just the tip of the iceberg. But there's many, many different ways: you can inhale it. You can eat it, you can drink it. There's, lots of different ways folks can consume these products.
Erin McClain: So what do we know about pregnant women in particular using cannabis? Why are they using it? What do we know about that?
Megan Williams: Well, we're seeing an uptick in use of cannabis products among folks that are pregnant. I think the rate is somewhere around 5%., the last research that I saw that are using these products, and this is among folks that aren't using other addictive substances necessarily. Sometimes there's tobacco co use, but it's not folks that have other substance use disorders like various, opioids and other [00:08:00] kind of harder drugs. It's folks that are using them casually or for self-medication purposes in pregnancy. And so oftentimes what, folks will cite is that they're, you know, they're really nauseous, or they have morning sickness, or they have like anxiety or trouble sleeping. And for lots of reasons, including really aggressive marketing by the industry, they're trying cannabis products to get some relief from those symptoms.And I, I think, you know, oftentimes folks aren't really getting the best information because they're just relying on the salesperson.to let them know, you know what it could potentially be used for. They're not evidence-based remedies. They're just sort of trying to sell products, so they wouldn't necessarily have the very best information as far as research goes.
Erin McClain: One thing I've seen is that people think it's natural, and so it's safer than maybe a prescription drug or something like that.
Megan Williams:Yeah, I mean, it kind of feeds into this, [00:09:00] this trend that we see, which , in a lot of ways is, is really nice. Like, it's nice to be interested in things that are closer to the earth and to, you know, more fruits and vegetables in our diet.
Those are all great things. But I think sometimes what's happening is people are extending that into this comes from a plant and so like, therefore maybe it's better, but lots of things come from plants, including tobacco and opioids and the origin of it doesn't necessarily make it innocuous.And so, you know, I think there's, there's also a lot of, like I was saying, pressure from the industry. And I think the industry has really embraced that. Like this is a natural alternative and this comes from the earth and so it must be better. They're not really mentioning all of the potential contaminants or what we are seeing as evidence that has been building around the potential real harms that can happen when folks are using cannabis products.
Erin McClain: And that [00:10:00] was definitely a strategy of the, to industry when they, you know, there's like American spirit and different brands that were supposed to be natural tobaccoso this is definitely things we've seen before. What can you tell us about what we know about the risks of cannabis use during pregnancy. So I know that we haven't been able to study it for a long time, but we are starting to get more information. So can you tell us kind of what we know at this point?
Megan Williams: Yeah, and so a lot of the research is centered more around the impacts of THC, although some researches from CBD type of use. So I'll just speak to cannabis in general because really it's a spectrum, right? Like they're all a similar product and so sometimes it's just a matter of degree in terms of the potential impacts on pregnancy. So one thing that we know for sure is that folks that are using cannabis have a [00:11:00] higher risk of their baby being born too small or too soon, so small for gestational age or low birth weight.
We also have a higher preterm birth rate among folks that use cannabis when they're pregnant. There are some other impacts that have less solid evidence with them. So we have, we see some evidence of increased hypertension, gestational hypertension. We see increased risk of infant death, although there's a smaller association there.
But you know, the evidence is starting to build that there's potentially other things that could go wrong as well. But one thing that's really important is to know that those might sound like familiar impacts 'cause they're really similar to the impacts of tobacco on a pregnancy and there's a really high rate of co-use among tobacco and CBD products.
And so when you see that co-use, we actually see much higher rates of some of those negative [00:12:00] impacts. So rates as high as double if folks are using both THC or CBD products along with tobacco, they can have like double the rate of, for example small for gestational age or preterm birth rate.versus if they were using one or the other. And so that's an important thing to just kind of keep as part of this conversation.
Erin McClain: What can providers do? We've heard a lot of kind of feedback from obs and family medicine folks and pediatricians that they're seeing that pregnant women and parents are using THC they're talking about cannabis use. So how should providers talk about this with patients and with parents?
Megan Williams: Well, I think it's important for providers to talk about it. Like, I think that's one thing is that providers might feel like they don't have the information and so hopefully getting more information and getting more comfortable with the topic can be helpful in that because we know that it's [00:13:00] happening.
It's sort of like tobacco, like we're seeing similar rates of use. So it's, it's really important to, um, you know, get prepared and to feel like you can speak about this topic, but then to make sure that we're asking about it. So there is some stigma around use of any products during pregnancy, and so opening up that door in a nonjudgmental way and making sure that we're asking it uniformly across different populations we certainly wouldn't want to single out, you know, certain populations just because we assume based on their sociodemographic appearance or background that, that they might be using these products. It's actually being used among all different types of folks. We recommend using a kind and a proactive approach. So, you know, we wanna make sure you and your baby have the best information to keep people safe. So not just, “so are you using cannabis?”
