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Marijuana Use and Breastfeeding

Marijuana Use and Breastfeeding | Medpage Today
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Marijuana Use and Breastfeeding | Medpage Today
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Nursing > Nursing
Marijuana Use and Breastfeeding
10 things every nurse needs to know
by Carina A. Ryder, MS, CNM, NCMP
April 22, 2018
A wave of marijuana legislation has rolled over the country during the past several
years. As of now, 29 states and the District of Columbia have legitimized the use of
medical marijuana; eight of these states also permit the recreational use of marijuana.
Medical or recreational, legal or not, marijuana is the "illicit" drug used most
commonly during pregnancy and lactation.
We can help our patients make decisions about breastfeeding and marijuana use by
being informed and educated ourselves.
1. Cannabinoids (like THC) pass into breast milk.
THC (delta-9-tetrahydrocannabinol) is one of the most physiologically active of over
400 chemical components of marijuana. Cannabinoids' physiologic effects occur via
the endocannabinoid system, which spans the brain and the central and peripheral
nervous systems. The endocannabinoid system helps to regulate appetite, pain, mood,
and memory by affecting neurotransmitter patterns.
Cannabinoids are fat-soluble and enter into breast milk via passive diffusion. THC is
stored in the brain and may have both acute and cumulative neurological effects.
2. Professional organizations recommend that breastfeeding women stop using
The Academy of Breastfeeding Medicine, the College of Family Physicians of Canada,
and the American College of Obstetricians and Gynecologists all recommend that
women stop using marijuana while breastfeeding. Screening pregnant women for the
use of tobacco, alcohol, and other drugs during pregnancy is a standard of prenatal
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3. Research about the safety of marijuana use while breastfeeding is limited in quality
and quantity
Research about the safety and efficacy of marijuana use is scant, period. Conditions
further limit the study of maternal marijuana use and the breastfeeding infant.
The studies of infants of women who have used marijuana while breastfeeding
attempt to assess the effects of non-medical-grade marijuana. "Street" marijuana
may be contaminated with other drugs or chemicals, confounding study results.
Most of the studies either document or presume the use of C. sativa, which is not the
only species of available marijuana. Even within a cannabis species, there are many
varieties, and cannabis hybrids are common, each with different chemical
constituents, properties, and levels of THC -- which means there may not be universal
effects, adverse or otherwise.
In utero exposure confounds research results. At least some of the infants in the
studies were exposed to marijuana both while in utero and during breastfeeding,
rendering it impossible to conclude that the marijuana in breast milk is the causative
factor of any ill effect on psychomotor development.
Studies of the psychomotor development of children exposed to marijuana in breast
milk have not been done beyond the age of 1.
4. There is no available evidence about secondhand exposure of infants to marijuana
We are aware of the risks to infants of exposure to secondhand tobacco smoke,
which include respiratory conditions and sudden infant death syndrome (SIDS). We
could extrapolate that marijuana smoke exposure would have similar effects. We do
not know what benefit, if any, there is to stopping breastfeeding if the infant will
have secondhand exposure to THC and marijuana smoke.
5. Marijuana may reduce milk supply by inhibiting prolactin production
Prolactin is a hormone responsible for breast milk production. Regular and frequent
suckling of the infant at the breast (or, less efficiently, breast pumping) stimulates
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A drop in prolactin levels occurs when there is less frequent nipple stimulation, and
there is downregulation of milk production. Prolactin levels may also drop in response
to certain medications, such as the estrogens in many contraceptive products.
Research suggests that prolactin levels may also drop in response to maternal
marijuana use.
Women who are not making enough milk -- for whatever reason -- are likely to
supplement or replace breastfeeding with formula. Formula feeding deprives mother
and child of the beneficial effects of breastfeeding.
6. Most women who use marijuana during pregnancy will continue to use it while
Studies have examined recreational marijuana use rates in pregnant and
breastfeeding women and document a relationship between the two. However,
screening for drug use during pregnancy may be an indicator of drug use while
breastfeeding and would guide our counseling and treatment efforts during both
pregnancy and lactation.
