When considering that medical patients use cannabis to find relief from nausea and pain every day, it’s not hard to imagine how the herb might impact maternal care. From conception through to the post-partum period, pregnant women and nursing mothers experience symptoms ranging from irksome to debilitating. While a woman’s instinct might be to turn to cannabis for relief from first-trimester nausea or postpartum pain, the topic engenders a lot of controversy and differing opinions, especially when moms choose breastfeeding.
Though 29 states have legalized some form of medical marijuana, a dearth of medical research on maternal care offers mothers few answers on whether cannabis is safe for them.
Medical Studies on Maternal Care and Marijuana Use
Ittai Bushlin, MD/PhD, at the Department of Child Neurology at the Oregon Health & Science University (OHSU), is currently overseeing a study on the effect of marijuana in breast milk. The study’s primary goal is to understand how cannabinoids transfer to maternal breast milk, while also measuring tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in the breast milk of breastfeeding mothers. As of 2018, research is still ongoing, so has yielded no conclusive medical evidence.
In October 2017, the American College of Obstetricians and Gynecologists (ACOG) updated their official committee opinion, writing that due to insufficient data of the effects of marijuana use on infants during breastfeeding, use is discouraged. The ACOG cites impaired neurodevelopment as the primary concern for maternal cannabis use and recommends that: “Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data.”
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At the Infant Risk Center at Texas Tech University, Dr. Thomas Hale is a leading expert on infant health and outspoken advocate for the health benefits of breastfeeding. The Infant Risk Center is regarded as the world’s leading research center for medication safety during lactation and breastfeeding. Yet, only one report published on the institute’s website, “Effects of Marijuana on the Fetus and Breastfeeding Infants,” addresses cannabis.
In the report, Dr. Hale and his colleagues write that “an increased risk of motor, social and cognitive disturbances,” has been documented in some recent studies, citing lower birth rates and reduced head circumference in pre-exposed infants. Specifically regarding cannabis and breastfeeding, the Infant Risk Center reports only one study with conclusive results, noting, “no differences in growth, mental or motor development.”
Yet the same study suggests that “cannabis may produce long-term [consequences], such as reduced cognition and changes in mood and reward … early exposure to cannabis is not benign and cannabis exposure … may produce long-term changes in behavior and mental health.”
Dr. Hale’s final conclusion echoes ACOG’s and that of other mainstream medical associations: “While the effect of cannabis on infants from breastfeeding mothers is limited, cannabis use in breastfeeding mothers should be strongly discouraged.”
Co-Existing Behavioral & Socioeconomic Factors
The ACOG acknowledges that behavioral co-factors can accompany smoking marijuana, including tobacco, alcohol and drug use. For nursing mothers to make well-informed decisions about cannabis, research that divorces cannabis from socioeconomic impacts, including proven high-risk behaviors like smoking tobacco, needs to be undertaken.
The ACOG recognizes this gap in knowledge, stating, “Adverse socioeconomic conditions, such as poverty and malnutrition, may contribute to outcomes otherwise attributed to marijuana.”
Heavy Marijuana Use During Pregnancy in Jamaica
Most folks who believe cannabis is safe for pregnant women cite a study conducted in Jamaica in the late 1980s. Dr. Melanie Dreher used funding from the National Institute on Drug Abuse (NIDA) to compare babies of Jamaican mothers who smoked cannabis during pregnancy and those that didn’t. She followed up after 30 days, comparing the cognitive function and motor skills of 59 Jamaican children. Her research team conducted studies on the children again at ages four and five.
Dr. Dreher’s conclusions found that no decrease in motor function or cognitive skill was apparent in the children of cannabis-using mothers at any age. In her ethnographic report published in Pediatrics in 1994, she writes, “The neonates of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability and self-regulation, and were judged to be more rewarding for caregivers.”
Skeptics of the Jamaica study cite its age, small sample size and the fact that marijuana has changed since the 1980s as reasons why it’s far from a definitive study. Cannabis is now more potent—with a higher THC content—than it was back when Dr. Dreher was in Jamaica. People are also ingesting cannabis in different ways today. One example is dabbing, where you consume more concentrated doses of marijuana. It would be dangerous for nursing or expectant mothers to read the Jamaica study and conclude that consuming marijuana is absolutely safe for their growing baby.
In Humboldt County, Cannabis Is Medicine—But Is It Safe for Breastfeeding?
In Humboldt County, CA, cannabis is culturally interwoven into the community where Dr. Pepper Hernandez runs a holistic medical practice. A naturopathic doctor, Hernandez studied medicine at Trinity Holistic Wellness in Indiana before landing in Humboldt. A firm believer in “both worlds” of Western and holistic medicines, Dr. Hernandez is also a raw/live nutritionist, cannabis therapy consultant and spiritual guide.
Personally, she has used her own body as research, successfully reducing the size of a large tumor and managing epilepsy symptoms by juicing raw cannabis leaves. Working with patients, Dr. Hernandez will “lightly suggest what type of cannabis strains are good for the patient’s ailment,” finding that strain-specific treatments can be especially effective.
But when it comes to maternal care, Dr. Hernandez flips her script almost entirely. For pregnant women and nursing moms, she views cannabis as a substance to eliminate entirely, along with sugar and caffeine. She doesn’t condone smoking cannabis, in any condition, but highly recommends salves, juicing and tinctures for her non-pregnant patients who aren’t breastfeeding. If a nursing mom approaches with a medical or personal need for cannabis, tinctures are a last resort, but she reaffirms that no level of cannabis is safe in breast milk until some definitive medical facts are published.
Dearth of Research, No Studies on CBD
While it appears that 2018 brought significant cannabis reform, lifting the gates on prohibition far outpaces medical research. The disparity is particularly frustrating for those who already experience plenty of stigma for using cannabis: women.
For nursing mothers with chronic health conditions responsive to cannabis, evidence that supports safe or no-risk breastfeeding simply doesn’t exist. As research moves forward, pregnant women, nursing mothers or those with sensitive immune systems should remember that smoking cannabis introduces carcinogens.
Finally, though high-CBD salves, tinctures, extracts and edibles are bringing much relief to many patients with chronic pain or everyday anxiety, CBD contains a similar cannabinoid load to THC. So, while a CBD product might not alter the headspace of a nursing mom, the amount of cannabinoids in her breast milk won’t necessarily be lower than that of a mother consuming a THC product.
Photo credit: Mothering Touch
If you’re new to cannabis and want to learn more, take a look at our Cannabis 101 post. HelloMD can help you get your medical marijuana recommendation; it’s easy, private and 100% online.