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MotherToBaby’s pregnancy and breastfeeding exposure information services are available only for residents of the United States and the U.S. territories. MotherToBaby Pregnancy Studies provides study opportunities to residents of the United States, its territories, and Canada. For services that are available in other regions of the world, please visit: https://mothertobaby.org/international/.

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Unless you don’t own a television and never listen to the radio, you know that marijuana has been in the news a lot lately and for marijuana users who have had to smoke in illegally, it appears societal attitudes about pot smoking may be changing. Twenty states have laws legalizing some form of marijuana use. Two states, Colorado and Washington, have legalized its recreational use. In an interview, the NFL Commissioner seemed to leave open the possibility that medicinal use could be considered for NFL players if there was scientific evidence that it was helpful to treat injuries and pain. Even President Obama has said that he doesn’t believe marijuana is any more dangerous than alcohol. Marijuana is currently listed as a Schedule I drug. Other Schedule I drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy).

What The Research Shows Us

According to studies, pregnant women who use illicit substances are more likely to use marijuana compared to other drugs. This is often due to the belief that marijuana is less harmful to the developing embryo and fetus, compared to other drugs such as cocaine or heroin.

Marijuana is Cannabis. The delta-9-tetrahydrocannabinol (THC) in the Cannabis plant produces the psychoactive effect or “high.” Marijuana can be smoked in a joint, inhaled through a bong or vaporizer, eaten in food and teas/beverages, used in tinctures, and topical balms. Smoking and ingestion exposes the user to THC, producing the high. When smoked in a joint, the user is exposed to carbon monoxide from the burning of the leaf as well as tar, which can stay behind in the lungs.

Marijuana use during pregnancy has been studied since the 1960’s. Like all studies, there are weaknesses that have been pointed out. For example, asking women about past drug use may not be the most accurate way to make a connection between the dose of the drug and the adverse effects because the women may have forgotten. Also asking women to volunteer information about drug use, which they may fear disclosing even in a confidential setting, may make it difficult to know how frequently pregnant women use drugs overall. Still, a number of experts have reviewed hundreds of reports in humans and animals. At least to this point, the studies do not support an association between marijuana smoking and birth defects. One large study of 12,825 interviews done after delivery, did not find a statistical association between marijuana use and birth defects.

However, the studies also show that marijuana is not risk free. Studies have reported associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) In a Brazilian study, exposed newborns were “more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates.” Pregnant women who smoke daily and/or through delivery, have a higher risk for complications in their pregnancy compared to women who quit in the first trimester.

Researchers have attempted to assess the long-term effects of prenatal marijuana exposure. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. Studies are needed to assess which prenatally exposed children are most at risk. Its important to note that the children in these studies often have had prenatal exposure to other drugs as well, struggles with poverty and other life challenges, making it difficult to know that the findings are due to a single drug exposure.

So Where Does Marijuana Rank Compared To Other Drugs?

Alcohol: Specific to use during pregnancy, marijuana is not alcohol. Alcohol is still the drug with the highest risk and the widest range of birth defects, including physical, mental and behavioral. Alcohol is a drug with the highest use throughout the world, easy legal access, and social acceptance.

Cocaine: Cocaine, by comparison, is associated with a small risk for birth defects, and a higher risk for admission to newborn intensive care for withdrawal and toxicity. Additionally, cocaine is associated with prenatal growth retardation, lower birth weight, shorter length, and smaller head circumference. Studies suggest the effects on height extend into childhood.

Heroin: Heroin has not been associated with an increased risk for birth defects, however, is associated with a higher risk for withdrawal and admission to newborn intensive care and sudden infant death syndrome.

Bottomline: Snuff Out Smoking It

Clearly, marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. Changing societal attitudes doesn’t change the fact that the developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well.

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about beauty products, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.

