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  • Marijuana and colostrum

    I'm an LC in a hospital. We have a NICU, too. I was reading some of your posts about marijuana use and breastfeeding. We are working on developing a policy for healthy term babies, Special care nursery babies (over 32 weeks) and sicker very preterm infants when the mother is positive for marijuana at delivery. We do advise patients to stop smoking marijuana if they are going to breastfeed. It's our understanding that legally we can't really prevent anyone from breastfeeding their babies if they have their babies in their room. We can just advise them not to continue using marijuana. We could only send a report to CPS if we knew for certain, but CPS doesn't really care unless there are other issues to tell you the truth. In the SCN or NICU though, it is the doctors discretion as to whether or not to give this milk. I read your post from several years ago in which you mentioned that you were mainly concerned about marijuana impairing the mother and her ability to care for the baby and not so much the transmission of the small amount of drug to the baby. I have a few questions about this. I also saw your recent study in which you stated that it appears that a 3 to 5 month old baby would receive approximately 8 mcg of THC total daily dose. I'm assuming that's when consuming about a 1 L of milk. So if a baby is getting 1 or 2 ml of colostrum on day one, presumably their daily dosage would be much, much smaller? We are all in agreement here that the best thing would be to tell the mother to stop using marijuana and breastfeed her baby. But we are looking for guidance about when she comes in positive and states that she's not going to use anymore. Some hospitals are beginning to create policies saying that the patient can't breastfeed, or needs to pump and dump her milk for weeks until the milk tests completely negative. Or that they need to freeze her milk and will give it if they test the baby's urine and meconium and it comes back negative. Can you give us any guidance on this? Especially in light of what we know about the critical importance to the baby of colostrum, and the extremely small volume of colostrum. It would seem that the biggest dose would be when the mom's milk comes in and the volume increases rapidly. I would think that the drug amount would probably be extremely, extremely small. Would you view be different about giving this colostrum to a 28 week preterm infant? In the NICU though, the staff are caring for the baby and maybe the mother's impairment wouldn't be as much of an issue. Also, I've always thought that the problem of it affecting the neuroleptic effect on the mother is not really improved by the mother formula feeding. Then she's still caring for the baby in an impaired state and formula feeding. It seems as though the question really is - if the mother is going to continue to use marijuana and breastfeed (which she shouldn't) is it healthier for the baby to get the benefits of the breast milk with the small amount of drugs in it, or be formula fed and raised by a mother that is smoking marijuana and not get drugs in the milk but lose the health benefits? It's a tough question and seems there are no easy answers. Just wondering if there is enough research to support at least the use of her colostrum in the NICU, even if she smoked marijuana a few days before delivery. We would appreciate any help you could give. Thank you.

  • #2
    tcs710:

    My recent study on Marijuana in breastfed women: [url]https://journals.lww.com/greenjournal/Fulltext/2018/05000/Transfer_of_Inhaled_Cannabis_Into_Human_Breast.5.a spx[/url]

    1. The amount of THC present in milk is dependent on the daily dose the mother consumes. Our recent study suggests this is about 2.5% of the maternal dose of 23.18mg. NOTE: this is for moms that are infrequent users. Further, the ORAL absorption of THC in humans is around 1-5%, thus very little of it ever gets past the liver.

    2. It appears that in heavy users, these mothers are at "steady state" and that THC levels in their milk MAY be much higher (maybe 8% or more). We don't know this for sure, but hope to test it in the next year.

    3. THC is rapidly cleared from the plasma compartment and stays for longer periods in the adipose and other peripheral compartments.

    4. The fact that a mom is "urine screen" positive is meaningless, only that she used cannabis sometime in the past. It does NOT mean levels in her milk are clinically relevant. In our study, after a significant dose, THC only was detectable for up to about 4 hours or slightly longer. Some lower levels may continue to be present in milk, but they were undetectable by our mass spectrometer.

    5. I personally think that using THC in pregnant or breastfeeding mothers is absolutely crazy. I know these mothers have lots of problems, but the preliminary data on neurobehavioral outcome is worrisome to say the least.

