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  • BF and marijuana

    I'm a medical director of a hospital mother baby unit and updating our policy on breastfeeding and illicit substances. Previously we've supported breastfeeding in mothers who are "casual" or infrequent users of marijuana (vs. daily or heavy use). Is this still a reasonable stance in light of 2014 NEJM article on adverse effects of marijuana?

  • #2
    The NEJM article that you mentioned crystalizes the evidence for long-term neurobehavioral changes in adolescents and young adults who use cannabis. It does not discuss infants or "sub-therapeutic" exposure. We know that medication safety in breastfeeding has only a low to moderate correlation with safety concerns in pregnancy or with direct use of the drug.

    However, there has not been a "no effect" dose limit established for THC in any age group. The existing literature on THC exposure through breastmilk is both limited and conflicted. There is enough evidence to suggest the possibility of problems in the infant, even at that low level. We can say with confidence that a woman who insists on breastfeeding should not use recreational cannabis; the risks to the infant clearly exceed the benefits to the mother.

    Can we flip this statement around and say that a mother who insists on using recreational cannabis should not breastfeed? This question requires comparing the benefits of breastfeeding to the risks of incidental cannabis exposure. The former are tangible and well-established, while the latter are vague and scary. The literature is not well-established enough in this area to be of much help in making useful generalizations. Issues of pregnancy exposure, drug contaminants, drug interactions, and addiction all confound the question further.

    It is our considered opinion that the benefits of breastfeeding probably outweigh the detriment caused by occasional or "casual" exposure to cannabis. That detriment increases with more frequent use and, at some point, will exceed the benefits. We do not have enough information to say where that division lies. It will have to come down to a case-by-case judgement.

    James Abbey, MD and Thomas W. Hale, PhD
    InfantRisk Center

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