Hi everyone, welcome to the LactFact 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 entitled:
Intussusception in an Infant Chronically Ingesting Marijuana Via Breastfeeding
First author- Leslie Strickler
Published – Breastfeeding Medicine Online before print March 13 2025

In the December 2024 LactFact podcast I discussed evidence that there is a lack of prenatal education about the use of cannabis during pregnancy and lactation, and that in general cannabis use during the peripartum time period is not really frowned upon.

Today I want to discuss a published case of an infant who developed intussusception in the setting of chronic marijuana exposure via breastfeeding.

The case was a generally healthy 8-month-old baby girl who was brought to the pediatric emergency room from a local fire station due to changes in mental status and a concern for substance exposure. Her mother smoked cannabis daily and reported smoking outside, away from her infant. She denied using any other substances. On the day that the infant was brought to the emergency room the mother had smoked marijuana and the baby breastfed about four or five hours later. After breastfeeding the baby had difficulty crawling and appeared limp, and reportedly ‘passed out’. The parents brought her to a local fire station where she appeared agitated with constricted pupils. She was given intranasal naloxone and brought to the emergency room where urine drug screening was positive for THC and negative for opiates including fentanyl.

The baby was hospitalized and on the second day, the baby was ill with vomiting and had bloody stools. An abdominal ultrasound showed evidence of an ileocolonic intussusception. The initial treatment with an air enema was not successful and the baby required abdominal surgery. For people who are unaware of what intussusception is it's basically a telescoping of the gut into itself which can cause acute obstruction and is a GI emergency.

According to the authors there is an association between intussusception and chronic THC exposure in adults, but this has not been seen in children because children typically are not exposed to chronically high doses of THC.

THC is known to act on multiple cannabinoid receptors in the GI tract which can slow gut movement, delay gut emptying and increase the risk of intussusception. The effect of THC on the gut is also responsible for cannabinoid hyperemesis syndrome which has been more widely discussed in the media and is likely more common than intussusception.

The astounding issue here is that this child must have had exposure to high dose THC via breastmilk, given the mother's chronic daily use of marijuana.

Studies have shown that the amount of THC in breast milk gradually rises overtime with continued use because of its fat solubility and its long half-life estimated to be about two weeks. In addition, there's so much variability with the amount of THC in marijuana, something like less than 1% THC to over 30% THC. The question is how do people choose which marijuana to use and as people use marijuana longer they may become more tolerant of higher THC doses, putting the infant at higher risk if the parent is breastfeeding.

There were two main lessons in this case, the first being that THC exposure via breast milk is not benign and there needs to be more awareness of this infant risk among lactating individuals who use cannabis. In addition, when infants present with the possibility of toxicity from a substance, it's important to think about the source of that substance being from breast milk.

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 be back with another LactFact in 2-4 weeks.