Dear Friends:
    The subject of marijuana use and  breastfeeding is another place where 
values and evidence collide. (Alcohol  use and breastfeeding is another.) We 
must be aware of this when we are working  with mothers. 
     Klonoff-Cohen and Lam-Kruglick found that  there was no association 
between maternal recreational drug use and SIDS, in a  sample of 239 matched 
case-controls. (Arch Pediatr Adolesc Med 2001).
    Dreher, Nugent, and Hudgkins (Pediatrics  1994:93;254-260) concluded that 
"the absence of any differences between the  non-exposed or nonexposed groups 
in the early neonatal period suggest that the  better scores of the exposed 
neonates at 1 month are traceable to the cultural  positioning and social and 
economic characteristics of mothers using marijuana  that select for the use of 
marijuana but also promote neonatal  development."
    Certainly we are not going to recommend the use of  an illegal substance. 
However, we are also aware that lots of folks use  marijuana. We are 
concerned about infant safety when there is a situation where  a mother's judgement 
may be impaired. This is the real concern.
    The actual evidence about marijuana use in  pregnancy is interesting. The 
Ottawa Prenatal Prospective Study has given  many, many tests to children 
(physical development, psychomotor ability,  emotionals and psychological 
adjustment, cognitive function, intellectual  capacity and behavior) and found very 
few differences between marijuana-exposed  and nonexposed children. Dr. Peter 
Fried also found that negative consequences  of prenatal drug exposure diminish 
as children get older.
    Marijuana byproducts are stored in fat for a long  time, at least a 
month. So a person that uses marijuana recreationally once will  test postive in a 
urine screen; however, that person is not under the influence  beyond the 
hours it takes for the bioactive effect to wear off. This is very  confounding to 
industry, that doesn't want stoned employees and hasn't figured  out how to 
distinguish between being under the influence and having a positive  urine 
screen. (This is very different to alcohol, where a high-enough score on a  screen 
means the person is under the influence.)
    Briggs, Freeman, and Yaffe describe the mechanism   whereby THC is 
concentrated in human milk, while noting that the infants  developed normally in all 
the studies.
    Dr. Thomas Hale discussed marijuana on Friday 16  Jule 1999 (for those 
that want to search the archives).  He says, among  other things, "So, lets be 
clear. If the mom smokes marijuana occasionally, she  should expect that only 
small levels will be transferred to the infnat, probably  subclinical, which is 
why the studies show no developmental abnormalitiese.  However, it should 
also be clear, that the infant will probably receive enough  drug to be 'drug 
screen positive' for some time. We don't actually know if this  would be 3 days, 
a week, or a month, it would totally depend on the mother's  dose of 
marijuana. So while none of us should support marijuana (or alcohol) use  in 
breastfeeding mothers, we should not get overly strident when it does occur  in our 
clients."
    warmly,
    
 
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
www.breastfeedingalwaysbest.com

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