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    • The legal consequences of using cannabis during pregnancy don't align with the available evidenceParents face harsh legal penalties for using cannabis during pregnancy despite unclear scientific consensus, creating a need for alternative sources of information

      Despite the lack of clear scientific consensus on the safety of using cannabis during pregnancy, the legal consequences for its use can be severe and may not align with the available evidence. Karen Landman, a physician and health science reporter, shares her experience of helping a friend navigate this issue and the widespread concern among parents for guidance and support on this topic. The fear of legal repercussions often deters parents from seeking advice from healthcare providers, creating a need for alternative sources of information. The science on the effects of cannabis on fetal development is still inconclusive, but the legal and societal penalties for its use during pregnancy remain harsh, even in states where it is legal. This raises questions about the impact of our limited understanding of pregnancy on parents' lives, their freedom, and their health.

    • THC use during pregnancy: Unclear safetyDespite widespread use of THC by pregnant individuals, its safety remains unclear, and more research is needed to understand its potential effects on the fetus.

      THC, the main psychoactive component in marijuana or weed, is commonly used by pregnant individuals for various reasons including morning sickness, pain relief, appetite stimulation, sleep aid, and symptom management. Despite its widespread use, there's a lack of clear messaging about its safety during pregnancy. THC can pass through the placenta and into the fetus's bloodstream, although less of it reaches the fetus compared to the parent. The potential effects of THC on the fetus are not well understood, and it's unclear if the fetus gets high or not. Studies suggest that only a fraction of THC in the parent's bloodstream reaches the fetus. Overall, more research is needed to fully understand the risks and benefits of THC use during pregnancy.

    • Effects of THC on Fetal DevelopmentObservational studies suggest small differences in attention, behavior, and learning for children of mothers who used cannabis during pregnancy, but long-term effects and cause-and-effect relationship are not clear due to ethical and practical challenges in conducting controlled trials.

      There is evidence suggesting that THC, the psychoactive component in cannabis, can reach the developing fetus through receptors in the placenta and brain. However, the long-term effects on the child's cognitive development and behavior are not fully understood. Observational studies have shown small but measurable differences in attention, behavior, and learning for children of mothers who used cannabis during pregnancy. These effects are within the normal range, making it difficult to establish the intensity of the impact. Randomized controlled trials, considered the gold standard for medical drug testing, are challenging to conduct with pregnant women due to ethical and practical considerations. As a result, it is difficult to separate the effects of cannabis use during pregnancy from other factors that may contribute to neurobehavioral problems in children.

    • Cannabis use during pregnancy: Risks and UncertaintiesWhile cannabis use during pregnancy may have potential negative effects, the research is not definitive and alternatives for managing pregnancy symptoms are limited, making the issue complex and requiring more research

      While there is evidence suggesting that cannabis use during pregnancy may have some negative effects on fetal development, the research is not as clear-cut as with substances like alcohol or smoking. The effects of cannabis on a fetus are more nebulous and uncertain, and there is no definitive causality linking specific cannabis use during pregnancy to specific developmental issues in children. Additionally, the lack of effective alternatives for managing common pregnancy symptoms, such as nausea and chronic pain, leaves many pregnant women with few options other than using cannabis or other substances, some of which may have even more harmful effects on pregnancy. Furthermore, studying the effects of drugs on pregnant women is challenging due to ethical considerations and restrictions on research. As a result, the vast majority of FDA-approved drugs, both legal and illegal, have unknown effects on pregnancy. Therefore, the debate around cannabis use during pregnancy is complex, and more research is needed to fully understand the risks and benefits.

    • Confusion and Fear for Expecting Parents Due to Lack of Scientific Knowledge on Drug Use During PregnancyThe lack of scientific understanding about drug use during pregnancy, including cannabis, results in families feeling left in the dark and facing potential legal consequences. Strict laws in some states consider drug use as child abuse, causing confusion and fear for expecting parents.

      There is a lack of scientific knowledge about the effects of various drugs, including cannabis, during pregnancy, leading to limited treatment options and potential legal consequences for parents. This lack of knowledge results in families feeling left in the dark and forced to find their own solutions, which can be penalized or judged. Some states even consider drug use during pregnancy, including cannabis, as child abuse, leading to potential jail time or involuntary commitment to rehab or jail. Despite the absence of strong scientific evidence indicating significant negative effects on babies, these strict laws create confusion and fear for expecting parents.

