Dear Lactnet Friends:

3) LACTMED as of 5/16/14

Summary of Use during Lactation:

Although published data are limited, it appears that active components of
marijuana are excreted into breastmilk in small quantities. Data are from
random breastmilk screening rather than controlled studies because of
ethical considerations in administering marijuana to nursing mothers.
Concern has been expressed regarding marijuana's possible effects on
neurotransmitters, nervous system development and endocannabinoid-related
functions. One long-term study found that daily or near daily use
might retard the breastfed infant's motor development, but not growth or
intellectual development.

This and another study found that occasional maternal marijuana use during
breastfeeding did not have any discernable effects on breastfed infants,
but the studies were inadequate to rule out all long-term harm. Although
marijuana can affect serum prolactin variably, it appears not to adversely
affect the duration of
lactation. Other factors to consider are the possibility of positive urine
tests in breastfed infants, which might have legal implications, and the
possibility of other harmful contaminants in street drugs.

Marijuana use should be minimized or avoided by nursing mothers because it
may impair their judgment and child care abilities. Some evidence indicates
that paternal marijuana use increases the risk of sudden infant death
syndrome in breastfed infants. Marijuana should not be smoked by anyone in
the vicinity of infants because the infants may be exposed by inhaling the
smoke.

Because breastfeeding can mitigate some of the effects of smoking
and little evidence of serious infant harm has been seen, it appears
preferable to encourage mothers who use marijuana to continue breastfeeding
while minimizing infant exposure to marijuana smoke and reducing marijuana
use.


4) Social drugs and breastfeeding - Health e-Learning

https://www.health-e-learning.com/resources/articles/40-social-drugs-and-breastfeeding

scroll down for a review of marijuana


5) Cannabis and Breastfeeding

J Toxicol. 2009; 2009: 596149. Published online Apr 29, 2009.

This paper contains theory and conjecture and some inaccuracy. Marijuana is
usually smoked on its own, either in a joint or a water pipe or vaporized,
it can also be mixed with tobacco.

Remember too, as this paper points out, she was smoking when she was
pregnant if she has a positive drug screen in the hospital.

6) Marijuana use and breastfeeding
Can Fam Physician. Mar 10, 2005; 51(3): 349–350. PMCID: PMC1472960 :
Josephine Djulus, MD, Myla Moretti, MSC, and Gideon Koren, MD, FRCPC

This study says again, as all of them do, that there is little evidence of
harm, although marijuana is a popular drug.

7) This study from 1990 highlights a frustration: the lack of current
research. There isn't much from the 21st century that I could find. Another
problem with marijuana research is that mothers using cannabis in pregnancy
could also be using tobacco, and alcohol, and other things. So saying that
the baby's condition is linked with marijuana is impossible.

Many of the side effects of marijuana on neonates are seen with infants
withdrawing from nicotine, a legal substance that is clearly harmful.

Neurotoxicology and Teratology, Vol. 12, pp. 161-168. © Pergamon Press plc,
1990,
Maternal Marijuana Use During Lactation and Infant Development at One Year
SUSAN J. ASTLEY *l AND RUTH E. LIq'TLEt

THE reported use of marijuana among pregnant women varies from five to 34
percent.  Fetal effects associated with prenatal exposure to marijuana
include decreased birth weight ,increased frequency of preterm delivery,
increased labor and delivery complications, and altered visual, tremor and
startle responses in neonates. Many of these findings  remain suggestive
due to the number of factors associated with marijuana use which are
difficult to control in clinical and epidemiologic studies.

(snip)

From among the 417 infants with one-year assessments, those who had been
breast-fed for at least two weeks with less than 16 ounces of supplemental
formula per day were eligible for the
present study. For cigarette use, a nicotine score was determined by
multiplying the number of cigarettes smoked per day by the nicotine content
of the brand specified. Use of
supplemental formula was recorded as no use, < 16 ounces per day or >16
ounces per day.

(snip)



Variables initially regressed on infant motor development were maternal
race and the number of days that infants were exposed to marijuana during
each trimester and the first and third months of lactation. Of these
variables, infant exposure to marijuana via the mother's milk during the
first month postpartum was the only variable identified by stepwise and
backward selection that explained a significant proportion of the variance
in infant motor development (Table 6). Five percent of the variance was
explained by the infant's exposure to marijuana during this period. Infant
exposure expressed as the number of joints smoked by the mother during
lactation did not change the results.



