Some women choose to consume cannabis during pregnancy and while breastfeeding, but a few studies indicate that this could cause developmental problems and cognitive deficits.
On a worldwide scale, an estimated 211 million pregnancies occur annually and about 6.2 million of those pregnancies occur in the U.S.. Although many pregnancies are unplanned, there’s a significant number of new births every day. The ages of expecting mothers varies, and numerous soon-to-be mothers are unaware that they’re pregnant for quite some time. Therefore, they may choose to consume drugs including cannabis for medical and/or recreational purposes during their first stage of pregnancy.
Although cannabis and various cannabinoids are medically beneficial for consumers, according to recent research findings, these substances could negatively impact a fetus and a newborn. Regardless, some women choose to consume cannabis during pregnancy and while breastfeeding, but a few studies indicate that this could cause developmental problems and cognitive deficits.
Preview of Data on Cannabis Usage During Pregnancy and Breastfeeding by AAP
In August 2018, the American Academy of Pediatrics (AAP) announced and released their guidelines on the topic of cannabis usage amongst pregnant and breastfeeding women, which are the first guidelines AAP has ever released. These guidelines are in the form of recommendations, which are based on an analysis of the present research regarding cannabis’s impact on pregnancy, breastfeeding, and childhood development. Currently, there’s little evidence on the usage of cannabis during pregnancies. Nonetheless, the guidelines/report expresses that refraining from consuming all forms of cannabis during pregnancy and breastfeeding is the best choice. This is partially due to THC’s ability to cross the body’s placenta.
In addition, this recommendation builds upon additional studies that focused on newborn babies, which found that newborns who were exposed to cannabis in utero experienced different irregularities including unusual sleep patterns as compared to newborns who weren’t exposed to cannabis in utero.
Based on the limited amount of evidence on this topic, the AAP advises pregnant women to not use cannabis during pregnancy, which is according to Dr. Seth Ammerman, a pediatrics professor at Stanford University and co-author of AAP’s report. One main reason why pregnant and breastfeeding women should avoid cannabis consumption during this time is because THC and other cannabinoids can seep into breastmilk. Also, it was discovered that various cannabinoids like THC can affect fetal development.
Recent Study Findings from Journal Pediatrics
Furthermore, one recent study was published in the Journal Pediatrics around the time of the AAP report, and it focused on breast milk content amongst fifty women who consumed cannabis via smoking, edible ingestion, and other methods. Between 2014-2017, fifty women provided fifty-four samples of breastmilk, which were analyzed by San Diego’s Mommy’s Milk Lab, which is a human milk research biorepository at the University of San Diego. After analyzation, it was discovered that THC was present in 63 percent of the breast milk samples up to six days after the women reported their cannabis usage. It was also found that nine percent of the samples had significant concentrations of cannabidiol.
Then, the researchers attempted to calculate how much THC a newborn would consume from that concentration. Breastfeeding frequency, quantity of ingested milk, and other factors were considered during this calculation. Although AAP’s report and the recent Journal Pediatrics study contain noteworthy information, several questions are left unanswered.
Unanswered Questions & Study Limitations
Researchers only focused on two cannabinoids, THC and CBD, even though there are many other cannabinoids present in the cannabis plant. There’s also room for additional research regarding any possible complications that can occur due to cannabis consumption by pregnant and breastfeeding women. Also, most researchers depended on data from mothers who reported using cannabis during and after pregnancy. In general, one of the study’s main limitations is the researchers’ reliance on women remembering their exact cannabis usage, dosage, and/or cannabis exposure and then reporting it.
Additionally, the researchers didn’t test the levels of THC and other cannabinoids that were found in the breastfed newborns themselves. But rather, they relied on their own projections. It’s also unclear regarding the specific levels of THC and CBD found in breast milk samples. Unfortunately, we don’t know why one-third (37 percent) of the samples don’t have measurable levels of cannabinoids. It doesn’t stop here though because we don’t know how cannabinoid metabolites accumulate in a child, how a child metabolizes these substances, the excretion speed, if they accumulate, and the length of time it hypothetically stays in a child.
Thus far, potential infant exposure to cannabis via breastfeeding isn’t entirely understood. There’s also limited data on the potential neurobehavioral impact that can occur from infant exposure to cannabis via breastmilk. Overall, the AAP report had various limitations including the fact that not all breast milk samples were directly observed. On top of this, no infant plasma samples were taken, and instead, assumptions were made regarding potential infant THC exposure.
Last but not least, the following statement was made about other information we don’t know: “The extent of oral absorption in breastfeeding infants, metabolism and accumulation patterns, and pharmacologic effects of even low levels of cannabinoids on neurodevelopment in infants are unknown.”
Neurodevelopmental Concerns in Infants Due to Maternal Cannabis Consumption
Moreover, it has been found that cannabinoids, especially THC can interrupt normal axonal growth and development in the developing human brain. How does THC make its way to a fetus and infant though? Well, THC and other cannabinoids can enter a mother’s breast milk supply due to the breasts’ blood vessels that provide access to the glands where milk is produced. This particular access permits chemicals and various medications in the blood to move into the breastmilk. However, this depends on the size of the cannabinoid, the concentration of it in the mother’s bloodstream, and whether the chemical or medication is conjoined to proteins and fats. Overall, THC is extremely soluble in fat, and breast milk has a high fat content as well.
Due to THC’s ability to interrupt normal axonal growth and development in the human brain, we must know the short and long-term developmental effects that can occur in infants exposed to cannabinoids via breast milk. So far, there are concerns about potential neurodevelopmental and behavioral consequences from prenatal exposure to cannabis. However, there’s limited data that reveals THC’s ability to transfer into human milk. There’s also no evidence regarding the safety or harm of cannabis during lactation. Unfortunately, current data is inadequate to assess the impact cannabis has on infants by their mothers during breastfeeding. Therefore, maternal cannabis usage is discouraged during pregnancy and breastfeeding.
However, we know that a child’s brain quickly develops when its main form of nutrition is human breast milk. So, if the child absorbs THC from its mother, this could alter brain development. Various researchers involved in other studies claim that prenatal cannabis exposure could inhibit brain development leading to cognitive and behavioral function deficits. But, the developmental infant deficits that were found in a previous study was during a time when cannabis concentrations were one-third of what they are today. As a result, there’s an essential need for additional research on neurodevelopmental outcomes in infants who are breastfeed by cannabis consuming mothers.
Also, oftentimes, cannabis is grown alongside the usage of herbicides, pesticides, rodenticides, and fertilizers, and many of these are toxic and unhealthy. Thus, if mothers consume that kind of cannabis, their fetus and soon-to-be infant could be exposed to those toxins too.
Recommendations for Future Soon-to-be Mothers
Overall, cannabis is the most commonly reported recreational drug consumed by pregnant and lactating women, and up to thirty-six percent of women reported consuming cannabis at some point during their pregnancy. Whereas, eighteen percent reported consuming cannabis while breastfeeding. Due to the limited data on potential adverse effects on fetuses and newborns from maternal cannabis usage, it’s advised to refrain from consuming the herb.
Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists advise counseling mothers to avoid all cannabis consumption during pregnancy and breastfeeding. The AAP report also mentions that women should be aware of the lack of definitive research on this particular topic. It’s suggested that all women take time to learn more about the possible adverse effects that THC and other cannabinoids can have on a future child’s development.
To this day, cannabis is still classified as a Schedule I substance by the U.S. DEA. Therefore, there are many blockades that keep researchers away from performing more extensive and detailed research on the link between cannabis usage, pregnancy, and breastfeeding. In the meantime, proper education is essential and questioning recent studies and reports is strongly advised.