    6. BUT I do think it is important that the infant receive human milk, as in many cases it is absolutely lifesaving. Thus, if the mom would agree to stop using cannabis products while breastfeeding, I think she should be able to go ahead and breastfeed her infant.

    7. Lets face it, death from NEC or other such perinatal diseases is far worse than the "possible" neurobehavioral complications from exposure to cannabis.


    Tom Hale Ph.D.
    InfantRisk Center







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    • #3
      I'm a little confused. I've read that the infant gets about 2.5% of the maternal dose but I've also read that baby get 8 times more TCH which is the milk/plasma ratio.
      What is the difference. Thank you!

      Comment


      • #4
        Lora;

        From my study, we calculated that the infant gets about 2.5% of the MATERNAL DOSE OF THC.

        One older study stated that the amount of THC in breastmilk was 8 times THAT OF THE PLASMA. So if the plasma levels are low, then 8 times nothing is still nothing.

        The older milk/plasma studies are misleading which is the reason I never publish milk/plasma ratios, as they mislead the public.

        The Relative Infant Dose provides somewhat of a dose that the infant might get from a cannabis smoking mom.

        This is not the final study however, most of these moms were light or occasional users. The REST OF THE STORY is what is the Relative Infant Dose in Heavy users. This we don't know yet and need to research.

        Thus, while the maternal dose smoked is important, it is MORE important to know how often she smokes, week, daily, or numerous times daily.


        Tom Hale Ph.D.

        Comment


        • #5
          Who would do that in a sober mind?

          Comment


          • #6

            Transfer of Inhaled Cannabis Into Human Breast Milk

            Teresa Baker ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Baker+T&cauthor_id=29630019[/url]) 1 ([url]https://pubmed.ncbi.nlm.nih.gov/29630019/#affiliation-1[/url]), Palika Datta ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Datta+P&cauthor_id=29630019[/url]), Kathleen Rewers-Felkins ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Rewers-Felkins+K&cauthor_id=29630019[/url]), Heather Thompson ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Thompson+H&cauthor_id=29630019[/url]), Raja R Kallem ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Kallem+RR&cauthor_id=29630019[/url]), Thomas W Hale ([url]https://pubmed.ncbi.nlm.nih.gov/?term=Hale+TW&cauthor_id=29630019[/url])
            Affiliations expand
            • PMID: 29630019
            • DOI: 10.1097/AOG.0000000000002575 ([url]https://doi.org/10.1097/aog.0000000000002575[/url])
            Abstract


            Objective: To evaluate the transfer of delta-9-tetrahydrocannabinol and its metabolites into human breast milk after maternal inhalation of 0.1 g cannabis containing 23.18% delta-9-tetrahydrocannabinol.

            Methods: In this pilot pharmacokinetic study, breast milk samples were collected from mothers who regularly consumed cannabis, were 2-5 months postpartum, and exclusively breastfeeding their infants. Women were anonymously recruited for the study. After discontinuing cannabis for at least 24 hours, they were directed to obtain a baseline breast milk sample, then smoke a preweighed, analyzed, standardized strain of cannabis from one preselected dispensary, and collect breast milk samples at specific time points: 20 minutes and 1, 2, and 4 hours. Quantification of delta-9-tetrahydrocannabinol and its metabolites in these collected breast milk samples was performed by high-performance liquid chromatography tandem mass spectrometry.

            Results: A total of eight women were enrolled. Most were occasional cannabis smokers and one a chronic user. Delta-9-tetrahydrocannabinol was detected at low concentrations at all the time points beyond time zero. No metabolites were detected at any time point. Delta-9-tetrahydrocannabinol was transferred into mother's milk such that exclusively breastfeeding infants ingested an estimated mean of 2.5% of the maternal dose (the calculated relative infant dose=2.5%, range 0.4-8.7%). The estimated daily infant dose was 8 micrograms per kilogram per day.

            Conclusion: This study documents inhaled delta-9-tetrahydrocannabinol transfer into the mother's breast milk. Low concentrations of delta-9-tetrahydrocannabinol were detected. The long-term neurobehavioral effect of exposure to delta-9-tetrahydrocannabinol on the developing brain is unclear. Mothers should be cautious using cannabis during pregnancy and breastfeeding.

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