    • Outdated marijuana laws during pregnancy create issues for womenConfusing laws surrounding marijuana use during pregnancy, based on its illegal status under federal law, can lead to inconsistent policies and stigma, potentially causing more harm than the drug use itself.

      Outdated and confusing laws surrounding marijuana use during pregnancy continue to create significant issues for women, despite scientific evidence suggesting minimal harm. The case of a woman in Arizona, who was legally using marijuana for morning sickness but was still charged with child abuse and neglect, highlights the complex interplay between state and federal policies. The Comprehensive Addiction and Recovery Act (CARA) requires states to address newborns exposed to substances in utero, leading to inconsistent policies on testing and consequences. These policies are not based on science, but rather on marijuana's illegal status under federal law. The resulting stigma and confusion can potentially harm both parents and fetuses more than the drug use itself. If policies were grounded in scientific evidence, they would likely focus on substances like tobacco, which has proven negative effects on babies. Instead, the existence of these punitive policies may cause more harm than good.

    • Policies on drug testing during pregnancy create distrustDistrustful policies disproportionately impacting POC prevent people from seeking prenatal care, harming mothers and babies. Legalizing cannabis and improving provider-patient relationships may help.

      Current policies surrounding drug testing during pregnancy create a significant amount of distrust between healthcare providers and parents, particularly for parents of color. This distrust stems from the disproportionate application of these policies, leading many to view prenatal care and hospital delivery as traps. These policies can prevent people from seeking necessary medical care, which negatively impacts both mothers and babies. Experts suggest that federally legalizing cannabis could help reduce the negative effects of these policies by promoting trust and encouraging people to access prenatal care. However, it's crucial to focus on improving the relationship between healthcare providers and patients and increasing accurate information about drug use during pregnancy. Ultimately, a shift towards supportive care and evidence-based policies is needed to ensure the best possible health outcomes for mothers and their babies.

    • The criminalization of cannabis use during pregnancyPolicies criminalizing cannabis use during pregnancy can lead to feelings of isolation, fear, and shame, making it harder for parents to ask for help and prioritize their own well-being. We can create policies and environments that make parents' lives easier instead of harder by focusing on supportive and inclusive approaches.

      The criminalization of cannabis use during pregnancy, even in states where it's legal, creates challenging situations for pregnant women. These policies can lead to feelings of isolation, fear, and shame, making it harder for parents to ask for help and prioritize their own well-being. This conversation with Karen and Shanitria also highlighted the complex ways that pregnancy shapes parents' lives beyond just the physical changes. The lack of clear answers and the societal pressure to be perfect parents can leave many feeling overwhelmed and uncertain. As a society, we have the power to create policies and environments that make parents' lives easier instead of harder. By focusing on supportive and inclusive approaches, we can help reduce the stress and stigma surrounding pregnancy and parenthood. For more insights, listen to the full episode or read Karen's article on Vox.com/unexplainable.

    • Substance use during pregnancy is considered child abuse in 25 statesSubstance use during pregnancy is considered child abuse in 25 states, with far-reaching implications for expectant mothers and their babies. Listen to Unexplainable for valuable insights.

      Learning from the latest episode of Unexplainable is that substance use during pregnancy is considered child abuse in 25 states and the District of Columbia. This information was shared by Karen during the discussion, and it's an important reminder of the potential consequences for expectant mothers who use drugs or alcohol while pregnant. It's a complex issue with far-reaching implications, and the podcast provides valuable insights into this topic. If you're interested in learning more about pregnancy and the unknowns that come with it, be sure to check out the articles on Fox.com/unexplainable. And don't forget to leave a review or send your questions and thoughts to unexplainable@vox.com. Your feedback is always appreciated. Unexplainable is part of the Vox Media Podcast Network, and we'll be back in your feed in June after a brief hiatus. Stay tuned for more fascinating discussions on all things unexplainable.

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    What is FGR?

    [1:36]

    It is when the baby falls below the 10th percentile for weight. 10% of babies will be below the 10th percentile, by definition. Hence, 10% of babies will be classified as fetal growth restricted. It's important for you to know that because 10% of babies are not in a pathological situation. They're not in a bad situation. They're not in a situation where they're not growing. 