8) Prenatal Marijuana Exposure and Intelligence Test Performance at Age 6

LIDUSH GOLDSCHMIDT, Ph.D. GALE A. RICHARDSON, Ph.D., JENNIFER WILLFORD,
Ph.D., NANCY L. DAY, Ph.D.

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 47, Issue 3, March 2008, Pages 254–263


Study Design

Pregnant women who were at least 18 years of age and attended the prenatal
clinic at the Magee-Womens Hospital were approached at their fourth
prenatal month visit to enroll in the MHPCD project, a study of the effects
of prenatal marijuana and alcohol exposure. The project was approved by the
institutional review boards of the Magee-Womens Hospital and the University
of Pittsburgh. A total of 1,360 women were screened. All of the women who
reported using two or more marijuana cigarettes per month during the first
trimester of pregnancy, and all women who reported drinking three or more
drinks per week during the first trimester were selected. After each
marijuana and/or alcohol user was enrolled, a woman who reported using less
than these amounts was also selected. Thus, the sample represents the
continuum of marijuana and alcohol use. Information regarding marijuana,
alcohol, tobacco, and other drug use during the first, second, and third
trimesters of pregnancy was obtained at the fourth and seventh months of
pregnancy and at delivery, respectively.



(snip)

Forty-four percent of the women (284/648) reported marijuana use at any
time during pregnancy. To describe the distribution of use at each
trimester, women were categorized as abstainers, those who smoked less than
one marijuana cigarette per day (light/moderate users), and those who
smoked one or more marijuana cigarettes per day (heavy users). The
frequency of prenatal and current marijuana use based on these categories
is shown in Table 2. In general, women decreased their use after
recognition of pregnancy except for 16 women (2.5%) who initiated marijuana
use while in their second and third trimester of pregnancy. On average,
first-, second-, and third-trimester heavy users smoked 2.3, 2.0, and 2.4
marijuana cigarettes per day, respectively. Although marijuana use between
trimesters was moderately correlated, ranging from 0.56 to 0.64, the
pattern of use was not consistent. Only one third of women who reported
smoking at the rate of one or more marijuana cigarettes per day during the
first trimester of pregnancy continued to smoke at this rate during the
later part of their pregnancy, and only 53% of second-trimester heavy users
(ADJ ≥ 1) smoked at that rate during the third trimester of pregnancy.


(snip)



The average SBIS test scores across different levels of PME are presented
in Table 3. Bivariately, the composite scores of children exposed to heavy
use (ADJ ≥ 1) during any trimester of pregnancy were significantly lower
than the scores of children of abstainers and light/moderate users. Heavy
exposure to marijuana during gestation was also significantly associated
with poorer performance on the verbal and quantitative reasoning and
short-term memory subscales. There were no significant differences between
PME groups on the abstract/visual reasoning subscale.


(snip)

However, as can be seen from Table 3, the means of the SBIS composite and
area scores across different levels of prenatal marijuana use were not
linear. The children of light/moderate users did not score differently from
the children of abstainers on any of the outcome variables.


(snip)



These findings are of concern, but they do not by themselves demonstrate
causality. The inability to randomly assign subjects to treatment groups is
an inherent limitation of human studies, and it is not possible to
eliminate all of the sources of differences between the exposed and
unexposed groups or to fulfill experimental criteria, such as Koch's
postulates, that demonstrate causality. Epidemiological studies use other
criteria to impute causality, including biological plausibility, strength
of association, consistency, dose-response relationships, and specificity.


(snip)



In our study, the observed effects were associated with heavy use. This
lack of linearity has also been reported by the OPPS, in which effects of
PME on offspring cognitive functioning at 3 to 417 and 13 to 1648 years
were only found among offspring of heavy users. Other studies, as we noted
in the introduction, did not find effects of PME. This may be associated
with different measures, smaller sample sizes, or differing levels of
marijuana use. Predictors of performance on the SBIS, such as maternal IQ,
social support, and preschool attendance, were the same as other
researchers have reported,26,27 which also supports the validity of our
results.


warmly,
-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Author:* Complementary and Alternative Medicine in Breastfeeding Therapy*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth

*Get my FREE webinar series*

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