New research questions hospital bans on breastfeeding when marijuana present

Emery Cowan

Marijuana
Katherine Hitt, flickr

When it comes to marijuana use and breastfeeding, Flagstaff Medical Center and other local providers of breastfeeding services have clear policies: if a mother is using marijuana, her newborn baby shouldn’t be drinking her milk.

If a mother or her baby test positive for marijuana, FMC declines to provide mothers with breastfeeding instructions and supplies and requires the physician to order formula instead of breastfeeding.

At the Flagstaff Birth and Women’s Center, lactation consultant Maya Radoccia-Kennen said she will never refuse lactation services but definitely discourages marijuana use and breastfeeding. La Leche League volunteer leaders also advise against marijuana use during breastfeeding.

But one of the best-known experts on drugs and medications in mothers’ milk says his new research suggests a more flexible policy might be better for the health of newborn babies.

The small study of mothers who smoked marijuana found that breastfeeding infants ingested an estimated 2.5 percent of the maternal dose of THC, the active chemical in marijuana.

The study, published this month in Obstetrics and Gynecology, also found that the levels of THC in the mother’s milk decline with time, so if a mother smoked marijuana then waited three to four hours there would be “virtually none” in her milk, said study co-author Thomas Hale, a professor of pediatrics at Texas Tech University School of Medicine and co-director of the InfantRisk Center.

Hale also co-authored the popular reference book “Medications and Mother’s Milk.”

With the legalization of marijuana on the rise and hospitals creating or revising policies to address it, Hale cautioned against hardline policies about marijuana use and breastfeeding. Instead, hospitals should assess mothers individually and more carefully evaluate the potential harm of marijuana use versus the risks associated with not breastfeeding, which are major and well-known, he said.

Those risks include a higher likelihood of the infant dying from infectious disease, having a lower IQ, developing diabetes and getting diagnosed with a cardiac disease, Hale said. It also increases the risk of breast cancer in mothers, he said.

“Just to say because the (marijuana) drug screen is positive that a mother can't breastfeed just is not analyzing the situation,” Hale said. “That means what you're doing is banning the baby from getting breastmilk and increasing the risk of infectious disease and other harmful effects."

In short, according to his research, the risk to the baby of not breastfeeding is high while the risk of the mother being an occasional marijuana user is low, Hale said.

“We’re trying to interject some reality in this and get rid of the hysteria associated with it,” he said.

Hale stressed that a heavy user, meaning a mother who uses marijuana every day, should not breastfeed her baby. And despite what he said are low risks, Hale also said he would advise a mother who does use marijuana, even occasionally, to discontinue that practice. Mothers absolutely should not breastfeed at the same time they are smoking marijuana, he said.

The study also noted that it remains unclear what exposure to cannabis products does to an infant’s brain during such a critical development period.

HOSPITALS WEIGH IN

Northern Arizona Healthcare, the parent organization of Flagstaff Medical Center, does stress that “breast is best” for both mom and baby, spokeswoman Sophia Papa wrote in an email.

The hospital generally supports breastfeeding if a mother has a history of marijuana use but is currently not using and the urine toxicology for mom and baby are negative, Papa wrote.

Banner Health, which has hospitals in six states including Arizona, has a policy similar to FMC though there’s a possibility things could change as more people use marijuana and further research comes out about the effects of the drug during and after pregnancy, said Barbara Edwards, director of the women and infant services unit at Banner Desert Medical Center and Cardon Children’s Medical Center in the Phoenix area.

In looking at creating policies based on a study like Hale’s, however, it’s important to note that his involved a controlled amount of THC while in real life the amount of the chemical compound in a mother’s breastmilk is highly dependent on how much and how frequently she uses marijuana, said Kristi Kramer, a lactation consultant with the hospital.

Some of the country’s largest medical organizations caution against the practice as well.

The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics all discourage breastfeeding while mothers are using marijuana. Studies have found that exposure to THC through breast milk is associated with decreased motor development in babies, and a March, 2018 paper in The Journal of Pediatrics found prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight.

Hale’s own study also recognizes the need for much more research.

“Larger-scale investigations are warranted and necessary to enable us to counsel women who may be using cannabis medicinally or recreationally,” the authors state.