The Misleading Storyline on Ketamine Use During Pregnancy
In the realm of medical discourse, sensationalism often overshadows nuance, leading to misunderstanding and fear. Negative ketamine publicity is all the rage nowadays, given the Matthew Perry case. A recent article from Brenda Baletti, PhD, published in Children’s Health Defense (CHD) on ketamine use during pregnancy, exemplifies this trend, painting a stark picture of risk without the necessary context or balance. Here’s why this narrative misses the mark:
CHD Article Title: Ketamine Poses Serious Risks for Pregnant Women, But Providers Often Fail to Warn Them
“Ketamine — which can be addictive — “readily and rapidly” crosses the placental barrier and can cause serious birth defects if taken by pregnant women. Its use is on the rise, but prescribers are failing to warn women of the risks, a new study found.”
If the article had focused on the fact that healthcare providers don’t often discuss the risks, benefits, and alternatives of ketamine use around pregnancy, which they don’t, then that would have been fine. However, the CHD article builds on the narrative that ketamine is a serious risk for pregnant women.
Billions of Doses
The CHD article suggests that ketamine poses “serious risks” to pregnant women. Pregnant women have been given billions of doses of ketamine worldwide since its inception in the 1960s.
While it’s true that any substance crossing the placenta could theoretically affect the fetus, the article fails to mention that many anesthetics and medications, including common over-the-counter drugs, also cross this barrier. The key lies in understanding the dosage, frequency, and context of use, which the article glosses over.
Ketamine is administered under controlled conditions for specific purposes in medical settings. The article’s broad attack on its use ignores these medical contexts where benefits might outweigh risks, especially when alternatives are limited or ineffective.
The first half of the title states that ketamine poses significant risks for pregnant women. Okay, at what point in the pregnancy? Anesthetics like ketamine and propofol are routinely given early in pregnancy worldwide. This is a vast topic in the world of anesthesia; most studies show no harm to developing fetuses. In very high doses, just about every anesthetic drug shows harm to a developing fetus when given to rats early in fetal development – nitrous oxide, pentothal, sevoflurane, propofol, fentanyl, and ketamine. So, ketamine is not unique in this regard. It was in the Russian literature for years that giving a benzodiazepine called midazolam to a growing fetus (even in the third trimester) could cause congenital disabilities, and this was debunked only after 25 years, but notwithstanding dozens of doctors being sued for millions for giving benzodiazepines to pregnant mothers.
The rat study in the CHD article showed that 70 mg/kg - a crap ton of ketamine, does toxic things to the brain. This article is in really poor form. Ketamine used correctly in a clinic with concomitant psychotherapy usually revolves around 0.5 to 1 mg/kg of body weight. Another study shows that ketamine caused harm in developing rats:
“The total dose of ketamine used in each dam (female rate) was 144.2 ± 4.6 mg/kg (n = 9), and all anesthetized dams recovered fully without complications, such as respiratory depression, cardiac arrest, or miscarriage.” Even in the ridiculous dose used in this study, ketamine did not have the effects that the above study purported.
Here’s another study they cited:
Safe Ketamine Use and Pregnancy: A Nationwide Survey and Retrospective Review of Informed Consent, Counseling, and Testing Practices Lead author - Rachel M. Pacilio, MD
“Ketamine is contraindicated in pregnancy, given the lack of knowledge about its potential effects on a developing fetus. This study aimed to characterize current clinical practices specific to pregnancy and reproduction related to the use of ketamine for the treatment of psychiatric illness.
Methods: Online surveys were sent to outpatient ketamine clinics across the United States …
Most Research Finding Are False
The study cited for this article is a survey—a survey like those used in nutrition and psychology studies, of which most are inaccurate, irreproducible, and pure garbage. Stanford professor John Ioannidis showed years ago that most research findings are false.
I’m not arguing that healthcare professionals shouldn’t discuss the risks, benefits, and alternatives of any medication during pregnancy. But let’s be clear: we’re not talking about Thalidomide. For those curious, Thalidomide was an antinausea drug that caused the fetus not to develop its limbs, and many babies were born without arms and legs. No one knows the effects of ketamine on a developing fetus. It’s certainly not zero, just like cocaine or crack or alcohol.
Ketamine has been used safely in billions of births all over the world. Billions. The article cites a 1977 study that shows a transient level of ketamine in 10 births. All anesthetics do this.
Here’s a summary of points about the CHD article:
Misrepresentation of Addiction Risks: While ketamine can be addictive, particularly in recreational misuse, the article does not differentiate between medical use under supervision and recreational abuse. This conflation misleads readers about the addiction risks associated with medically supervised ketamine therapy.
Lack of Comparative Analysis: The piece lacks a comparison with other medications or treatments used during pregnancy. For instance, many antidepressants have their risks but are often prescribed after weighing these against the benefits. Ketamine’s risks should be discussed in this comparative light.
The Role of Providers: While healthcare providers must discuss all potential risks, the article’s claim that providers often fail to warn patients might be more reflective of communication gaps rather than negligence. Medical professionals are trained to discuss risks, but the complexity of these discussions can sometimes lead to misunderstandings or perceived omissions.
The Need for Balanced Reporting: Health journalism should aim for balance, presenting both sides of the scientific debate. The CHD article leans heavily into alarmism without adequately exploring the scenarios where ketamine might be a necessary or even beneficial choice for pregnant women under medical supervision.
Breastfeeding considerations:
According to the FDA, a quick search of breastfeeding and ketamine shows that it is not recommended. However, limited clinical data suggest that ketamine and its metabolites are present in low concentrations in breast milk, and its low oral bioavailability implies a minimal risk to infants. The use of ketamine in nursing mothers does not affect lactation. Ketamine should be used to monitor the infant clinically.
Ketamine: Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006.
Ketamine and its active metabolite appear in milk at very low levels, and its oral bioavailability is low, indicating a low risk to breastfed infants. Available data indicate that ketamine use in nursing mothers may not affect the breastfed infant or lactation. Until more data are available, ketamine should be used with careful infant monitoring of the infant for sedation, poor feeding, and poor weight gain.
Breastfeeding while taking ketamine or having received ketamine during labor and delivery:
Ketamine has not been well studied for use while breastfeeding. Small amounts of ketamine get into breast milk. There are four case reports of infants who did not have side effects from breastfeeding after ketamine was given during labor. Be sure to talk to your healthcare provider about all your breastfeeding questions.
Conclusion
The CHD author, Brenda Baletti, Ph.D., is writing a “scare” article about ketamine. If the point were to truthfully raise awareness that healthcare professionals in ketamine clinics should be more mindful of discussing the risks, benefits, and alternatives of ketamine therapy with women trying to become pregnant, then that would have been a great article. But it’s disheartening to read something like this in CHD. It’s easy to be scared about the effects of a drug on our developing children. Perhaps this author should have consulted with doctors who give ketamine and other anesthetics before she wrote such a piece.
Refs
Ketamine as an induction agent for caesarean section