BACKGROUND AND PURPOSE:

• There is limited data on safety of infant exposure to cannabis
• Bertrand et al. (Pediatrics, 2018) examined the levels of cannabinoids in human milk after maternal marijuana use based on dose and timing

METHODS:

• Women who were breastfeeding and reported marijuana use
• Questionnaires included
  • Route of administration (inhaled, ingested, topical) | Frequency of use | Dose | Time since last use before sample collection.
• Using liquid chromatography mass spectrometry electrospray ionization, concentrations were measured for
  • Δ-9-tetrahydrocannabinol (∆9-THC)
  • 11-hydroxy-Δ-9-tetrahydrocannabinol
  • Cannabidiol
  • Cannabinol

RESULTS:

• 54 women were included in the study
  • Most common route of administration: Inhalation only (64%)
  • 88% reported at least daily marijuana use
• ∆9-THC was detectable in 63% samples up to ∼6 days after last reported use
  • The median concentration of ∆9-THC was 9.47 ng/mL (range: 1.01–323.00)
• Five samples had detectable levels of
  • 11-hydroxy-Δ-9-tetrahydrocannabinol (range: 1.33–12.80 ng/mL) or cannabidiol (range: 1.32–8.56 ng/mL)
• The sample with the highest concentration of cannabidiol (8.56 ng/mL) did not have measurable ∆9-THC
• Cannabinol was not detected in any samples
• The number of hours since last use was a significant predictor of ∆9-THC concentrations (P = .005)
• Adjusted for time since last use
  • The number of daily uses (P=.039) and time from sample collection to analysis (P=0.38) were also significant predictors of ∆9-THC concentrations

CONCLUSION:

• Cannabinoids are lipophilic compounds and are expected to cross into breast milk
  • Brain development may be altered
  • Levels in infant plasma samples not measured
• There is significant transfer of Cannabinoids into breast milk following marijuana use
• Further research is needed on impact of marijuana use on neurodevelopment, especially as ∆9-THC concentrations are higher than doses in previous research
• AAP and ACOG both recommend that marijuana use should be discouraged while breastfeeding

Learn More – Primary Sources:

Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk

Related ObG Topics:

ACOG Recommendations on Marijuana Use During Pregnancy and Lactation

Does Marijuana Affect Time to Pregnancy?

Does Inhaled Cannabis Appear in Breast Milk?

Reduced Risk of Autism in Offspring Exposed to Folic Acid During Pregnancy

Marijuana Detection in Breast Milk: Does Route and Timing Make a Difference?