Jul 31, 2018
by Gary Pace M.D.
Now that marijuana is legal, a slew of questions come up about the health risks of cannabis use. One such concern is the safety of marijuana consumption when breastfeeding.
Usually, clinical studies would guide the reponse to a question like this, but there really are very few due to federal restrictions. There was some research back in the 1980s, and now with renewed interest and flexibility, many are currently in progress. Studies done with pregnant women before birth have shown that the babies tend to be smaller in size, but they have not convincingly demonstrated developmental or behavioral problems. So far, the best we can say from the research is captured by Dr. Stellwagen, a neonatologist in San Diego: “We do not have good quality evidence that use of marijuana in lactation causes poor outcomes.”
Is It Safe Then? No, this is not to suggest that it is safe. In reality, we simply don’t have proof from the research either way. A big study currently going on at UCSD is using pumped milk from a milk bank to determine effects of THC exposure, and some preliminary findings suggest some developmental issues may be present. The final results won’t be out for a few years, though.
In the absence of credible research, the next step is to look at the advice from the relevant professional organizations. Organizations representing pediatricians, obstetricians, and public health are all essentially saying the same thing: “We don’t have clear evidence, but our suspicion is that it is bad for the baby, so breastfeeding women shouldn’t use marijuana.”
In Sonoma County, though, providers can counsel women to avoid cannabis while breastfeeding, but we know that many women will continue to use. The relevant question for these women is: “If I choose to use cannabis, is the possible risk to my baby while breastfeeding worse than the known deleterious effects from switching to formula?”
Let’s look at what we know (from Stellwagen):
● Cannabis gets into the baby and breastmilk (although unclear how much), and THC is stored in the fat and in the brain.
● Pregnancy and post-partum are when the baby’s brain is growing rapidly.
● Cannabis could change the baby’s brain development, but we don’t know enough about this yet.
● We do know that breastfeeding is great for the baby’s brain.
● Breastfeeding is clearly better for a baby than bottlefeeding. Lactation experts recommend that women who smoke cigarettes should continue breastfeeding. Research shows that the benefit of the breastmilk clearly outweighs the risk of the nicotine exposure. Could that be the case with marijuana, as well?
Conclusions: Here is a reasonable synopsis from Motherisk (an organization devoted to educating about risks to babies from exposures):“Very little is known about marijuana use and lactation. Lactating mothers should refrain from consuming cannbinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannibinoids must incorporate the known risks of formula feeding.”
So, medical providers will almost uniformly say, “Don’t use marijuana when breastfeeding your baby.” But, for women that choose to continue to use, there may be some ways to decrease whatever risk there is (although there is no research):
● Contact with smoke is not good for the baby. Therefore, vaping, tinctures, edibles, and sublinguals are probably better than smoking.
● Know what is in the product you consume. LIke with your food, knowing who grew it and what they put in it can be a important. Organic, chemical-free is definitely better, particularly in vaping, where industrial production with chemicals is common.
● Use less quantity, less frequently. Take breaks. Don’t use with tobacco and alcohol, as these are known to have negative health effects on the baby.
● Have others available to care for your baby if you use, because you may be less responsible when high.
● Don’t expose your child -- to the smoke or to the substance. If you choose to smoke, do it outside and wear a ‘smoking jacket’ that you can take off when holding the baby. Also, don’t leave the material around where children or pets can get into it.
● Cannabis Use Disorder is a real thing. If you think you need help, contact your medical provider.
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