Hasch-rökning och fosterskada. Gravid patient, SM slutet av maj, tidigare amfetaminmissbrukare. För

Fråga: Hasch-rökning och fosterskada. Gravid patient, SM slutet av maj, tidigare amfetaminmissbrukare. Förnekar nu missbruk. Urinprov 15/9 positivt för hasch.

Sammanfattning: Clinical experiments indicate that delta-tetrahydrocannabinol may induce malformations in foetuses of pregnant laboratory animals. It has been suggested that the combination of L.S.D. and marihuana may produce congenital malformations in the offspring of women who take this combination during gestation. There is also the possibility that marihuana might induce subtle biochemical changes that might influence the development of the central nervous system in a deleterious way. Although conclusive data in man on the possible risk of teratogenic effects of marihuana and haschish are still lacking we think that the potential hazards strongly motivate total abstention during pregnancy.

Svar: Marihuana and haschish are ancient drugs native to the Middle East and North Africa. They are prepared from the plant Cannabis Sativa and the primary active pharmacologic constituent is delta-9-tetrahydrocannabinol (1).

Abel (1980), reviewed the literature on animal experiments and found that delta-9-tetrahydrocannabinol caused various teratogenic effects (2). Harbison et al (1972) showed that tetrahydrocannabinol is embryocidal and fetocidal when administered to pregnant mice. Some of the mice also had foetuses with reduced birth weight (3). In a review article Nahas (1979) points out that Huang et al have shown that cannabis impairs spermatogenesis in rats (4). Two reports however refute the above findings and do not think that tetrahydrocannabinol is grossly teratogenic in rats (5,6). In another article Harclerode (1980) showed that marihuana may decrease male fertility in rats and increase the percentage of abnormal sperm in the semen of both rats, mice and humans (7). Neu et al (1969) have demonstrated chromosomal damaging effects of marihuana when added to cultures of human leucocytes (8). There are two case reports in the literature on babies with congenital abnormalities of the limbs born to mothers who have taken a combination of L.S.D. and marihuana during pregnancy (9,10). However, a prospective clinical trial in 291 pregnant women, 20 per cent of whom reported abuse of marihuana before and/or during pregnancy (11) did not show any increase in congenital malformation in babies born to mothers abusing marihuana. It must however, be pointed out that these babies showed a number of neurologica l and behavioural abnormalities (11), such as highpitched cry and tremor.