Efectos de la exposición perinatal a cannabis

Authors

  • N. Pons Interno(a) de Medicina, Facultad de Medicina, Universidad de Chile
  • L. Renard Interno(a) de Medicina, Facultad de Medicina, Universidad de Chile
  • M. Raggio Interno(a) de Medicina, Facultad de Medicina, Universidad de Chile

Abstract

La marihuana o cannabis constituye actualmente la droga ilícita más utilizada en la población general y en mujeres embarazadas. No existen datos nacionales, pero en Europa y EEUU se ha estimado que el 10% de las embarazadas consumen cannabis. Los efectos de la exposición prenatal a esta sustancia no están claramente definidos y múltiples estudios han tratado de esclarecerlos. En este artículo se intenta revisar los aspectos más importantes de la exposición prenatal. La cannabis actúa sobre el sistema endocannabinoide fetal alterando su neurodesarrollo. En la etapa neonatal se ha descrito alteraciones biométricas y neuroconductuales, mientras que en la infancia se ha observado alteración en el desarrollo del lenguaje, de la memoria, de la atención y de las funciones ejecutivas, persistiendo algunas hasta la adultez. Pese a que un ambiente desfavorable es capaz de explicar en forma significativa las alteraciones descritas, la exposición a cannabis prenatal es un factor de riesgo de presentar resultados adversos en el neurodesarrollo tanto fetal como en etapas posteriores de la vida, por lo que debe ser pesquisado en toda embarazada o mujer con deseos de estarlo y aconsejar fuertemente la suspensión inmediata de su consumo.

Keywords:

cannabis, marihuana, lactancia, neurodesarrollo

References

(1) SENDA, boletín Nº 1 Mercado de la Marihuana en Chile: Análisis serie 2004-2010 http://www.senda.gob.cl/observatorio/boletines/boletin01/ (Accessed on 26 June 2015).

(2) SC Jaques, A Kingsbury, P Henshcke, C Chomchai, S Clews, J Falconer, ME Abdel-Latif, et al.Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology (2014) 34, 417–424.

(3) Center for Substance Abuse Treatment. MedicationAssisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.) Chapter 13. MedicationAssisted Treatment for Opioid Addiction During Pregnancy. www.ncbi.nlm.nih.gov/books/NBK64148/ (Accessed on June 08, 2012).

(4) Fergusson DM, Horwood LJ, Northstone K, ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Maternal use of cannabis and pregnancy outcome. BJOG 2002; 109: 21.

(5) Cavilgioni D, Hurd L, Harkany T, Keimpema E.Neuronal substrates and functional consequences of prenatal cannabis exposure Eur Child Adolesc Psychiatry.

(6) A.C. Huizink. Prenatal cannabis exposure and infant outcomes: Overview of studies. Progress in Neuro-Psychopharmacology

& Biological Psychiatry 2013.

(7)Hebebrand J, Verhulst F. Prenatal risk factors and postnatal central nervous system function. Eur Child Adolesc Psychiatry (2014) 23: 857–861.

(8) Subsecretaria de salud de Chile, Programa nacional salud de la mujer guía perinatal 2014.

(9) Djulus J, Moretti M, Koren G. Marijuana use and breastfeeding. Can Fam Physician 2005; 51: 349.

(10) Tennes K, Avitable N, Blackard C, et al. Marijuana: prenatal and postnatal exposure in the human. NIDA Res Monogr 1985; 59: 48.

(11) Fried PA, Watkinson B, Gray R. Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol 1999; 21: 513.

(12) Van Gelder M, Reefhuis J, Caton A, Werler M,Druschel C, Roeleveld N. Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. Drug and Alcohol Dependence 109 (2010) 243–247.

(13) Fried PA, Watkinson B, Gray R. Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol 1999; 21: 513.

(14) Witter FR, Niebyl JR. Marijuana use in pregnancy and pregnancy outcome. Am J Perinatol 1990; 7: 36.

(15) Fergusson DM, Horwood LJ, Northstone K, ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Maternal use of cannabis and pregnancy outcome. BJOG 2002; 109: 21.

(16) Brown HL , Graves CR. Smoking and marijuana use in pregnancy. Clin Obstet Gynecol. 2013 Mar; 56(1): 10713.

(17) Minnes S, Lang A, Singer L.Birth outcomes associated with cannabis use before and during pregnancy . Addiction Science and Clinical Practice, 2014.

(18) Witter FR, Niebyl JR. Marijuana use in pregnancy and pregnancy outcome. Am J Perinatol 1990; 7: 36.

(19) Varner MW , Silver RM, Rowland Hogue CJ, Willinger M, Parker CB, Thorsten VR, Goldenberg RL, et al. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol. 2014 Jan; 123(1): 11325.

(20) SaurelCubizolles MJ, Prunet C, Blondel B. Cannabis use during pregnancy in France in 2010. BJOG 2014; 121: 971.

(21) Hayatbakhsh MR, Flenady VJ, Gibbons KS, et al. Birth outcomes associated with cannabis use before and during pregnancy. Pediatr Res 2012; 71: 215.

(22) Janisse J, Bailey B, Ager J, Sokol R. Alcohol, Tobacco, Cocaine, and Marijuana Use: Relative Contributions to Preterm Delivery and Fetal Growth Restriction. Substance Abuse, 35: 60–67, 2014.

(23) de Moraes Barros MC, Guinsburg R, de Araújo Peres C, et al. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. J Pediatr 2006; 149: 781.

(24) Willford J, Chandler L, Goldschmidt L, Day N. Effects of Prenatal Tobacco, Alcohol and Marijuana Exposure on Processing Speed, Visual-Motor Coordination, and Interhemispheric Transfer. Neurotoxicol Teratol. 2010 ; 32(6): 580–588.

(25) Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 13 to 16yearolds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 2003; 25: 427.

(26) Fried PA, Watkinson B. Differential effects on facets of attention in adolescents prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 2001; 23: 421.

(27) Fried PA, Watkinson B, Siegel LS. Reading and language in 9 to 12year olds prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol 1997; 19: 171.

(28) Day N, Leech S, Goldschmidt L.The Effects of Prenatal Marijuana Exposure on Delinquent Behaviors are Mediated by Measures of Neurocognitive Functioning. Neurotoxicol Teratol. 2011 ; 33(1): 129–136.

(29) Frank D, Kuranz S, Appugliese D, Cabral H, Chen C, Crooks D, Problematic substance use in urban adolescents: Role of intrauterine exposures to cocaine and marijuana and post-natal environment. Drug and Alcohol Dependence 142 (2014) 181–190-

(30) PerezReyes M, Wall ME. Presence of delta9tetrahydrocannabinol in human milk. NEnglJMed1982; 307: 819.

(31) Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990; 12: 161.

(32) ListonJ. Breastfeeding and the use of recreational drugs alcohol, caffeine, nicotine and marijuana. Breastfeed Rev 1998; 6:27.

(33) Hill M , Reed K. Pregnancy, breastfeeding, and marijuana: a review article. Obstet Gynecol Surv. 2013 Oct; 68(10): 7108.

(34) Goldschmidt L, Richardson G, Willford G, Severtson S, Day N. School achievement in 14-year-old youths prenatally exposed to marijuana. Neurotoxicol Teratol. 2012 January; 34(1): 161–167.