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FDA on Marijuana, THC, CBD-Breastfeeding and Pregnancy

November 14, 2019



New Alert from the FDA on Marijuana, THC, CBD

Now that the sale and use of marijuana is legal in many states for medical use and in some states for recreational use, do you discuss the use of cannabis and cannabis-derived products with your pregnant and breastfeeding patients? These products have become much more common in recent years and many new parents are confused as to whether they are safe to use.

In response to a flood of new cannabis-containing products on the market, the Federal Drug Administration (FDA) recently released a statement strongly advising against the use of cannabidiol (CBD), tetrahydrocannabidiol (THC) and marijuana in any form during pregnancy or while lactating. There are many unanswered questions as to exactly how these substances affect the developing fetus, breastfeeding infants and even mothers’ milk supplies.

People are often confused by all the terms used to describe additives, supplements and oils. Cannabis is a plant that contains over eighty biologically active chemical compounds. THC and CBD are the two most commonly known compounds. Marijuana is one type of cannabis plant which contains varying amounts of THC, the compound that causes a person to feel "high." Hemp is another type of cannabis plant which contains very low amounts of THC. CBD, a compound which does not produce a "high," can be derived from either marijuana or hemp. The FDA says there may be serious risks to pregnant or breastfeeding mothers using cannabis products, including those containing CBD.

Research suggests that there are potential negative effects from using marijuana and THC-containing products. The U.S. Surgeon General recently cautioned that THC can enter the fetal brain through a mother’s bloodstream and may increase the risk of low birth weight. https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-marijuana-use-and-developing-brain/index.html.

Premature birth and potential stillbirth may also be linked to marijuana use. Breast milk can contain THC for up to six days after use and may affect the baby’s brain development resulting in hyperactivity, poor cognitive function and other long-term effects.

There is not a large body of research on the effects of CBD in pregnancy and while breastfeeding, but the FDA is continuing to look at the research and collect data. High doses of CBD in animal models has shown an adverse effect on the reproductive systems of developing male fetuses. There is also potential for contamination from other substances and concern about side effects, drug interactions and long-term use.

Discussions about marijuana, THC, and CBD use are important when interacting with preconceptual or pregnant patients and new parents. Not only should they make informed decisions regarding the use of cannabis-containing products, they need to be aware of state regulations regarding their use.

Some things to consider and discuss include:

• THC enters breast milk and has the potential to affect the baby.
THC is stored in body fat and remains in the body for a long time. Babies have a high percentage of brain and body fat.
The American Academy of Pediatrics states that marijuana should not be used while breastfeeding.
Not much is known about the amount of THC in breast milk, the length of time it remains in the breast milk, and the effects on the infant.
Since THC is stored in fat and stays in the body a long time, it’s not known how long a mother would need to "pump and dump" to wait for THC to be eliminated from breast milk.
Marijuana is legal in some states in the U.S., but this doesn’t mean it is safe for pregnant moms or babies. Some hospitals test babies after birth for drugs and may notify child protective services if they test positive.

For more information, check out the resources below.

Resources:

1. https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding

2. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/marijuana.html

3. https://www.colorado.gov/pacific/sites/default/files/MJ_RMEP_Factsheet-Pregnancy-Breastfeeding.pdf

Article Information collected from: Human Milk Insights, Medela, November 2019

Heather Knott, RN-IBCLC

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