Cheese is as old as modern mankind, with clues about its existence reaching all the way back to 8,000 BC when the first sheep and goats were domesticated by our ancestors (www.historyofcheese.com). And since cheese has been around for so long, it is now one of the most popular and beloved foods throughout the world. So, it did not come as a surprise to me that many who are pregnant and breastfeeding ask MotherToBaby about eating cheese all the time! On our texting service alone (855-999-3525), we have received over 400 questions about cheese in the past few years!

Here are some of the recent questions we have received at MotherToBaby:

• “Am I allowed to eat cream cheese on toast?”
• “Is raw milk cheese from the USA OK?”
• “Can I eat goat cheese while breastfeeding?”
• “Is it OK to eat feta cheese during pregnancy?”
• “Can I continue to eat queso cheese on a burrito or nachos while pregnant?”
• “Is unpasteurized cheese OK to eat if it’s been cooked on a pizza?”

When you start researching cheese, you can fall into a rabbit hole on kinds of cheese: hard versus soft, pasteurized or not, Mexican verses Italian? The questions are endless. There are over 1800 different kinds of cheese, divided into 7 categories (www.Funtrivia.com):

1. Fresh Cheeses: Banon, Ricotta, Feta, Cottage cheese, Cream cheese, etc.
2. Natural Rind: Sancerre, Chabichou, Crottin de Chavignol, etc.
3. Soft White Cheese: Camembert, Brie, Chevre Log, etc.
4. Semi-Soft: Edam, Pont L’Eveque, St Nectaire, Tomme de Savoie, Langres, Carre de L’Est, Epoisses, etc.
5. Hard Cheeses: Cheddar, Parmigiano Reggiano, Gruyere, Manchego, etc.
6. Blue Cheeses: Stilton, Roquefort, Gorgonzola, Maytag Blue, Cashel Blue, etc.
7. Flavored Cheeses: Cornish Yarg, Gouda with Cumin, Stilton with Apricots, Devon Garland, etc.

So, what is the bottom line for you if you are pregnant or breastfeeding?

First, check to see if the cheese has been pasteurized or not. Look at the label and you will find that most types of packaged cheese or cheese products sold in America have been pasteurized or heat treated. Pasteurization is defined as a process in which both packaged and non-packaged foods (such as cheese and milk) are treated with moderate heat, usually up to 212 °F, to eliminate pathogens and extend shelf life. If the cheese has gone through pasteurization, then any increased risk for bacteria or other pathogens is very small, and the product isn’t considered to increase risks if eaten during pregnancy and breastfeeding. Of course, keep an eye on the fresh or sell-by date, and keep the product properly refrigerated. Cheese that has not been pasteurized has an increased risk for bacteria such as Listeria. See our fact sheet at Listeria Infection (Listeriosis) – MotherToBaby for more information. If the cheese has not been pasteurized, but has been cooked or heated prior to eating, then there also is little increased risk. Plus, cheese that has been dried, such as parmesan cheese, has a longer shelf life and no known increased risk for bacteria.

One of the most common questions about cheese when pregnant and breastfeeding is about the difference between hard and soft cheese. Hard cheese has been ripened longer and is drier, having a lower water content. Whereas soft cheese is younger or fresher, with a higher moisture content. The higher moisture content in soft cheese can allow for more growth of bacteria. That is why it is a good idea to be sure that soft cheeses are either heated prior to eating or have been pasteurized at the time of production (again, pasteurization is a process to kill bacteria). Most soft cheeses in the U.S. have undergone this process by FDA pasteurization law — so look at the label to be sure and be aware of any possible increased risks if unpasteurized!

Cheese is rich in protein and minerals such as calcium and phosphorus. During pregnancy and while breastfeeding, cheese can be part of your good diet. Some cheese types, such as hard cheese, are higher in fat. So, do watch the fat content if cheese is part of your daily diet! Just follow a few simple rules about checking for pasteurization and being sure the cheese product is heated or has been cooked prior to eating if it was not pasteurized. And then, enjoy eating cheese without worry during pregnancy and breastfeeding! If you have any cheese related questions during pregnancy, or any other exposure questions, be sure to contact MotherToBaby! We will be happy to help you!

