Authors

  1. Wallman, Carol DNP, APRN, NNP-BC
  2. Baessler, Catherine BSN, RN
  3. Hoffman, Jacqueline M DNP, APRN, NNP-BC

Article Content

EXECUTIVE SUMMARY

Breastfeeding is the optimal feeding method and human milk the optimal source of nutrition for neonates and infants. Research addressing the impact of marijuana use during breastfeeding is limited. As the professional voice of neonatal nurses, the National Association of Neonatal Nurses (NANN) recommends women abstain from marijuana consumption while breastfeeding or providing human milk for consumption.1

 

The most common illicit drug used during pregnancy and lactation in the United States and Canada is marijuana. Actual use is most likely higher than reported ranges of 3.4% to 16%, as it is based on self-reporting.2-6 Marijuana is often perceived by consumers as being safe, likely contributing to continued use throughout pregnancy and lactation.7

 

Confusion regarding the safety of marijuana use while pregnant or breastfeeding has followed its legalization in parts of the United States and Canada.8,9 However, there is sufficient evidence that marijuana use during pregnancy can lead to decreased infant birth weights and increased risks of preterm delivery, along with neurodevelopmental impacts in school-aged children and adolescents.2,10-18

 

Marijuana crosses into human milk after maternal consumption.1,19-21 Because of insufficient data on both immediate neonatal risks and potential long-term impacts regarding maternal marijuana consumption, women who are providing human milk for consumption should be advised to avoid marijuana consumption.1 When maternal milk is not available, donor human milk should be obtained from a reputable milk bank and milk sharing is highly discouraged.1,22-24

 

Educating and counseling lactating mothers in a supportive and nonjudgmental manner regarding the goal of abstaining from marijuana consumption based on the potential risks of marijuana use during lactation are key roles of the nurse. For lactating mothers who choose to continue using marijuana, the nurse should continue to provide lactation support and advise them to minimize their consumption. Nurses should participate in developing evidence-based, nonjudgmental, and nonpunitive hospital, state, and national guidelines and legislation addressing marijuana use during lactation. Nurses should play key roles in driving further research addressing maternal use of marijuana during pregnancy and lactation.

 

References

 

1. National Association of Neonatal Nurses. Marijuana, breastfeeding and the use of human milk [position statement]. http://nann.org/uploads/About/PositionPDFS/Marijuana_Breastfeeding_and_the_Use_o. Published 2020. Accessed February 2, 2021. [Context Link]

 

2. Crume TL, Juhl AL, Brooks-Russell A, Hall KE, et al Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr. 2018;197:90-96. doi:10.1016/j.jpeds.2018.02.005. [Context Link]

 

3. Ko JY, Farr SL, Tong VT, et al Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. Am J Obstet Gynecol.2015;213(2):201.e1-201.e10. doi:10.1016/j.ajog.2015.03.021. [Context Link]

 

4. National Institute on Drug Abuse. Study Finds Increased Cannabis Use During Pregnancy. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health; 2019. https://www.drugabuse.gov/news-events/news-releases/2019/06/study-finds-increase. Accessed June 24, 2020. [Context Link]

 

5. Perinatal Services BC. Cannabis use during pregnancy & lactation: practice resource for healthcare providers. http://www.perinatalservicesbc.ca/Documents/Resources/HealthPromotion/cannabis-i. Published 2020. Accessed June 29, 2020. [Context Link]

 

6. Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use and Health: Women. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2020. https://www.samhsa.gov/data/sites/default/files/reports/rpt23250/5_Women_2020_01. Accessed June 24, 2020. [Context Link]

 

7. Chang JC, Tarr JA, Holland CL, et al Beliefs and attitudes regarding prenatal marijuana use: perspectives of pregnant women who report use. Drug Alcohol Depend.2019;196:14-20. doi:10.1016/j.drugalcdep.2018.11.028. [Context Link]

 

8. Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med.2016;68(1):71-75. doi:10.1016/j.annemergmed.2016.01.004. [Context Link]

 

9. Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. Am J Obstet Gynecol. 2015;213(6):761-778. doi:10.1016/j.ajog.2015.05.025. [Context Link]

 

10. Corsi DJ, Walsh L, Weiss D, et al Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA. 2019;322(2):145-152. doi:10.1001/jama.2019.8734. [Context Link]

 

11. El Marroun H, Tiemeier H, Steegers EA, et al Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study. J Am Acad Child Adolesc Psychiatry. 2009;48(12):1173-1181. doi:10.1097/CHI.0b013e3181bfa8ee. [Context Link]

 

12. Fergusson DM, Horwood LJ, Northstone K; ALSPAC Study Team. Maternal use of cannabis and pregnancy outcome. BJOG. 2003;109(1):21-27. doi:10.1111/j.1471-0528.2002.01020.x. [Context Link]

 

13. Gray TR, Eiden RD, Leonard KE, et al Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clin Chem. 2010;56(9):1442-1450. doi:10.1373/clinchem.2010.147876. [Context Link]

 

14. Gunn K, Rosales CB, Center KE, et al Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6(4):e009986. doi:10.1136/bmjopen-2015-009986. [Context Link]

 

15. Hayatbakhsh MR, Flenady VJ, Gibbons KS, et al Birth outcomes associated with cannabis use before and during pregnancy. Pediatr Res. 2012;71(2):215-219. doi:10.1038/pr.2011.25. [Context Link]

 

16. Luke S, Hutcheon J, Kendall T. Cannabis use in pregnancy in British Columbia and selected birth outcomes. Obstet Gynaecol Can. 2019;41(9):1311-1317. doi:10.1016/j.jogc.2018.11.014. [Context Link]

 

17. Leemaqz SY, Dekker GA, McCowan LM, et al; on behalf of the SCOPE Consortium. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77-86. doi:10.1016/j.reprotox.2016.04.021. [Context Link]

 

18. Saurel-Cubizolles MJ, Prunet C, Blondel B. Cannabis use during pregnancy in France in 2010. BJOG. 2014;121(8):971-977. doi:10.1111/1471-0528.12626. [Context Link]

 

19. Baker T, Datta P, Rewers-Felkins K, et al Transfer of inhaled cannabis into human breast milk. Obstet Gynecol. 2018;131(5):783-788. doi:10.1097/AOG.0000000000002575. [Context Link]

 

20. Hale TW, Abbey J, Baker TM. Lactation pharmacology. In: Campbell SH, Lauwers J, Mannel R, Spencer B, eds. Core Curriculum for Interdisciplinary Lactation Care. Burlington, MA: Jones & Bartlett Learning; 2019. http://samples.jblearning.com/9781284111163/9781284111163_CH05.pdf. Accessed .... [Context Link]

 

21. Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med. 1982;307(13):819-820. doi:10.1056/NEJM198209233071311. [Context Link]

 

22. American Academy of Pediatrics, Committee on Nutrition, Section on Breastfeeding, Committee on Fetus and Newborn. Donor human milk for the high-risk infant: preparation, safety, and usage options. Pediatrics. 2017;139(1):e20163440. doi:10.1542/peds.2016-3440. [Context Link]

 

23. Haiden N, Ziegler EE. Human milk banking. Ann Nutr Metab. 2016;69(suppl 2):8-15. doi:10.1159/000452821. [Context Link]

 

24. National Association of Neonatal Nurses. The use of human milk and breastfeeding in the neonatal intensive care unit [position statement]. http://nann.org/uploads/About/PositionPDFS/1.4.3_Use%20%20of%20Human%20Milk%20an. Published 2015. Accessed June 17, 2020. [Context Link]