Not like that kind of approach, but, you know [00:14:00] weaving it into the other things that we talk about when we're providing this information to folks. And it's also nice if we can, instead of leading with the risks if we can lead with, you know, how we can keep yourself and your baby most healthy and, you know, kind of look at it in more of a positive way rather than just sort of listing out all the risks that can potentially happen.
Erin McClain: So kind of like with tobacco, where we would say, you know, if you quit, your baby is more likely to be born at a healthy weight. Or to be born at the right time as opposed to too soon.
Megan Williams: Yeah. Right.
Erin McClain: Okay. So kind of that similar approach. Yeah, I know, and I've seen, you know, I'm in parenting groups and things like that, that women say they use it specifically, they're using cannabis to deal with nausea.That one comes up a lot and they think it's maybe a safer option. So how should providers approach this piece, nausea and vomiting in [00:15:00] pregnancy?
Megan Williams: Well, I think, you know,we need to definitely acknowledge that that's an issue that needs to be addressed and that they deserve relief from that.
And there are lots of evidence-based approaches that do work. Oddly enough, cannabis can actually, for some people it can, you know, work just generally speaking, but for others it can play into this cyclical vomiting syndrome where it actually makes things worse, which we certainly don't want. But there are some basic things that people can try and then there's sort of higher level things people can try.
So, things like avoiding strong smells, maybe having smaller meals rather than large meals. Sucking on sour candy or ginger or peppermint candy can be helpful for folks.Sometimes drinking cold beverages through a straw, oddly enough, can be helpful for nausea. So there's a little bit of trial and error with sort of basic daily lifestyle type changes. But then if they're not finding relief from that, there [00:16:00] are prescription medications that can be helpful for nausea during pregnancy, like Zofran. And so it's important to, to talk about the fact that there is evidence that that works versus cannabis where there's not, and we know there's evidence of harm.
Erin McClain: Yeah, that's really important. We have another podcast episode about hyperemesis and we had Dr. Andrew Householder on from Birmingham who talked a lot about Zofran safety profile and, and how there are some misconceptions among obstetricians and other folks about the increased risk of oral facial clefts and, you know, he really broke that down and looked at what that increased risk is and that it's pretty marginal.and that compared to a woman, particularly somebody who has hyperemesis, where you know, they're losing dramatic amounts of weight or their life is really compromised, you know, in terms of daily function. it's super important to balance the risk and benefits there and make Zofran available, particularly in those 12 weeks.
And [00:17:00] so we can link to that episode in the show notes. I think it's a really good connector to this one. So what do we know about using cannabis after the baby's home and, you know, breastfeeding and those kind of things? What do we need to think about there as providers?
Megan Williams: Well, first of all, babies just in general are really vulnerable to secondhand exposure of any type. So we would include under that tobacco, cannabis, you know, anything that's gonna impact their ability to breathe…that can be really dangerous.
Erin McClain: So, is it just the smoke or are you also talking about the vaping as well?
Megan Williams: Yeah, so there's all sorts of harms that come from, from these products. It can be like, there's definitely harm just from tobacco and from the cannabis itself, but all of the other ingredients or all the other components of if they're vaping of the vaping product can also be harmful.
So sometimes we have. Heavy metals like lead. [00:18:00] There's flavoring compounds that can be harmful, so all of that can impede the ability of the infant to breathe freely and it can increase the risk of sleep related death in an infant. Another harm that can potentially come from, just having these products around is the fact that young children could potentially get into them.
So if we're looking at something that smells like candy or it looks like candy or you know if it's like an edible, they could potentially get into that. Um, and we've seen a real uptick in the number of calls to poison control that are related to cannabis products. So if a child is exposed to any of these products, so, you know, I'm including liquid nicotine because that can cause burns on the skin.
A teaspoon of liquid nicotine can cause death to a 20 pound toddler if they ingest it. If a child is exposed to any of that, or if they accidentally [00:19:00] consume an edible, parents should really be calling poison control and they don't need to be worried about repercussions or anything like that.
And the number for poison control is 1-800-222-1222. And that way you can get the proper guidance to make sure that you get, if needed, the medical care that your child might need if that happens.
Erin McClain: So it's whether they're actually ingesting it or they even get it on their skin in terms of when we talk about vape liquid.
Megan Williams: Yeah. So vape liquid can cause burns on the skin. It's you know, it's, it's liquid nicotine, so it.
Erin McClain: They also, even with cannabis, they're absorbing the drug as well.
