Pregnancy, Breastfeeding and Marijuana Use
by Anne Eglash MD, IBCLC, FABM
In August 2018, The American Academy of Pediatrics published their Clinical Report entitled Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes. The report reviews the most recent science regarding how THC may effect fetal brain development, the negative effects of marijuana use on fetal growth, placental function, and long term negative effects on cognition, behavior, neurodevelopment in children exposed to marijuana as fetuses.
There is less information on the effects of THC during lactation as compared to the effects during pregnancy. So far, it has been hard to separate the effect of THC during lactation from the use of other substances such as alcohol, and the effect of marijuana use during pregnancy.
- Pregnant women who have reported use of marijuana during pregnancy were more likely to report nausea during pregnancy.
- Half of the states in the USA that have legalized medical marijuana list pregnancy as a contraindication to dispensing medicinal marijuana.
- In many states, pregnant women who are found to have positive marijuana screens can be subject to child welfare investigations.
- The active ingredient in marijuana, THC, has low transmission into breastmilk because it is a very large molecule.
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Marijuana is one of the most widely used substances during pregnancy in the United States. Emerging data on the ability of cannabinoids to cross the placenta and affect the development of the fetus raise concerns about both pregnancy outcomes and long-term consequences for the infant or child. Social media is used to tout the use of marijuana for severe nausea associated with pregnancy. Concerns have also been raised about marijuana use by breastfeeding mothers. With this clinical report, we provide data on the current rates of marijuana use among pregnant and lactating women, discuss what is known about the effects of marijuana on fetal development and later neurodevelopmental and behavioral outcomes, and address implications for education and policy.
Marijuana use is increasing during pregnancy and lactation, likely related to the legalization of medicinal and recreational marijuana. None of the states that have legalized medical marijuana indicate pregnancy as a contraindication. THC does transfer into breastmilk because of its small size and high lipid solubility. More research is needed, so that families have facts for informed decision-making on the use of marijuana during pregnancy and lactation. Several organizations recommend screening pregnant women regarding substance use and I suggest doing so during lactation as well. In recognition that mind-altering substances effect parenting skills and household safety, it seems reasonable that all parents, not just pregnant and lactating mothers, ought to be asked about use.
If women are using marijuana for pain, anxiety, or sleep during pregnancy and lactation, these medical problems should be addressed and safe alternative therapeutic options should be offered.