     

    [2:35]

    It's important to consider each woman and her partner uniquely in pregnancy.  A women that is  5'9 with women and a woman that is 5 feet tall will have different size expectations and patterns when it comes to pregnancy. 

     

    Possible reasons that the baby is small

    [4:17]

    The number one reason that a baby could be on the smaller side is that the mother is small and the father of the baby is maybe not the tallest guy. We use the term FGR/Fetal Growth Restriction when they're in utero, but once they're delivered, we call them SGA/Small for Gestational Age. 

     

    [5:06]

    When you find the baby's not growing well, this will generally be after 20 weeks Babies are generally the same size until 20 weeks. 

     

    [6:08]

    Another reason the baby is small is that it's supposed to be small and there's nothing wrong. The number two reason is placental perfusion. It has a problem with the baby getting enough blood flow and nutrients. It is just not getting enough of what it needs to grow well. And there are many reasons why the placenta won't function. So when you see a small baby, especially in the third trimester after 27 weeks, 30 weeks, start thinking, "Oh, how are her blood pressures? She's spilling protein. Is there something going on with this patient that's pointing me towards preeclampsia?"

     

    [8:07]

    TORCH is an acronym that stands for toxoplasmosis, rubella cytomegalovirus, herpes simplex, and HIV. Cytomegalovirus is a virus that's very common in the population. Most people have been exposed to cytomegalovirus. T 

    Ultrasound tools

    [12:09]

    To understand Dopplers without getting into the physics of what the Doppler effect is, you can take your transducer, you could put it over the cord, and you can turn on the Doppler and you could see the blood flow through the cord.

     

    [13:48]

    When you look at a Doppler, and you see the blood flowing the way it should, before the next heartbeat, you measure how fast it's going right before the next heartbeat.

     

    [15:14]

    When you talk about fetal growth restriction, you can't just talk about the baby's size because there's only one piece of it. The other piece is what is the placenta telling you? What are the Dopplers telling you? 

     

    [15:34]

    Biometry is when you measure the femur and the abdomen and measure the head to get the size and weight of the baby and estimated fetal weight. 

     

    Guidelines about how to approach Fetal Growth Restriction

    [18:12]

    If you're below the third percentile, even if everything else is okay, that's the baby you got to deliver at 37 weeks. You can't just sit around and look at that baby for 37 weeks get the baby out. If your baby is above the third percentile and the Dopplers are elevated but not absent, get the baby up. And if there's no flow, the blood stops, that's even more concerning. If you see the reverse flow, you're dealing with a much more ominous situation and you don't want to go past 32 weeks. If you don't think the baby's doing well, you might have to come out even earlier.

     

    Biophysical profile

    [22:09]

    One of the things that some patients might have to consider in other practices is that they would need to start having biophysical profiles done. A biophysical profile is when you're checking for a series of four different things and looking to ensure that the baby is reassuring overall. What is the baby's movement? What is fetal breathing, which is an exercise the baby does to inhale and exhale fluid? What is his tone? Is the baby flex or the floppy? Or if you feel the baby's not moving, these are things that you have to consider.

     

    [23:51]

    One of the things you're looking for when talking about growth restriction is you want to see how the baby is handling the uterine environment? How's the baby doing on the inside? These tests will wish to you to identify a baby that's not doing well or not getting enough blood flow. You need to know if you can wait on it and let the baby stay inside, or is it time to get the baby out? Because then the baby will do better outside of the womb. 

     

    Recommendations

    [24:20]

    The recommendation is that if you recognize growth restriction, you should at least be monitoring weekly, that might be nonstress tests, or that might be a biophysical every week. And if you have a severe growth that restricts a baby under the third percentile or abnormal Dopplers or accident, then twice a week. If you have reversed outside flow, put those patients in the hospital because they need to be monitored around the clock and you got to pull the baby out before it's too late.  

     

    [29:08]

    The most reliable and consistent way to assess blood flow to the baby is the umbilical artery. Look at the ductus phimosis. When the umbilical cord hits the baby's belly button, a big part of the vein goes up into the heart carrying the birth at heart, and you can see if there's resistance, or even at the umbilical vein.

     

    Here is the photo that we have permission to share. 

     

    Visit https://www.truebirthpodcast.com/ to listen more episodes!

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