In Reply

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In Reply:
We very much appreciate the letter from Drs. Braillon and Bewley regarding Committee Opinion No. 722.1 This Committee Opinion was developed based on the available evidence to provide clinical guidance related to the use of marijuana by pregnant women and during breastfeeding.
The authors claim that the Committee Opinion was far too timid. As part of the periodic review process of all American College of Obstetricians and Gynecologists (ACOG) clinical guidance, an interim literature review is conducted in updating clinical guidance; thus, any publications addressing this issue since the prior version was published would be included in the most recent review. The most important issue that the authors raise is the need for more investigation to better understand the effects of marijuana use on the pregnant woman, the developing fetus, and breastfed infants. The authors also address the fact that psychoactive substances usually are used in conjunction with one another—the current Committee Opinion also addresses that issue. However, the Committee Opinion points out that there are challenges with interpreting the data on the use of multiple substances. This Committee Opinion addresses marijuana as the main clinical question in this document.
The authors also address the issue of aggressive marketing of addictive substances, misrepresentation of facts, policies, and potential vulnerability of substance use populations. We completely agree with these concerns. The focus of this Committee Opinion is to provide clinical guidance; we did not address advocacy concerns. The American College of Obstetricians and Gynecologists has other materials that address these issues, including Committee Opinions on research in pregnancy, alcohol dependence, and alcohol abuse and substance use disorders.2–4 Furthermore, ACOG advocates for provider and patient education, research, policies, and regulations as appropriate, to address marijuana, alcohol, and other substance use in adolescents and women, including pregnant women.2–5 Clearly, ACOG shares the concerns raised by the authors, but these are addressed in other resources.
We again thank Drs. Braillon and Bewley for writing is response to the Committee Opinion. We agree that additional information is absolutely necessary to refine and present evidence-based guidance and advocate for women's health.
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