In the past few years, discussions surrounding cannabis use during pregnancy and lactation, along with effective postpartum depression treatments, have gained prominence.
Informed decision-making is crucial to maternal and infant well-being. These interventions may be effective. But are they safe?
In this blog, we’ll delve into the pros and cons associated with cannabis in pregnancy and the emergence of zuranolone as a new treatment for postpartum depression.
Cannabis in Pregnancy: A Complex Landscape
While alcohol and cigarette use during pregnancy has declined, the prevalence of cannabis use among pregnant individuals has risen, with reports suggesting up to 25% usage.
Some use it recreationally, while many turn to it to alleviate pregnancy symptoms such as nausea, insomnia, and stress.
However, the impact of in-utero cannabis exposure on offspring remains a topic of concern.
Research points to potential associations between cannabis exposure and various neuropsychiatric and neurodevelopmental conditions, including autism spectrum disorder, ADHD, and psychosis. Short-term outcomes linked to cannabis use during pregnancy encompass adverse pregnancy results such as preterm delivery, low birth weight, and even increased infant mortality within the first year of life.
Moreover, maternal cannabis use appears to influence DNA expression and placental and fetal epigenetic patterns.
Interestingly, even paternal cannabis use before conception has shown links to infertility, pregnancy loss, and DNA methylation issues in offspring, underscoring the importance of considering both parents’ behaviors when assessing fetal health risks (1).
Navigating the Endocannabinoid System
The impact of cannabis compounds like THC and CBD on the endocannabinoid system raises questions about how maternal cannabis use impacts fetal development.
Although specific effects aren’t fully understood, what we currently know about cannabis use in pregnancy highlights the need for caution and proactive consultations with medical teams before using cannabis-derived products. This includes not just illicit substances but also nutritional supplements that interact with these pathways.
One question I have about cannabis, CBD, and even products such as palmitoylethanolamide, known as PEA, that act on the endocannabinoid system, is how maternal use during pregnancy may affect the fetus’s developing endocannabinoid system. I don’t have an answer to this question yet, but the question itself suggests that we should be cautious and prudent about the potential costs and benefits of using even the highest-quality nutritional supplements that act on these pathways during pregnancy.
Preconception, pregnancy, and postpartum are such delicate moments where so many factors are at play, and it can be hard to navigate what is safe, especially in a situation where the mother has complex health conditions that have led to the use of self-medication with products derived from cannabis or even herbs and supplements that work alongside the endocannabinoid system.
Zuranolone: A New Dawn in Postpartum Depression Treatment
Of course, the search for effective and safe interventions doesn’t end in pregnancy.
Postpartum depression is a significant concern affecting new mothers’ mental health. The recent introduction of zuranolone offers a promising avenue for treatment.
Zuranolone is an oral medication that has been approved for the treatment of severe postpartum depression as of August 4th, 2023, and is the first pill that the FDA has specifically approved for the treatment of postpartum depression.
Prior to that, the only approved drug specifically for postpartum depression was brexanolone, an intravenous medication that required infusions with a 60-hour hospital stay. Zuranolone is essentially the pill version of brexanolone and is much more practical because it can be taken at home once a day.
A course of zuranolone lasts two weeks. The drug is fast-acting, providing symptom relief as early as day three due to its effect on GABA receptor expression and GABAergic signaling. This study, which followed patients for four weeks after the end of the treatment period, revealed that the effects of the medication endured through that timeframe.
Specifically, the 77 patients randomized to the treatment group experienced a clinically significant decrease in baseline depression symptoms as determined by the 17-item Hamilton Rating Scale for Depression (−17.8 vs −13.6; difference, −4.2; 95% CI, −6.9 to −1.5; P = .003).
This level of effect lasted through day 45, and only one adverse event was reported in the zuranolone group, a “confusional state” that led to the participant withdrawing from the trial (2).
This brings to light obstacles that may limit some people’s access to zuranolone. First, the study conducted on zuranolone prohibited the patients from breastfeeding during treatment and for a week after treatment because of concerns regarding infant safety.
Second, the cost of the drug is quite high, and it remains to be seen whether insurance companies will provide coverage for the medication.
Third, because the medication can cause sedation, there is a black box warning against driving or operating machinery within 12 hours of taking it. Because the medication is taken once daily in the evening, it might be difficult for working mothers who must drive to work in the morning to take the medication.
Challenges and Considerations
While zuranolone shows promise, potential barriers to its accessibility include breastfeeding restrictions, high costs, and safety concerns related to sedation.
Moreover, zuranolone’s addresses only a specific aspect of postpartum depression, leaving room for a comprehensive approach that considers multiple factors like microbial balance, nutrient status, thyroid function, ethnicity, and socioeconomic status.
Combining nutritional therapy, psychotherapy, and medication could offer the most effective solution for individuals with complex postpartum depression cases.
In the ever-evolving landscape of pregnancy and postpartum health, informed decision-making is paramount. The surge in cannabis use during pregnancy prompts attentiveness and the importance of medical consultations.
Simultaneously, the introduction of zuranolone as a treatment for postpartum depression offers hope but with cautious caveats, emphasizing the need for comprehensive approaches that address the multifaceted factors influencing maternal mental health.
With expert guidance and a thorough understanding of available options, individuals can navigate these critical phases with confidence and prioritize the well-being of both themselves and their infants.
Click here to learn more about my self-paced pregnancy-specific blood chemistry course for balanced, evidence-based guidance from preconception through postpartum.