08 Mar THC Concentrated and Long Lasting in Breast Milk
MedicalResearch.com Interview with:
Erica M. Wymore, MD MPH
Assistant Professor, Neonatal- Perinatal Medicine
Department of Pediatrics, Section of Neonatology
University of Colorado School of Medicine
Children’s Hospital Colorado
Maya Bunik, MD, MPH | Professor, Pediatrics
Medical Director, Child Health Clinic, Primary Care | Breastfeeding Management Clinic
Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)
School of Medicine| University of Colorado Anschutz Medical Campus
Children’s Hospital Colorado
MedicalResearch.com: What is the background for this study?
Response: Marijuana legalization has been increasing in the United States, with increasing consumption of marijuana products. Currently, the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG) and Academy of Breastfeeding Medicine (ABM) do not recommend marijuana use during pregnancy or lactation due to concerning though limited data on the effects of perinatal marijuana exposure.
As there has been increasing prevalence of women using marijuana during pregnancy due to legalization and perceptions of safety, we sought to determine the duration of THC excretion in breast milk among women who had evidence of marijuana use at delivery and abstained post-partum.
MedicalResearch.com: What are the main findings?
Response: We screened 394 women with marijuana use identified at delivery by urine toxicology testing and enrolled 25 women into the 6 week study. Study inclusion criteria were marijuana abstention for the 6 week study period, intent to breastfeed and provision of breastmilk, urine and plasma samples several times per week. Among the 25 women, 12 reported abstention by survey though only 7 had biological evidence of abstention. We found that THC excretion in breastmilk for women who abstained after birth was at least 6 weeks. THC is concentrated in breastmilk with a milk to plasma ratio of 6.1:1 (IQR 3.8-8.1:1), and women had difficulty abstaining from marijuana.
There are several factors which may contribute to the duration of THC excretion in breast milk, including but not limited to mothers’ history of use (chronic use, heavy use), maternal BMI as THC is lipophilic, and fat content in human breastmilk. Our study does not address the effects of THC exposure during lactation on infants, however it is concerning that THC excretion could be much higher in women who continue marijuana use throughout the postpartum period, increasing the dose and duration of exposure to the infant.
MedicalResearch.com: What should readers take away from your report?
Response: The current limited data on THC exposure and neurodevelopmental impact on children is decades old, and is not reflective of today’s marijuana products which are over 5 times more potent that what was available in the 1980-90’s. The true effect of THC exposure on the developing fetus and newborn brain is challenging to study, due to various timing of marijuana use throughout gestation, frequency and dose of the product as well as postpartum exposure. However, recent data on adolescents with marijuana use and cognitive function is concerning.
is no known safe amount of marijuana use in pregnancy or during lactation. As THC is excreted for 6 weeks, pumping and dumping breastmilk is not a realistic solution for mothers. Due to increasing marijuana legalization, it is important to recognize that pregnant and breastfeeding women and their infants are a vulnerable population, and that exercising caution is imperative. We recommend that all clinicians counsel women who are pregnant or considering pregnancy to abstain from marijuana, throughout pregnancy and in the postpartum period. Healthcare providers can encourage marijuana abstention, to provide the best outcomes and also to allow for the safest breastfeeding experience. There is an urgent public health need for further research to quantify the long-term effects of perinatal marijuana use on infants and children, in addition to evaluating reasons for maternal use and support for mothers who struggle with abstention.
Wymore EM, Palmer C, Wang GS, et al. Persistence of Δ-9-Tetrahydrocannabinol in Human Breast Milk. JAMA Pediatr. Published online March 08, 2021. doi:10.1001/jamapediatrics.2020.6098
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