U.S. Food and Drug Administration
What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding
FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.
Cannabis and Cannabis-derived products have become increasingly available in recent years, with new and different types of products appearing all the time. These products raise questions and concerns for many consumers. And if you are pregnant or breastfeeding, you might have even more questions about whether these products are safe for you.
FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.
What are cannabis, marijuana, hemp, THC and CBD?
Cannabis is a plant of the Cannabaceae family and contains more than eighty biologically active chemical compounds. The most commonly known compounds are THC and CBD. One type of cannabis plant is marijuana, which contains varying levels of THC, the compound that produces the “high” that is often associated with marijuana. Another type of cannabis plant is hemp. Hemp plants contain extremely low amounts of THC. CBD, which does not produce a “high,” can be derived from either marijuana or hemp.
We are now seeing CBD-containing products everywhere. CBD can be found in many different products, like drugs, foods, products marketed as dietary supplements, and cosmetics. These products often make questionable health promises about CBD.
FDA wants you to know there may be serious risks to using cannabis products, including those containing CBD, if you are pregnant or breastfeeding.
What do we know about the effects of marijuana use during pregnancy and while breastfeeding?
There are many potential negative health effects from using marijuana and other products containing THC during pregnancy and while breastfeeding. In fact, the U.S. Surgeon General recently advised consumers that marijuana use during pregnancy may affect fetal brain development, because THC can enter the fetal brain from the mother’s bloodstream. The Surgeon General also advised that marijuana may increase the risk of a newborn with low birth weight. Research also suggests increased risk for premature birth and potentially stillbirth 1 .
While breastfeeding, it is important to know that breastmilk can contain THC for up to six days after use. This THC may affect a newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences.
Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke. Neither marijuana nor tobacco products should be smoked around a baby or children.
What do we know about the effects of CBD use during pregnancy and while breastfeeding?
There is no comprehensive research studying the effects of CBD on the developing fetus, pregnant mother, or breastfed baby. FDA is continuing to collect and study the data on the possible harmful effects of CBD during pregnancy and while breastfeeding. However, based on what we do know, there is significant cause for concern.
High doses of CBD in pregnant test animals have caused problems with the reproductive system of developing male fetuses 2 . In addition, based on what we already know about CBD, we expect that some amount of CBD will be transferred to babies through breast milk.
We also know that there is a potential for CBD products to be contaminated with substances that may pose a risk to the fetus or breastfed baby, including THC. We have also heard reports of CBD potentially containing other contaminants (e.g., pesticides, heavy metals, bacteria, and fungus); we are investigating this.
Moreover, CBD has known risks for people in general. Based on clinical studies in humans, risks can include the following:
- liver toxicity (damage)
- extreme sleepiness
- harmful interactions with other drugs
FDA is studying the effects of CBD use from different angles, such as: (1) the use of CBD-containing products, like food, cosmetics, or supplements, over a person’s entire life; and (2) the effects of using these various products in combination. There are many unanswered questions about the science, safety, and quality of products containing CBD.
We especially want to learn more about the effects of CBD during pregnancy and while breastfeeding, including, for example, whether and to what extent the presence of CBD in human milk harms the breastfed baby or the mother’s milk production.
Has FDA approved any CBD products and are there any benefits?
FDA has not approved any CBD products except for one prescription drug to treat rare, severe forms of seizure disorders in children. It is still unclear whether CBD has any other benefits.
Other than the one approved prescription drug, CBD products have not been evaluated or approved by FDA for use as drug products. This means that we do not know:
- if they are safe and effective to treat a particular disease
- what, if any, dosage may be considered safe
- how they could interact with other drugs or foods
- whether they have dangerous side effects or other safety concerns
The clinical studies that supported the approval of the one available CBD drug product identified risks related to the use of CBD, including liver toxicity (damage), extreme sleepiness, and harmful interactions with other drugs.
What about hemp seeds?
FDA recently completed an evaluation of some hemp seed-derived food ingredients and had no objections to the use of these ingredients in foods. THC and CBD are found mainly in hemp flowers, leaves, and stems, not in hemp seeds. Hemp seeds can pick up miniscule amounts of THC and CBD from contact with other plant parts, but these amounts are low enough to not raise concerns for any group, including pregnant or breastfeeding mothers.
What should you remember about using cannabis or cannabis-derived products?
If you are considering using cannabis, or any products containing THC or CBD, you should be aware of the following:
- FDA strongly advises that during pregnancy and while breastfeeding, you avoid using CBD, THC, or marijuana in any form.
- Although many of these products are being sold, FDA has not approved these products, other than one prescription CBD drug product and two prescription drug products containing dronabinol, a synthetic version of THC (which are approved to treat certain side effects of HIV-AIDS or chemotherapy). All three of these prescription products have associated risks and side effects.
