By Jackie Kruszewski
Kenneth and Dianne Wright Center for Clinical and Translational Research

As marijuana decriminalization and legalization laws inch across the country state by state, health care providers are seeing more women use the drug during pregnancy. According to a 2019 national study, the rate of marijuana use during pregnancy doubled between 2002 and 2017 — to about 7%.

“There’s this popular belief that cannabis is relatively safe,” said Nancy Jallo, Ph.D., an associate professor at the Virginia Commonwealth University School of Nursing. “But it does contain lots of different substances, one of which, THC, is rapidly distributed in the brain and has been found to disrupt neural connections.”

Those connections in the brain — how they affect maternal attachment and breastfeeding — are the focus of new research projects at VCU. Clinicians like Jallo, across multiple disciplines, are launching pilot studies that hope to fill gaps in knowledge about marijuana use during the perinatal period, the time before and after birth.

With the help of VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research, their research will lead to treatments and educational output for patients and health care providers, providing a critical need in a field with more questions than answers.

Clinical practice to research

Dace Svikis, Ph.D., a professor of psychology at VCU, works with mothers struggling with addiction, for years focusing on cocaine and opioid use. Recently, a former colleague alerted her to the growing trend of cannabis use by pregnant and postpartum women — with a worrying observation.

“She was concerned because she was seeing marijuana-using women coming to her clinic saying things like, ‘I feel nothing for this baby,’” Svikis said. “Granted, these were not casual marijuana users. But her anecdotes were relative to consequences she was seeing in heroin- and cocaine-using mothers.”

However, anecdotes were all they had. Svikis notes that, while there is plenty of guidance and information on opioids, cocaine, alcohol and tobacco use during the perinatal period, no such guidance existed for cannabis.

That’s especially true when it comes to screening for cannabis use at delivery and guidelines about breastfeeding while using marijuana.

“We have no data. We don't know what to tell people,” Svikis said. “And different hospital systems are doing different things.”

Legalization and decriminalization make the gaps in knowledge even more pressing. A 2018 study in Obstetrics & Gynecology found that seven out of 10 cannabis dispensaries in Colorado recommended its products to pregnant women with morning sickness.

In October, the Wright Center awarded Svikis pilot funding for her project on perinatal cannabis use and breastfeeding. Her project will focus on women after they deliver, during that important time for maternal-infant bonding when women who can breastfeed, something with myriad health benefits for both mother and infant, typically begin.

The study team will survey participating women while they are still in the hospital about cannabis use, mood and more. The team will also collect urine and breast-milk samples. Critical to the project is a new test developed by Carl Wolf, Ph.D., an assistant professor in VCU’s Department of Pathology, to measure cannabis levels in breast milk.

Along with Wolf, Svikis’ team includes Nicole Karjane, M.D., a professor in the Department of Obstetrics and Gynecology, and Robert Balster, Ph.D., a professor in the Department of Pharmacology and Toxicology.

As a feasibility study, the research will tell the study team how realistic it is to plan for a larger scale version. Challenges include finding women willing to join the study and measuring the quantity of marijuana the women may have consumed.

“Dosages are irregular,” Svikis said. “This isn't the pot that was being smoked in the ’60s. This is much more potent. How to capture the amount is going to be really challenging.”

Ultimately, she hopes the study will ultimately lead to the creation of guidelines on what amount of marijuana is safe for pregnant and breastfeeding women.

Deeper research through brain imaging

Svikis’ project will feed volunteer participants into another more longitudinal study, following a subset of surveyed women for further tests.

Jallo and Lisa Brown, Ph.D., an associate professor at the VCU School of Nursing, received funding from the Wright Center for a pilot project that will look for the effects of cannabis on women’s brains.

Like Svikis, Brown and Jallo’s extensive clinical experience informs their research in women’s health. As a nurse in the neonatal intensive care unit, Brown paid close attention to the differences in mothers’ interactions with their infants.

“Some moms are very sensitive and responsive to their babies,” Brown said. “Their babies cry and they're offering the pacifier. They're trying to calm the babies down, paying attention to the baby's cues. Other moms, they don't know what to do, or they’re very rough in what they do.”

When Brown decided to pursue her Ph.D. degree, she knew that’s what she wanted to study.

Jallo, too, worked with women before, during and after preterm delivery and became curious about the interaction between attachment behaviors and the quality of health outcome for mothers and infants. Like Svikis’ former colleague, as cannabis use became more widespread, Jallo noticed anecdotally that some cannabis-using moms showed difficulty in developing attachment to their babies, similar to women experiencing substance use disorders.

“Maternal attachment is critical to the health and the well-being of developing infants,” Jallo said. “I really became interested in how the THC in cannabis could physiologically disrupt neural connections, which could then affect a mother’s behavior and the mother-infant interaction.”

Other researchers have examined maternal-fetal attachment — how a cannabis-using mother feels about her baby before it's born. But Jallo and Brown hope to enroll 20 mothers after they’ve given birth for a close look at neural activity and attachment levels.

“We’re hoping to find if there are differences in neural connectivity between the cannabis-using and the non-cannabis-using moms,” said Brown. “Whether changes in neural connectivity are associated with lower attachment scores.”

The team will see whether they can collect and quantify statistically significant data, enough to apply for grants for a larger version.

“This could have some really interesting implications for health,” Jallo said. “If we find that there are changes in the brain, then that would help inform evidence-based guidelines for cannabis use in pregnant and postpartum women.”

That could lead to designing treatments and interventions to enhance maternal-infant outcomes in cannabis-using postpartum woman.

Dedicated research facilities and collaboration make projects happen

In addition to funding, the Wright Center’s Collaborative Advance Research Imaging facility is crucial to Brown and Jallo’s study.

To look at neural connections, Jallo and Brown need access to a functional magnetic resonance imaging machine. An fMRI scan shows brain function in addition to structure. Rather than remain still, study participants will interact with the study team while they are in the machine, giving the team insight into how their brains work.

The CARI facility is home to VCU’s research-dedicated fMRI machine, giving Jallo and Brown access to the technology they need.

“That the CARI facility is designed to be a research center is such a gift,” Jallo said. “It’s an invaluable tool for translational neuroscience. Without it, we couldn’t do the work.”

Also crucial are the multidisciplinary teams involved in both projects, including faculty from radiology, biostatistics, psychology, pathology, OB-GYN and pharmacology-toxicology.

“I really came to appreciate, with the complicated issues these women, their children and their significant others face, and with everything going on in their lives, that the importance of having the obstetrical team’s perspective, the pediatrician's perspective and the social worker's perspective grows,” Svikis said.

Along with the Wright Center, Svikis credits the VCU Institute for Women’s Health, where she serves as deputy director, and the VCU Institute for Drug and Alcohol Studies as lifelines for establishing those connections.

“Those institutes are all about bringing multidisciplinary teams together under broader umbrellas,” she said. “Without them, you see fewer new ideas that move the field forward generated. Those exchanges and those bridges are really important.”

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