Originally Published 5/11/22. Updated 9/30/25.

I recently received a phone call from Molly.  Molly told me that she had just found out that she was pregnant; this was a surprise, but a welcome one.  However, Molly confessed that she smokes a pack of cigarettes per day and her doctor recommends that she quit smoking since cigarettes can present a number of hazards for her pregnancy and baby.  Molly’s friend told her that e-cigarettes were safe in pregnancy and would help Molly with her efforts to reduce use of traditional cigarettes.  Molly wanted to be sure.  “Don’t both cigarettes and e-cigarettes both contain nicotine,” she asked?  

What are e-cigarettes? 

‘E-cigarettes’ is short for electronic nicotine delivery system, sometimes also referred to as vapes, e-hookah, or other slang names.  E-cigarettes utilize a device that heats up nicotine-containing fluid from a cartridge, which can then be inhaled as a vapor.  Using an e-cigarette does have the potential to avoid some of the hazardous compounds found in traditional cigarettes such as tar and cadmium.  However, e-cigarettes are a relatively new product and not very well regulated.  Some e-cigarette fluids contain a lot of nicotine while others very little.  They often have other substances added to them including preservatives and flavorings. Many of these agents have not been studied regarding their safety in pregnant women.   

All of this makes it difficult to draw accurate conclusions about what risk e-cigarettes might present to a pregnant woman and her baby.  What we do know is that traditional cigarettes and nicotine (the chemical which is in both tobacco and e-cigarettes) do present a risk for a wide number of issues including birth defects (cleft lip and palate), miscarriage, and poor growth in the developing baby.  In addition, substituting e-cigarettes for traditional cigarettes is not a proven way to quit smoking, and in some cases, people continue to smoke conventional cigarettes as well as e-cigarettes which makes the exposure to the baby even larger.  Scientists are still learning about this, and most public health agencies recommend behavioral approaches as the safest strategy for pregnant women who are trying to quit smoking.

Molly is smart to ask about the safety of e-cigarettes before she uses them.  She also shows how much she cares about herself and her baby by trying to decrease smoking as much as possible!  I suggested she speak with her healthcare provider about strategies for quitting.  I also told her about free services like the CDC’s Smoker’s Quitline (1-800-784-8669).

MotherToBaby has fact sheets on e-cigarettes, cigarette smoke and vaping...

… and people can call (866-626-6847), text (855-999-3525), email, or chat to speak with a specialist on exposures in pregnancy.

What happens when a researcher studying pregnancy becomes a patient navigating her own autoimmune diagnosis? In this powerful episode of The MotherToBaby Podcast, genetic counselor Chris Stallman, CGC, sits down with Dr. Christina Longo, Assistant Professor at the University of Montreal and perinatal epidemiologist, to discuss her lived experience managing rheumatoid arthritis during pregnancy and breastfeeding.

Dr. Longo shares how her first diagnosis during pregnancy reshaped her research focus—from child outcomes to the importance of maternal health, mental wellbeing, and self-advocacy. She opens up about the difficult decisions she faced around medication safety, breastfeeding, and treatment during pregnancy, and how patient-led communities and research studies helped her find strength and clarity.

Listeners will learn:

• How autoimmune diseases can change during pregnancy and postpartum
• Why controlled treatment plans matter before conception
• The emotional and physical toll of navigating chronic illness while pregnant
• The importance of participating in pregnancy studies to improve care for future parents

Whether you’re living with a chronic condition, supporting someone who is, or counseling patients through pregnancy, this episode sheds light on the urgent need for research, empathy, and balanced care for both parent and baby.

🔗 Learn more or join a pregnancy study.

💡 Have questions about exposures during pregnancy or breastfeeding?
You can contact MotherToBaby for free, confidential, evidence-based information:
📞 Call: 866-626-6847
📱 Text: 855-999-3525
💻 Visit: https://mothertobaby.org/