7. Women should be counseled regarding the potential adverse effects of marijuana
use on infants while breastfeeding
Women need to know that:
Breastfeeding women should stop using marijuana
There is some, but limited, evidence about the safety of breastfeeding
while using medical marijuana
We know that marijuana passes into breast milk, but we don't know how
it affects a breastfeeding baby, immediately or long term
There are potential risks to using marijuana, just like there are for any
other drug
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There are alternatives to dealing with anxiety and depression that have
been studied more rigorously during lactation and are potentially safer
for the breastfeeding infant
Using marijuana may affect the ability to parent
Using marijuana may reduce a mother's milk supply, affecting her ability
to provide her child with optimal nutrition
There may be legal repercussions to using marijuana while breastfeeding,
which may or may not involve custody issues
We will support her breastfeeding efforts whether or not she chooses to
stop using marijuana
If she does continue to use marijuana while breastfeeding, she should
observe her infant for signs of delayed motor development, lethargy, low
tone, irritability, and poor sucking, which are considered possible effects
of infant marijuana exposure
If she chooses to continue marijuana and stop breastfeeding, she needs
education about formula feeding
If she chooses to continue using marijuana and stops breastfeeding, she
needs to know the presumed risks of smoking marijuana in proximity to
her baby, or use marijuana in another form to avoid secondhand smoke
exposure to the infant
8. Lactation support should not be withheld from women who choose to use
marijuana while breastfeeding
Not breastfeeding has health risks. The benefits of breastfeeding for both mom and
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preemies. However, depriving preemies of human milk has significant and wellestablished health risks. Women who are appropriately counseled about the potential
for adverse neonatal neurodevelopmental effects of breastfeeding while using
marijuana should not be prohibited from breastfeeding.
9. Some breastfeeding women may be using marijuana for medical indications
There is no data on how often we might encounter breastfeeding women using
marijuana for medical purposes. The most common indications for medical marijuana
use are chronic pain, cancer, post-traumatic stress disorder, HIV/AIDS, seizure
disorders, and muscle spasms due to multiple sclerosis and other chronic conditions.
We think of pregnant and breastfeeding women as being relatively healthy and have
no indication for medical marijuana use. This would be true in an ideal world, but we
all know that health conditions are not ideal for every pregnant and breastfeeding
woman. Keep in mind that women may self-medicate with recreational (not medical
grade) marijuana.
10. There are many areas that require further research
The ethical issues surrounding the research of drug use (prescription or otherwise) in
pregnant and breastfeeding women are prohibitive, yet we need answers to the
following questions and more:
Does using marijuana impact parenting skills?
If maternal marijuana use while breastfeeding increases the risk of SIDS,
what is the cause of the increased risk? Would it be because the infant is
exposed to cannabinoids? Or that the exposure to smoke (as a product of
combustion) might increase the risk of SIDS?
Does maternal marijuana exposure by routes other than smoking result in
the same levels of marijuana in the breastfed infant as does a mother's
smoking marijuana?
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versus discontinuing (or never initiating) breastfeeding and continuing to
use marijuana
Are there deleterious long-term consequences for infants exposed to
marijuana through breast milk?
Perhaps the legalization of marijuana will help facilitate more research. Perhaps
women will feel more comfortable disclosing marijuana use if they are less afraid of
legal repercussions. Knowing that women are using marijuana or any other drug
during pregnancy or while breastfeeding provides us with the opportunity to
intervene for the best interests of women and their families, even when we have
incomplete information.
Carina Ryder, MS, CNM, NCMP is a midwife currently in practice in Washington, D.C.
This story was originally published by The Nurse Professional, a resource for nursing
news and information and a portal for the latest jobs, scholarships, and books from
Springer Publishing Company.
Primary Source
American Journal of Obstetrics and Gynecology
Source Reference: Metz TD, Strickrath EH "Marijuana use in pregnancy and lactation: A review of the evidence" Amer
J Obstet Gynecol 2015; DOI: 10.1016/j.ajog.2015.05.025.