Today, with the proliferation of medical marijuana across the United States, many women of child-bearing years are opting for alternative medicines such as legal cannabis to treat a plethora of ailments. As such, there are questions regarding smoking marijuana while breastfeeding.
Current research shows there are reasons to be concerned about the influx of cannabinoids on the developing brain. While we know cannabinoids, as a lipophilic – or fat-soluble – substance, are transferred through breast milk to the nursing infant, the science is unclear as to whether or not the amount transferred should be of concern.
As with all substances consumed by the mother, one should weigh the risks and benefits. Although much more research is necessary, let's review a few key points about smoking marijuana while breastfeeding.
First, Smoking Anything is Not Healthy
If the tobacco industry has taught us anything at all, we know that inhaling the smoke of any variety is not the best approach for the health of our lungs. Additionally, second-hand smoke around a newborn baby is thought to be one of the leading causes of Sudden Infant Death Syndrome, or SIDS. Try to think of it like this: For every smoke particle an infant inhales, that's one less oxygen particle to contribute to healthy lung function and brain development of your newborn.
However, that being said, thanks to the modern market of legal cannabis, there are dozens of alternatives for cannabis consuming parents to avoid exposing their children to second-hand smoke including edibles, tinctures, and vaping.
Newborns Are Still Developing
We are not born as fully-functional human beings. When a child is born, their tiny, little bodies are still developing; their eyes are developing, their hearing is developing, and their brains are developing synapses at a rapid pace. While the brain continues to develop throughout adolescence and into early adulthood, introducing foreign substances at this young age could alter or impair how the central nervous system develops.
At birth, a baby relies solely on its mother for sustenance, and breastfeeding is known to be one the best methods for providing superior nutritional benefit for the best infant health. However, a nursing mother must remember the foods and substances she consumes can be transferred to the child through the breastmilk including many pharmaceuticals, over-the-counter drugs, and recreational substances such as nicotine, alcohol, and cannabis.
Smoking Marijuana While Breastfeeding
Tetrahydrocannabinol, or THC, the psychoactive component of cannabis, is a lipophilic substance, which means it binds to fat cells and is transferrable through breastmilk. A study from 2009 showed an infant can test positive for THC for two to three weeks following ingesting breastmilk containing the substance. This research also suggests, during the first four weeks of an infant's life, THC may cause increased tremors, poor sucking, slow weight gain, and poor feeding habits. Additionally, the study stated cannabinoid receptors contribute to brain development during fetal stages, as well as, after birth to encourage infant suckling, therefore introducing cannabinoids which may alter how the endocannabinoid system functions in a newborn could affect development.
Yet, the jury is still out as conflicting studies exist. One study from 1985 evaluated 27 babies whose mothers admitted to smoking marijuana while breastfeeding and the results suggested there was no difference in adverse events between the non-consuming mothers and the consumers.
Is Marijuana Getting a Fair Comparison?
Clearly, introducing a newborn child to any chemical that can alter their development or harm them in any way is the last thing any new mother wants to do. However, many new mothers also have their own health to take into consideration. Pharmaceutical and over-the-counter medications are frequently prescribed for ailments including post-delivery pain, sleep deprivation, and mental disorders. In fact, its estimated that 1 in 5 new mothers is susceptible to postpartum depression.
So, what about the pharmaceuticals prescribed by doctors for new mothers? The US National Library of Medicine provides a vast amount of data regarding carry-over of hundreds of substances in breastmilk. Here's a comparison of cannabis with some of the common lipophilic drugs prescribed to new mothers:
- Cannabis: Keep in mind the supporting research consists of isolated studies of individuals, not averages of multiple mothers in an actual study, like other drugs. However, after smoking cannabis lactating mother's breastmilk was tested for cannabinoid content and each test shows varying levels of THC from just 20 micrograms per liter (mcg/L), up to as much as 340mcg/L. The research suggests an infant receives up to 2.5 percent of the maternal dose or around 8mcg daily when mothers are daily consumers.
- Zoloft (Sertraline): Frequently prescribed to combat postpartum depression, this SSRI involves the serotonin receptors in the brain. Various studies showed average levels of sertraline in breastmilk were anywhere from 45mcg/L up to 358mcg/L. However, peak levels were as high as 938mcg/L with the metabolite, norsertraline, as high as 1498mcg/L. This research suggests a 7mcg daily dose for the infant or about 2.4 percent of the maternal dose. While long-term effects on infants exposed to sertraline while breastfeeding have not been conducted, as with infant cannabis exposure, prenatal studies are also conflicting about the long-term effects of infant exposure to SSRI's.
- Xanax (Alprazolam): Frequently prescribed benzodiazepine for helping new moms cope with stress and anxiety. Only one example was shown, however, with a typical maternal dose of alprazolam, the infant can expect anywhere from .5 to 5mcg daily through the mother's breast milk or approximately 3 percent of the maternal dose. Side effects of this drug on the infant include sedation and drowsiness, as well as withdrawal effects of crying, irritability, and sleep issues. Again, long-term effects on the developing child are unknown.
- Vicodin (Hydrocodone): Maybe one of the most commonly prescribed opioid pain relievers, many new mothers leave the hospital with a prescription for post-delivery pain. While the NIH only provided a couple of examples, hydrocodone is suggested to transfer through breastmilk at a rate of more than 3 percent of the maternal dose, or around 3.9mcg daily dose for the infant which can cause grogginess, lethargy, and can even result in breathing cessation.
Alcohol and caffeine also carry over into breastmilk at astonishingly high levels. Breastmilk can contain up to 1.05 grams per liter which is enough to cause a breastfeeding infant to have problematic symptoms including weight gain, violent fits, seizures, inability to suckle, and decreased motor function development. Caffeine, on the other hand, can transfer as much as 10 percent of the maternal dose through breastmilk which can cause babies to experience jitteriness, irritability, restlessness, and jumpiness.
In 2014, during the Vermont Lactation Consultant Association conference, lactation experts were surveyed about smoking marijuana while breastfeeding. Forty-four percent of the respondents said their recommendations would depend on the frequency of the mother's use, while another 41 percent said they would suggest continuing breastfeeding while using marijuana because the benefits outweigh the harms. Only 15 percent recommended stopping breastfeeding due to chronic marijuana use.
As with all things cannabis, more research is needed. Obviously, when breastfeeding and adding chemical substances to your body, it's important to weigh the risks and benefits, not only for yourself but for your child. All lipophilic substances can carry through to a nursing infant from their mother's breastmilk, but to what extent is going to depend on the mother. Until there is conclusive research showing the long-term effects of smoking marijuana while breastfeeding, new mothers should be cognizant of the potential risks involved with consuming any substance, especially during the first several weeks of their infant's life.