- Always talk with your doctor, nurse, or pharmacist before taking any medicines, vitamins, or herbs while pregnant or breastfeeding.
Do not put yourself or your baby at risk by using cannabis products while pregnant or breastfeeding. Check out these links to learn more about cannabis, marijuana, CBD, and THC, and about taking medicines while you are pregnant.FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.
A Nutritionist Shares What and What Not to Eat When You’re Pregnant
It’s a lot simpler than you might think
From the minute that you discover you’re pregnant, your whole world changes. Nothing compares to that magical feeling of growing a new life inside of you. But as your body changes, so do your cravings, mood, and energy levels. It goes without saying that your appetite increases now that you’re feeding two people, but exactly how much your current diet should change is the big question.
Meet the Expert
Stephanie Middleberg, MS, RD, CDN, is founder of Middleberg Nutrition and author of The Big Book of Organic Baby Food. Middleberg is also a member of Cosmopolitan‘s Health Advisory Board and serves as the magazine’s nutrition expert.
According to Stephanie Middleberg, when you’re pregnant you need to ramp up your nutrient intake and load up on whole foods and plenty of water. To find out what, exactly, you should eat during pregnancy, we asked Middleberg to set the record straight.
MYDOMAINE: Being pregnant can be daunting for any woman. There are so many things to consider, and your health isn’t just about you anymore. What are some of the diet guidelines or food philosophies you advise women to stick to when they discover that they’re pregnant?
STEPHANIE MIDDLEBERG: This is such an exciting time and can also be incredibly overwhelming as your decisions don’t just impact you. I am often the first (okay, maybe second or third) phone call my clients make as they want to ensure they are on a healthy path. I help weed out the myths and give them a structure during a fairly unpredictable time. This is a time to start nourishing your body and your baby with nutrient-dense, whole foods.
I recommend that all pregnant women:
Increase Healthy Fats
This is probably the hardest for moms-to-be because it seems counterintuitive, but it is essential for many reasons. It’s vital to baby’s organ and brain development, your metabolism, absorption of key nutrients, and future milk supply. Women should focus on healthy fat sources like avocado, fish oils, eggs, olive oil, coconut oil, nuts, and full-fat dairy (no low-fat foods!).
Focus on Quality
When possible, aim for organic produce and eggs, grass-fed meats, and wild fish. (Check out Seafood Watch from the Monterey Bay Aquarium for a rundown on what fish to select.) Making the right choices can feel overwhelming, so control what you can and choose the healthiest option whenever possible. For instance, I’d rather you eat non-organic produce than no produce at all.
Stabilize Blood Sugar
Stay armed with snacks! We often feel nauseous and low energy during pregnancy because our blood sugar is low. Have a breakfast rich in what I call the two P’s: protein and produce. Morning is when our blood sugar is the lowest, and if you start the day with sugar, it can increase your hunger hormone ghrelin, which leads to increased hunger and blood sugar issues during the day. Protein will keep your appetite and energy consistent throughout the day. Good options include eggs, full-fat plain yogurt, and nut butters.
Have a protein/fat with every meal, including your afternoon snack. Tasty and healthy options include apples with almond butter, crackers with cheese, veggies with hummus, and dates with goat cheese.
MD: What are the top five supplements we should avoid?
SM: Neither the FDA, nor any other government agency reviews, investigates, or regulates what goes into a vitamin. Therefore, when you read the ingredients list, no officials verify that what the manufacturer says is actually true. Pretty crazy, right? So it is vital that you go with trustworthy brands that go above and beyond what is required of them by the law. If you want to do your own research, check out Consumerlab. It is an entirely independent verification of supplements and a fantastic resource.
MD: There are multiple and conflicting stories out there about what not to eat when pregnant, such as soft cheeses and raw fish. Can you set the record straight and list a few of the foods that women should avoid when pregnant and why?
SM: I know many people who eat whatever they want. When I was pregnant, I didn’t want to endure any unnecessary risk just because I was craving some lox. I’m not going to preach here, but I would stay clear of raw fish, cured meats, unpasteurized cheeses, undercooked anything (meat, fish, eggs), and deli meats. I’d also stay away from any open salad bars to avoid contracting a food-borne illness. Since you’re pregnant, your immune system is compromised, meaning a bug you could have shrugged off before you were pregnant can now be very dangerous. It’s just 10 months. You can enjoy all the sushi you want once that beautiful newborn is resting comfortably next to you. I asked for a huge spread of lox as my first meal once my son was born.
MD: There is now evidence to support the fact that what women eat when pregnant affects the baby’s future health and that “avoiding overindulgence and eating healthily” should be a priority. What is your advice to women who are craving sweets or fatty junk foods when pregnant?
SM: We crave what we eat. It is very easy to go down the path of just eating carbs, cheese, and sweets. However, I highly recommend eating nutrient-dense foods, like fresh veggies, fruits, and high-quality protein early on, even when you’re not feeling great. That can mean starting with just three slivers of cucumbers and slowly working your way up. Doing so will result in a much healthier pregnancy and recovery period.
