Hi everyone, welcome to the LactFact weekly podcast, which highlights recent, clinically relevant research, policy statements, and protocols that you, as a practicing lactation professional, should know about. I am your host, Dr Anne Eglash. I am a board-certified family physician and breastfeeding and lactation medicine specialist at the University of Wisconsin School of Medicine and Public Health.

This podcast is written and produced by the nonprofit organization IABLE, which is the Institute for the Advancement of Breastfeeding and Lactation Education. There are no commercial funders for this podcast series.

Today’s Lactfact comes from the following article:
Cannabis Use During Pregnancy and Lactation, which is an ACOG clinical consensus report, published in Obstetrics and Gynecology October 2025, Vol 146 Issue 4,
This is an update from their 2017 opinion statement.

This is my third LactFact podcast in the last year on cannabis or THC. I will admit that I am somewhat fascinated with THC because I grew up in the 60’s and 70’s when it was much more popular than alcohol among young people, so it was part of my experience growing up. Cannabis use has never gone away, although there is a documented resurgence of cannabis use over time. According to the ACOG consensus, about 23%, or nearly 1/4 pregnant individuals in high income countries use cannabis.

Overall, there's increased availability and familiarity with cannabis and increased social acceptability. There also has been a perception that cannabis is safe to use during pregnancy particularly during the first trimester, when use is greatest for nausea and vomiting. Then it appears that cannabis use declines during gestation but then picks up again about 6 to 12 months postpartum.

I didn't realize the wide variety of methods by which cannabis is consumed. In addition to smoking, vaping and eating products with cannabis, cannabis is in several transdermal substances such as patches and gels, and is available as chewing gum, vaginal suppositories, tampons and items that can be inserted rectally. The significance of this is that if a patient is asked if they are smoking cannabis or eating products with THC, they may say no, which would be correct if they're using it in another way.

This consensus statement was developed by performing a literature search followed by the development of a number of proposed recommendations. The members of the committee on clinical consensus then voted on the proposals and each recommendation had to reach at least 75% consensus.

Their recommendations are as follows:

#1- I want to bring up the last point in this consensus statement first which is that Cannabis use disorder is considered a diagnosis in the DSM 5 Manual, which is the diagnostic and statistical manual of mental disorders. Its defined as using cannabis in a problem-causing pattern such as taking larger amounts or for longer periods than intended, and/or having symptoms of craving, and/or continuing cannabis use even when experiencing physical, social, or interpersonal problems caused by cannabis. There are no US Food and Drug administration approved medications for the treatment of cannabis use disorder. Adverse symptoms associated with cannabis use tends to be dose related so strategies that help to reduce the amount of use can provide some benefit.

#2-Obstetrician gynecologists and other OB providers should be knowledgeable and educate all individuals whether they are seen for pre-pregnancy, pregnancy or postpartum visits on perinatal and newborn risks of cannabis use. They also state that there is no medical indication for the use of cannabis during pregnancy or postpartum. Their recommendation is to have this conversation with all patients, not just those who disclose use otherwise people are not going to disclose.

The consensus group acknowledges that there are several reasons why people use cannabis during pregnancy including treating pre-existing conditions or using it as a replacement for more harmful substances. Cannabis has been used for anxiety, depression, insomnia, chronic pain, nausea, so a conversation about cannabis use should include a discussion about why it's being used and medical options to treat those conditions

#3 Physicians and other providers should perform universal screening by interviewing, self-report or a validated screening tool for cannabis use during pregnancy or postpartum. There is a nice table in the statement that lists a variety of screening assessment tools and details regarding what substances they screen for what populations they are appropriate for, and who can administer the screening.

Biologic testing such as urine testing should not be used as a screening assessment for cannabis use, and there are several reasons for this. THC, the major psychoactive compound in cannabis is fat soluble so can last for several weeks in body tissues. A positive test does not diagnosis substance use disorder, since a positive test result does not correlate with severity of use. Also, biologic testing can have significant social and legal consequences so should always be done with the patients informed consent. Because guidelines and reporting drug test results have been found to be biased against racial and ethnic minority groups, patients who are black are 4-10 times as likely to have their drug screen be reported to Child Protective Services as compared to patients who are white.

#4 Obstetrical health care providers should advise cessation of cannabis during pregnancy and lactation however continued cannabis use is not considered a contraindication to breastfeeding and breastfeeding should not be discouraged. This recommendation is unchanged from their 2017 statement. We now know that cannabinoid receptors are present in the fetus as early as five weeks and that THC being fat soluble can cross the placenta and transfer into breast milk. The amount of THC that reaches the infant will depend on the dose and frequency of use. Fetal concentration of THC has been reported to be approximately 10% of the maternal concentration and the risk of adverse effects increases in a dose dependent fashion. So, again, encouraging people to decrease the amount of use can help to mitigate negative effects.

Cannabis exposure during pregnancy has been associated with low birth weight, small for gestational age status, admission to the NICU, and perinatal mortality. There's been concern for neurocognitive and behavioral dysfunction including attention deficit disorder, behavioral and short term memory challenges, as well as intellectual disabilities. It's been difficult to sort out to what extent these outcomes are related to gestational exposure versus lactation.

Cannabis hyperemesis syndrome has been recognized as a complication of moderate use of cannabis, which is characterized by cycles of nausea, vomiting, abdominal pain. Cessation of cannabis can totally alleviate those symptoms. It's important to identify this syndrome and distinguish it from nausea associated with pregnancy.

For patients who want to achieve complete resolution of cannabis use, particularly if they've been struggling with cyclical vomiting, supportive measures have included dopamine antagonists, topical capsaicin cream, and IV fluids.

Patients who are using cannabis for pain or for anxiety and stress should be evaluated for their symptoms and treated with standard evidence based approaches.

#5 The report discusses that cannabis withdrawal syndrome is considered a recognized disorder that's characterized by behavioral, emotional, and physical symptoms including irritability, anxiety, decreased appetite, abdominal pain, tremors, and headache, and it can occur within 24 to 72 hours after the last cannabis use and continue for two weeks. The severity of these symptoms correlates with the amount of cannabis consumed especially if using it more than two to three times a day. Withdrawal symptoms can be a barrier to achieving cessation and so recognizing these symptoms and helping patients with management to alleviate symptoms is important.

#6 Lastly, The committee recommends using motivational interviewing to assist individuals in making behavioral changes using patient centered approaches, along with identifying and promoting protective behaviors and reducing risk factors. For example peer, family and community social support can be effective to reduce cannabis use whereas the partner’s use of substances can be associated with greater cannabis use. The committee also suggests some other risk reduction strategies to educate and reduce the risk of cannabis use including cognitive behavioral therapy, brief electronic or text messaging interventions to educate patients, paraprofessional home visiting interventions, structured exercise programs, along with strategies that focus on quality of life improvement.

Thanks for listening. I encourage you to check out IABLE at lacted.org to learn more about our educational projects, courses, educational handouts, videos, events. By becoming a member, you are not only supporting our projects, but also receiving a discount on educational courses, participation in our google group listserv, and a free pin on our LactMap.

I will talk to you again in 2 weeks!