Megan Williams: Yeah, yeah. There's that as well. And so, you know, I think an important take home message for parents is to make sure that they're treating all this whole universe of products, so vape, tobacco vaping products, CBD, cannabis, THC. All of that needs to be treated like poison if you have a young child in the house because there's a real risk of harm if the kids get into those products. [00:20:00] So we wanna make sure that we're keeping them away from them.
Erin McClain: In terms of breastfeeding, so what do we know about cannabis and breastfeeding?We know with nicotine like nicotine's, a water soluble drug, so basically, you know, if a woman breastfeeds, then she uses a nicotine product and then by the time she breastfeeds again, most of the nicotine is kind of cycled in and out of the breast milk that we know that babies don't get a lot of, um, it's of course better to quit, but when they can't, you know, we know that we can minimize the way that babies, or how much nicotine babies are gonna get. Do we see the same thing with cannabis?
Megan Williams: Cannabis is entirely different. So cannabis is fat soluble, which means it's gonna hang around in the breast milk for a much longer time, days to weeks. Whereas with nicotine, you know, most of it's out within 90 to 120 minutes.
With cannabis, it can hang around for weeks. So you can't really control the exposure to the baby by timing or pumping and dumping or anything like that. None of that's gonna [00:21:00] work if you're. breastfeeding and using cannabis. And because it's fat soluble, it is more easily transferred, it stays in the mom’s system longer, and then it therefore goes into the baby’s system as well.And it can be stored in their, you know, their fat cells. And, it's possible that the baby can even test positive for cannabis. And, you know, that opens up a whole can of worms for parents that we don't wanna open.
Erin McClain: Right.
Megan Williams: Now all that being said, the, the benefits of breastfeeding outweigh the negatives of cannabis, at least as far as what we know at this point. And so the conversation with a mom who might be using cannabis really needs to be around risk reduction if she's absolutely opposed to eliminating it completely. So if she's using it more casually and it's occasional, it's okay for her to continue to breastfeed. It would be best if she eliminated it completely,, but we don't wanna be telling her to quit breastfeeding due to the cannabis. Now, if she's using really heavily, [00:22:00] that's a different story because we're talking about a higher level of exposure. And, you know, some of the impacts potentially on the infant are that it can suppress the infant feeding cues.
It can suppress the, you know, the ability of the mom's breast to respond to the infant and some of the impacts of breastfeeding aren't as clear as of yet, but some of the immediate impacts that have been shown are around infant feeding cues and you know, just the responsiveness.And anytime you're playing around with the responsiveness of an infant, we start to worry about potential impacts on sleep, safe sleep, and you know, other things.
Erin McClain: It sounds like not all women who use cannabis are necessarily gonna qualify as somebody who has a substance use disorder, because it is a product that's used more recreationally.
Um, certainly there are women who would, but if, if you have a [00:23:00] pregnant or postpartum mom or dad or really anybody in the household who needs increased help and really can't quit on their own, are there resources that you would point them to in North Carolina?
Megan Williams: So we have the Alcohol and Drug Council of North Carolina and that can be accessed through their website, which is alcoholdrughelp.org or by calling 1-800-688-4232 or texting, um, 919-703-1872.
And that would be a great gateway to treatment options if someone is needing treatment for substance use disorder. They have specialized services, specifically focused on pregnancy and also for folks that have young children and babies. Oftentimes they can live on site with the mom while she's getting treatment.And so that is something that we have in North Carolina that a lot of states don't have that. We highly recommend using [00:24:00] for all sorts of substance use disorders, if that's something that's needed by a family that you're seeing.
Erin McClain: So thank you so much for all this great information, Megan. Where can people go for more information or to reach YouQuit Two Quit folks?
Megan Williams: So our website is YouQuitTwoQuit.org and on our website you can reach us for either training or technical assistance, both of which are free, as well as a wide array of products that you can use for patient education. So all those are free as well. We have, many different handouts.Our newest one is related to cannabis use in pregnancy. We also have a practice bulletin that's coming out for providers that is available on our website as well. We have all sorts of patient education materials around tobacco use, including vaping, including secondhand tobacco for family members.
And all of that is available, like I said on our website, YouQuitTwoQuit.org. All of the [00:25:00] PDFs are available there, and there's also links to order them for free from the publications warehouse at the women Infant and children wellness section of DHHS.
Erin McClain: Awesome. And are those available only in English or do you have patient ed materials in other languages?
Megan Williams: Ah yes. So we have patient education materials in English and in Spanish. All of our materials are in English and Spanish, and we have a few materials that are also available in, I think eight other most commonly spoken languages in North Carolina. So if you have kind of a niche need for maybe a refugee population in your area, you might be able to find it there and you can always reach out to us if there's something that you're needing, 'cause we, we base our materials development on demand. So if you have something that you think would be helpful, please let us know.
Erin McClain: Awesome. Thank you so much, Megan.