Let’s look at why you’re having unhealthy cravings. Are you letting yourself get too hungry, not eating enough during the day or not eating the right balance of foods to stabilize blood sugar? Are you overly stressed and tired? Once we get to the root, we can figure out how and where to make changes.
Research suggests that what you eat can also affect your baby’s palate and food preferences later on. Try not to rely on bland foods because this is the first exposure your baby has to flavors. Instead, include a variety of flavors and herbs, like ginger, turmeric, sage, and rosemary. You should also avoid consuming too many sweets and fried foods.
Top 4 Supplements to Take While Pregnant
Prenatal vitamins ensure that you are meeting your dietary needs, which are much higher while pregnant. Opt for a high-quality prenatal vitamin from a trusted brand that contains at least 600 milligrams of folate rather than folic acid, which is synthetic. You can obtain the rest of your nutrients from green leafy vegetables.
Cod Liver Oil or DHA
Cod liver oil is a preferred source of DHA and omega-3 fatty acids (EPA) and rich in vitamins A and D.
Probiotics increase the good bacteria that support you and your baby’s gut health. Improving gut health in the womb can help minimize food allergies, infections, and illness.
Magnesium helps minimize muscle contractions and preeclampsia while improving sleep and constipation.
But remember, these suggestions are meant to supplement and not replace foods in your diet. While they can provide boosts in certain gaps in your diet, aim for food first.
Top 8 Foods for a Healthy Pregnancy
Omegas are vital for brain development and wild fish are loaded with them. Try to eat two to three servings per week of wild salmon, cod, halibut, or sardines. Avoid fish with high mercury levels, like tuna and swordfish.
Protein helps the body recover and satisfies a ravenous appetite. Try to eat 15 to 20 grams of protein per meal. Eggs—preferably pasture-raised and organic—are a great source of protein. I always aim to have hard-boiled eggs in my fridge along with Greek yogurt or goat’s milk yogurt and hemp hearts.
- Egg: 6 grams
- 4 ounces of chicken: 35 grams
- 1 cup of beans: 15 grams
- 3 tablespoons hemp hearts: 10 grams
- 1 cup of Greek yogurt: roughly 15 grams
This is probably the hardest for moms-to-be because it seems counterintuitive, but healthy fats are essential for many reasons. Fats are vital to baby’s organ and brain development as well as your metabolism and the quantity and quality of your milk supply. Healthy fat sources include avocado, fish oils, eggs, olive oil, coconut oil, nuts, and full-fat dairy.
Seeds like hemp, chia, pumpkin, and flax are filled with nutrients like fiber, omegas, magnesium, protein, and zinc. Magnesium helps combat constipation and headaches while promoting a good night’s rest. The fiber, protein, and fat found in many seeds help stabilize blood sugar levels. Tahini, made from sesame seeds, is an excellent source of calcium, which is a key nutrient (along with magnesium and vitamins D and K) for bone health. During pregnancy and breastfeeding, the body draws from mom’s bones to provide for the baby, so it is essential for mom to keep up her stores.
You can never eat enough vegetables, especially green leafy veggies, which are rich in folate (necessary for fetal growth); antioxidants; and other key nutrients, like potassium, fiber, and vitamin C. In the beginning stages of pregnancy, it can be tough to get in vegetables. I find that raw veggies are easier to eat at the start with a simple dressing of oil and lemon juice. I also recommend a cucumber salad with some rice wine vinegar, sesame seeds, and olive oil. Or, try blending veggies into a smoothie.
Fermented veggies are essential for gut health, and a happy gut means a happy mom. Plus, probiotics increase good bacteria in your stomach, which aids in the absorption of nutrients and boosts you and your baby’s immune systems.
About one to two servings of grass-fed meat or pasture-raised poultry supply an absorbable form of iron. I also recommend bone broth. Delicious and comforting, bone builds strong bones; boosts the immune system; improves digestion; and supports joints, hair, skin, and nails. It’s an excellent source of calcium, magnesium, and phosphorus in addition to being rich in chondroitin, glucosamine (which is good for our joint health and inflammation), glutamine, and other amino acids.
In addition to these foods, please hydrate! During pregnancy, your blood volume thickens, requiring more fluid, especially for amniotic fluid. Most preterm labor is due to dehydration. Water also helps prevent constipation. Aim to consume half of your body weight in ounces of water per day. When water wasn’t enough during my pregnancy, I found watermelon water and coconut water to be lifesavers. I would also blend coconut water, watermelon, lime, and mint for a refreshing beverage.Not sure what to eat when pregnant? We asked expert nutritionist Stephanie Middleberg to fill us in on the foods we should (and shouldn't) eat. ]]>