Survey of Newborn Nursery Directors Regarding Cannabis Use During Lactation
by Anne Eglash MD, IBCLC, FABM
According to the 2022 US National Survey on Drug use and Health, 50% of people aged 18 and older have used cannabis and in 2021, 7.2% of pregnant women reported cannabis use within the last month. According to the Academy of Breastfeeding Medicine protocol ‘Breastfeeding in the Setting of Substance Use and Substance Use Disorder’, cannabis products have been more potent and may be combined with synthetic cannabinoids and other artificial products. Cannabis use during pregnancy has been associated with neurocognitive and behavioral problems in children. Research on the effect of cannabis during lactation is less robust, but there is evidence for altered infant motor development. The American College of Obstetrics/Gynecology and the American Academy of Pediatrics recommend avoiding cannabis during lactation.
The study for this week is a 2021 survey through BORN, a US research network of pediatric clinicians and researchers who evaluate care in the birth setting and transition to home. The survey evaluated hospital practices and nursery director knowledge and attitudes towards cannabis using during lactation. Sixty-nine nursery representatives across 38 states participated, with most states having legalized cannabis for either recreational or medical use.
The researchers found that 59% of hospital practices encouraged mothers to breastfeed if they had a positive cannabis screen at the time of delivery, and 23% discouraged but didn’t restrict breastfeeding. Approximately 10% restricted breastfeeding, and some based their decisions on the extent of cannabis use.
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- The majority of hospitals surveyed had a policy of automatic referral to child welfare for lactating parents who screened positive for cannabis.
- The majority of hospitals surveyed requested a social work consult for lactating parents who screened positive for cannabis.
- The majority of hospitals provided resources for cannabis cessation when indicated.
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Abstract
Background and Objectives
Marijuana use has increased nationally and is the most common federally illicit substance used during pregnancy. This study aimed to describe hospital practices and nursery director knowledge and attitudes regarding marijuana use and breastfeeding and assess the association between breastfeeding restrictions and provider knowledge, geographic region, and state marijuana legalization status. We hypothesized that there would be associations between geography and/or state legalization and hospital practices regarding breastfeeding with perinatal marijuana use.
Methods
A cross-sectional, 31-question survey was sent electronically to the 110 US hospital members of the Academic Pediatric Association’s Better Outcomes through Research for Newborns (BORN) network. Survey responses were analyzed using descriptive statistics to report frequencies. For comparisons, x2 and Fisher exact tests were used to determine statistical significance.
Results
Sixty-nine (63%) BORN nursery directors across 38 states completed the survey. For mothers with a positive cannabinoid screen at delivery, 16% of hospitals universally or selectively restrict breastfeeding. Most (96%) nursery directors reported that marijuana use while breastfeeding is “somewhat” (70%) or “very harmful” (26%). The majority was aware of the potential negative impact of prenatal marijuana use on learning and behavior. There were no consistent statistical associations between breastfeeding restrictions and provider marijuana knowledge, geographic region, or state marijuana legalization status.
Conclusions
BORN newborn clinicians report highly variable and unpredictable breastfeeding support practices for mothers with perinatal marijuana use. Further studies are needed to establish evidence-based practices and to promote consistent, equitable care of newborns with perinatal marijuana exposure.
In this survey among hospitals and nursery directors, the majority in states where there was some form of cannabis legalization, 76% of hospitals requested a social work consult, 36% submitted an automatic referral to child welfare, and only 29% provided resources for cannabis cessation.
Given that most nursery directors in this survey agreed that cannabis during lactation was somewhat (76%) or very harmful (26%), I am surprised that only 29% of hospitals provided resources on cannabis cessation.
The Academy of Breastfeeding Medicine Substance Use Protocol, #21, recommends ‘For mothers who continue to use cannabis and wish to breastfeed, we recommend a shared decision-making process to discuss the risks and benefits of breastfeeding. Discussions may be guided by examining the route and type of cannabis product use, potency of product use, and frequency of use.’.
A 2018-2020 survey among perinatal women in Colorado found that the mothers were more likely to get information from cannabis websites, stores, or word-of-mouth than from their healthcare providers.
We need more research and professional guidance on the shared decision-making process regarding cannabis use during lactation. Until healthcare providers have more education on evaluation and treatment regarding the root causes of cannabis use, we may continue to see an increase in cannabis use during lactation.
Breastfeeding and Lactation Medicine practices should also consider routine screening for substance and cannabis use.
jennifer
Ironically many of these moms probably only used cannabis as a way to control pain in labor and do not regulary use it. And cannabis is a safer form of pain relief than Epidural drugs. How many moms tested positive for cannabis at 12 weeks postpartum? That would be a much better indicator. Probably a lot lower number. I think it’s an error to assume that a random test right after birth is giving us accurate information regarding which infants are truly at risk of long term exposure, and exposure worse than hospital supported Epidural drugs.
Felicia Termine-Bonner
What cannabis cessation materials do you recommend?