Centre of Excellence for Women’s Health: Webinar on Cannabis in the Reproductive Years
Nancy Poole, presenter of the webinar on What we know about cannabis in the reproductive years, is Director of the Centre of Excellence for Women’s Health, Prevention lead for CanFASD Research Network, and Lead on several pan-Canadian projects on trauma, gender and substance use with governments and addictions agencies. The panelists for the discussion were Karen Mason, Manager of the Family Treatment Centre in Prince Albert, and Bev Drew, FASD Prevention Coordinator with the Saskatchewan Prevention Institute.
Best Start/Health Nexus CEWH researchers reviewed the literature on the effects of cannabis in the perinatal period, looking at 60 articles published between 2007-2017, looking at fertility, pregnancy, birth outcomes, breastfeeding, child development, and parenting.
Methodological challenges included confounding factors such as use of tobacco, alcohol and other substance, and socio-demographics; small samples of women who use prenatally; self-report; clinical trials on humans unethical; lack of data on quantity, potency and method of ingestions; and interpretation of animal studies.
The reviewers found mixed results in the studies, which creates challenges for public health messaging. The recommendations of the review group are:
Given evidence gaps and unknown risks, the safest approach is to support women and their partners not to use cannabis when trying to conceive, during pregnancy and breastfeeding, and to take precautions whilst parenting.
Provide unbiased education and messaging.
Use of non-judgmental messaging: identification of use and support:
Begin in preconception
Reduce stigma and increase opportunities for dialogue
Address co-use with tobacco, alcohol
Offer holistic support
Discuss risks and benefits regarding medicinal use
Address safe storage, parenting, driving
The Centre of Excellence for Women’s Health has produced downloadable information sheets summarizing the evidence related to harmful effects of each four substances: alcohol, tobacco, cannabis, and prescription opioids, for women in general, in pregnancy, when breastfeeding, and when parenting. These are available at:
Prescription Opioids: http://bccewh.bc.ca/2016/08/women-and-perscription-opioids/
The Centre of Excellence is currently doing a national project about brief support on alcohol, tobacco, cannabis and prescription opioids, with financial support from the Public Health Agency of Canada. From their work on other substances, the project authors already know some strategies regarding brief support. The goal of the project is to inspire health and social care providers to incorporate brief intervention on alcohol, tobacco, cannabis and prescription opioids in their daily practice with girls and women and their partners, in order to promote women’s and men’s health, and prevent FASD.
The project involves 13 regional meetings (Vancouver, Edmonton, Saskatoon, Winnipeg, Thunder Bay, Toronto, Halifax, Moncton, Charlottetown, St John’s, Whitehorse, Yellowknife, and Iqaluit) involving midwives, nurses, physicians, pregnancy outreach workers, sexual health workers, substance use service providers, violence against women service providers, and Indigenous service providers.
The project has identified and summarized available academic evidence, tools and best practices related to the effects of legal substances and how to do brief intervention. Summaries of evidence for brief intervention by profession have been created, and will be published soon. An annotated bibliography of articles on 4 levels of FASD prevention to be published annually, is downloadable from www.canfasd.ca
Pathways Research in Winnipeg has produced a Healthy Living Workbook on Making Choices about Cannabis available for order at www.healthylivingworkbook.com
Co-Creating Evidence: National Evaluation of Multi-service Programs Reaching Pregnant Women at Risk is a multi-site evaluation involving 8 programs across Canada, led by Deborah Rutman, Carol Hubberstey, Marilyn van Bibber, Nancy Poole, and Rose Schmidt. It is looking at pregnancy outreach with multi-service programs serving pregnant women at risk, looking at seven components.
Kindness and compassion
Inter-disciplinary developmental lens: addressing women’s and children’s needs holistically
Culturally grounded: employing cultural programming and approaches and appreciating the multi-generational impacts of colonization
Trauma informed: appreciating that many women have experienced serious trauma
Harm reduction: focus on minimizing harm and promoting safety
Women-centred: women set their own goals for service
The Centre of Excellence publication Supporting Pregnant and Parenting Women who use Substances: What Communities are Doing to Help has identified 6 common approach elements. The report notes, “While all of these programs are different from each other in terms of funding, service delivery model, philosophies, and mandates, they share common elements that evaluation studies show work.”
Outreach: “Outreach provides flexibility for service providers in how they work with women. They can accompany women to appointments, share information informally, and help overcome barriers like lack of transportation and distrust of formal settings.”
Practical Support: “ Without practical support [e.g. food vouchers, free prenatal vitamins, socks, bus tickets, support in finding housing] women cannot succeed in meeting other goals like reducing or stopping their substance use or learning parenting skills.”
Harm Reduction: “A harm reduction approach means that abstinence is just one possible goal for women and that care and support do not require women to address their substance use issues until they are ready. Harm reduction allows for flexible, respectful, and non-judgmental approaches to engaging with and caring for women and children.”
Integrated: “An integrated ‘one stop shop’ model recognizes that no single service provider or agency can meet the often complex needs of women and that formal and non-traditional partnerships are required (e.g. between child-focused and adult-focused services).”
Mother + Child = Success: “All these programs view the needs of women and the needs of fetus/children as being linked….Approaches that view women’s substance use outcomes, child development outcomes, and parenting outcomes as linked lead to success.”
Trauma + Safety: “Substance use is often tied to women’s experiences of violence and trauma as well as histories of colonization and migration. Attention to issues of empowerment, trust and safety, cultural awareness, and social justice have shaped the development and success of these programs.”
What We Know about Cannabis in the Reproductive Years