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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