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, would probably like to 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 is that standardized education is needed regarding the use of marijuana and other substances during the peripartum period.
This LactFact comes from the article: Knowledge and attitudes about perinatal marijuana use among U.S. postpartum mothers: A BORN network study
First author-Neera K Goyal

Published – online in Nov 2024 in Academic Pediatrics

There has been greater use of marijuana during pregnancy and lactation in association with legalization of cannabis in many states within the US. The evidence on the risks of cannabis use during pregnancy and lactation is growing, with THC exposure during pregnancy being associated with an increased risk of low infant birth weight, sudden infant death syndrome and negative early childhood neurocognitive outcomes. THC also concentrates in breastmilk because of its fat content, lingering in breastmilk for approximately 6 weeks after use.

The AAP and ACOG have advised cessation of cannabis during pregnancy and lactation, as do some state health departments where marijuana is legalized.
The current study investigated the attitudes and knowledge of marijuana use among birthing parents. Although the term Cannabis is often used instead of marijuana, the term cannabis also includes hemp, and with the intention of studying cannabis with THC, the authors chose to use the term marijuana for this study.

The study was conducted in 15 US hospitals that participate in the BORN research network. BORN stands for Better Outcomes through Research for Newborns, with at least 130 hospitals around the US participating in this research network.

Each hospital enrolled postpartum birthing parents in June 2021 thru August 2022 to participate in a survey that collected sociodemographics and asked questions about attitudes, knowledge, and use of marijuana and other substances.

The study collected 484 surveys in 10 states, 5 where marijuana is legal, 4 where marijuana is approved for medicinal use only, and 1 state without any legalization.

They found that 9.5% of mothers used marijuana during their current pregnancy, while 7.9% used alcohol and 5.4% used tobacco.

At least 80% of mothers rated recreational marijuana use in general as either very acceptable or neutral and had approving attitudes towards people who use marijuana.

45.8% of participants perceived marijuana exposure during lactation to be very harmful, which means that more than 50% of mothers considered recreational marijuana use as either somewhat or very acceptable or neutral.

In terms of knowledge about marijuana use during pregnancy less than half of the participants agreed that marijuana was found in breast milk and 31% agreed that marijuana used in pregnancy increases the risk of sudden infant death syndrome. Approximately half agreed that marijuana used during pregnancy could cause child learning problems or child behavioral problems.

Less than 1/3 of participants reported that they received prenatal counseling from a health care provider about marijuana use. Mothers who were Black, Hispanic, less than 30 years old, publicly insured, had lower educational attainment, and presented for late prenatal care were more likely to receive counseling on the use of marijuana during pregnancy. Receiving counseling was associated with greater knowledge about the risks of perinatal marijuana use but was not associated with differences in attitudes towards marijuana use.

They also found that the acceptability and approval towards marijuana was associated with state legalization status. This is consistent with the research demonstrating increased acceptability of peripartum marijuana use in states where marijuana is legalized.

The results of this study demonstrate that there is an increased likelihood that people regard marijuana as safe when marijuana is legalized despite the fact that we have research showing that it is not safe during pregnancy and lactation. In this study nearly 10% of participants used marijuana perinatally, which is consistent with other recent studies. Therefore, it makes sense that we work on strategies to standardize education for all individuals about the use of marijuana and other substances during preconception, pregnancy, and lactation, rather than relying on our implicit bias regarding who we think may be using substances.

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I will be back with another LactFact in a few weeks!