Ericksen et al1 have underscored the need to have for additional study on the frequency of prenatal maternal cannabis use, as effectively as paternal cannabis use through pregnancy. Agrawal et altwo concur with this assessment, highlighting the prevalence of each day prenatal maternal cannabis use and the prospective epigenetic and passive exposure effects of paternal cannabis use by means of their reply in JAMA Pediatrics.

Ericksen et al note that the frequency of cannabis use through pregnancy could impact toxicity. Primarily based on information from 2018, cannabis use through pregnancy is extra probably to be happen each day, which would meet criteria for cannabis dependence.three In addition, education on prenatal cannabis use is scarce, which may possibly outcome in prospective fetal harm and missed possibilities to treat dependence. Agrawal et al supplement these issues with findings from 2015 and 2016 that 21.1% of pregnant black and white ladies reporting cannabis use in the prior month also reported each day use.two,four In between 50% and 60% of cannabis use disorder could be due to genetic variables that may possibly be passed onto offspring.five This could lead to a confound in research investigating causal relationships among prenatal cannabis exposure and later offspring outcomes.six

Ericksen et al also highlight the achievable effect of paternal marijuana use, which can lead to tetrahydrocannabinol accumulations in noncannabis-making use of partners’ oral secretions, blood, and urine following secondhand smoke exposure.1 It will also be essential for research and clinical procedures to account for the variety of intake, which includes vaping, edibles, or inhalation. Agrawal et al note that paternal cannabis customers are just as probably to transmit genetic susceptibilities to offspring as mothers.two Guys who use cannabis on a regular basis may possibly also practical experience epigenetic modifications in sperm cells, even though the final results of these modifications are unknown.7 Infant and childhood exposure to secondhand cannabis smoke poses a different threat to offspring effectively-getting. In addition, the coaggregation of all these effects serves to confound researchers’ capability to execute causal inference.

Each groups of authors assistance additional investigation into prospective harm resulting from prenatal cannabis use as marijuana is increasingly legalized. As Agrawal et al conclude, “Understanding the variables that could hinder a woman’s capability to quit making use of substances through pregnancy, be it social or person certain, is not only probably to determine important sources of conflation in research of the effects of prenatal exposure but also strengthen maternal effectively-getting, which has been documented as an independent supply of offspring well being.”two

Disclosure: Richard A. Grucza, PhD, reported getting costs from Allergan outdoors the submitted operate.


1. Ericksen K, Shah S, Brumberg HL. Public well being implications of increasing marijuana use in pregnancy in an age of growing legalization [published online April 8, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0644

two. Agrawal A, Grucza RA, Rogers CE. Public well being implications of increasing marijuana use in pregnancy in an age of growing legalization—reply [published online April 8, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0618

three. El Marroun H, Brown QL, Lund IO, et al. An epidemiological, developmental and clinical overview of cannabis use through pregnancy. Prev Med. 2018116:1-five.

four. Agrawal A, Rogers CE, Lessov-Schlaggar CN, Carter EB, Lenze SN, Grucza RA. Alcohol, cigarette, and cannabis use among 2002 and 2016 in pregnant ladies from a nationally representative sample. JAMA Pediatr. 2019173(1):95-96.

five. Agrawal A, Lynskey MT. Cannabis controversies: how genetics can inform the study of comorbidity. Addiction. 2014109(three):360-370.

six. Agrawal A, Knopik VS, Pergadia ML, et al. Correlates of cigarette smoking through pregnancy and its genetic and environmental overlap with nicotine dependence. Nicotine Tob Res. 200810(four):567-578.

7. Murphy SK, Itchon-Ramos N, Visco Z, et al. Cannabinoid exposure and altered DNA methylation in rat and human sperm. Epigenetics. 201813(12):1208-1221.