marijuana and breastfeeding

[Jim Shames]

I am new to this forum, and may have missed previous discussions on this subject. I live in an area with significant marijuana use, and a large number of medical marijuana card holders, some of whom are breast feeding and simultaneously utilizing marijuana. Dr. Hale's book lists marijuana in the most dangerous category, and consequently our State Health Division, relying on that information, will not provide any supports to lactating women who are marijuana users (WIC support for breast pumps for example). Our WIC coordinator, and our NICU lactating consultants would like clarification.

As I read the literature, the known effects of marijuana in this situation are largely undetermined, so I am confused by it's categorization. As the Health Officer for our county I want to be sure that we support breast feeding activity when appropriate, and of course discourage it when it would be dangerous. How can grouping marijuana along with chemotherapeutic drugs and heavy metals be justified by the existing literature?

[admin]

Jim:

This is a difficult question to answer, because thus far we only have two studies of breastfeeding women who used marijuana. One study showed no effect in neurobehavioral development of the infants, and the second study show a slight decrease in motor development at one year. We know that the milk/plasma ratio is about 8, so cannibis(mj) has a high affinity for milk. That said, plasma levels in humans are generally quite low, thus 8 times something low is still low. In my book I suggest that it is contraindicated, not because of a signficant hazard of the drug, but rather because it is an illegal drug of abuse that passes to the breastfed infant. (I have struggled for years with this L5 categorization myself.)

I think that women who consistently abuse marijuana should not breastfeed, because of the neuroleptic effect of the drug on the MOM, not so much of the effect of the drug on the infant because it is likely minimal. But if moms judgement and function is impeded by using this drug, then she should not be breastfeeding.

But at the same time, we all know that a lot of mothers show up to deliver a baby, with mj in their urine screen. Should they be allowed to breastfeed? I think this is a judgement call of the physician and other healthcare professionals that would involve such questions, as : Would this mom stop using this drug while breastfeeding? Is she using other dangerous drugs, such as methamphetamine, cocaine, etc?

If she ONLY used mj, then I wouldn't be too concerned about her breastfeeding. I'd simply tell her that it passes into milk easily, and we are going to bring her infant in at one month and do a urine screen on the infant.
I also often tell them that it is retained in infants for much longer than adults (and we can test for that). If she is using other dangerous drugs, I'd advise her not to breastfeed at all, she's simply too high a risk.

I don't have an absolute answer for you. I agree that the health benefits of breastfeeding are enormous, but the risks of drug abuse are significant with SOME drugs. Maybe not with mj, but certainly with others.

I do not however agree that you should deny women WIC services, pumps, and other support simply because they occasionally use marijuana, or have used it in the past. Seems to me this is the group that needs support more than any other and maybe if you allow them to breastfeed and be tested, they 'may' stop using these drugs. It is my opinion that breastfeeding an infant creates a wonderful bond between mom and infant, and that this along helps many moms stop using drugs of abuse.


Tom Hale Ph.D.

[jessica.mattingly]

Thank you for your response. Would your organization consider making an official statement on the topic given the increase in legal medical marijuana use (and soon non medical use) in the states? I have been in contact with a several mothers in neighboring states who take marijuana legally, but all are concerned about potential CPS involvement giving the current designation. Some of these families are breastfeeding children well beyond a year and using very minimal amounts of marijuana, so feel very comfortable with the safety factor - but they also recognize that CPS can get their knickers in a twist over all sorts of things and given the social bias against marijuana this would be a very easy thing to do so.

Thank you!

Jessica Mattingly M.Ed., IBCLC

[ckent]

Thank you, Dr. Hale for clarifying this L5 categorization.
Further to this topic, I wonder if there is any data on how long after using marijuana it would still be passing into the milk?
Not sure if it is still posted, but there used to be a great chart on this site somewhere regarding alcohol consumption and how long until is was considered safer to breastfeed based on the mother's weight and the number of drinks. Is there anything comparable at all for marijuana use? I understand this angle is only looking at transfer and not the mother's cognitive ability to care for an infant.


Regards,
Cassie Kent, LLLC, IBCLC

[Heidi Chavers]

The dilemma as to whether these moms who have used marijuana during the pregnancy and whose babies test positive (only for Marijuana, nothing else) be allowed to breastfeed has become a topic of concern on our Family Care Unit. If the pediatrician and/ or family practice physician and Lactation consultant have discussed with mom and counseled her and documented the concerns you have discussed in your book should she is allowed to continue to breastfeed in the hospital after delivery? What if she has also tested positive during the pregnancy as well which would have triggered the f/u testing at delivery. Again counseling and f/u are indicated.
I do have a an additional question about some accumulation of marijuana in fat. If mom / baby test positive at delivery and if it can be released from being stored in the fat with mom's weight loss, could there potentially be sufficient release of the cannabis from what has been stored in the fat to cause the baby to test positive after breastfeeding even up to 3 or more weeks after exposure even if mom has not actively used it since before delivery.

[cpride]

Dear Heidi,

I spoke with Dr. Hale about your question. He stated that within one to two weeks the cannibus should be out of the mother's fat tissue. The infant may remain positive due to his/her initial exposure for up to 3 weeks.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[JohnRolphr]

I am glad to have found this forum, with such an amount of valuable information about the usage of medical marihuana.

[Rgmatthys@msn.com]

Hi, I am an IBCLC and was honored to hear Dr Hale speak in Denver yesterday. I would like to make a suggestion about one of his research studies. Please have him email me at [email]rgmatthys@msn.com[/email].