Marijuana, also known as cannabis or weed, is the most commonly used illegal drug, and many women use medical marijuana legally as well. Although generally considered a "harmless" or "soft drug," there are risks associated with marijuana use, and so parents need to be cautious about exposing their baby to marijuana smoke, or to breastmilk if the mother has been consuming marijuana.
Here's what the research tells us.
The Breast is Best Philosophy
Breast is Best is the number one message to new moms, and with good reason. A 2012 policy statement by the American Academy of Pediatrics reviewed the evidence on breastfeeding, and concluded that given the short-term and long-term medical and neurodevelopmental advantages, breastfeeding should be promoted as the norm to new parents. For example, there is a 36% lower risk of SIDS when babies are breastfed.
The stereotype of the new mom and the stereotype of the chronic marijuana user don't align very well. Everyone wants to be seen as a good parent, and physicians don't want to upset a pregnant woman, or one who has recently given birth, so they often don't even bring up the subject of drug use if you don't look like the "type" of woman who would use drugs.
Given this fact, many physicians do not routinely ask pregnant women or mothers whether they use marijuana, and far less advise them not to breastfeed because of it. The discomfort around the implications of whether a drug-using woman should even be caring for her own child would make many new parents either avoid the question, or give the expected answer -- that they do not use marijuana.
Tip: The stigma around marijuana use and the universal promotion of breastfeeding may get in the way of getting accurate advice on breastfeeding from your doctor.
Breastfeeding and Marijuana
Cannabis is the most commonly used illicit drug among pregnant and breastfeeding women, yet probably because of stigma, we don't hear the same public health messages about marijuana use as we do with substances such as alcohol and nicotine. Yet the same policy statement advocating for breastfeeding actually cites marijuana use as a contraindication for breastfeeding, meaning that women who use marijuana should not breastfeed. A number of studies support this view.
Tip: If you smoke marijuana, you should not breastfeed.
What Will Marijuana Do to My Baby if I Do Use Marijuana and Breastfeed?
More research is needed to accurately predict the effects of a mother's marijuana use on children who are breastfed, but there are some risks we know about from research:
- Risk of SIDS -- exposure to marijuana smoke, including second hand and third hand smoke, increases the risk of your baby dying of SIDS.
- Effects on the Brain and Nervous System -- as a psychoactive drug, marijuana has a direct effect on the brain and nervous system. Babies who are breastfeeding are still rapidly developing, so using marijuana while you are breastfeeding increases the risk of impaired brain and nervous system development.
- Hyperactivity -- some studies have shown that children exposed to cannabis through breastmilk are at higher risk of developing problems such as hyperactivity and impulsivity, while others show reduced activity (or no effect for some). There is enough evidence to conclude that using marijuana while you are breastfeeding could put your baby at significant risk of developing problems such as ADHD.
- Mental Functioning -- executive functioning, including flexibility in thinking, being able to pay attention for long periods of time, and being able to hold information in "working memory," can all be damaged by early exposure to cannabis.
- Emotional Regulation -- early exposure to THC, the active ingredient in marijuana, has been found to cause long-lasting changes in the emotional reactivity of children.
- Risk of Drug Use Later -- there is some evidence from animal studies that early exposure to cannabis increases the reinforcing effects of other drugs, such as opiates. Although more research is needed to confirm this, it is well-known that substance use runs in families, and if you are using cannabis, exposing your baby to the drug through breastmilk may increase the risk that your baby will go on to use drugs -- possibly even "harder" drugs than marijuana.
Tip: Early exposure to marijuana is associated with a range of short-term and long-term mental, emotional and behavioral problems.
The Bottom Line
The best thing you can do to protect your baby from the potentially harmful effects of marijuana is to quit, and make sure no one smokes marijuana, or any substance, around your child. If you can't quit, don't breastfeed -- marijuana sticks around in the body much longer than most other drugs, so even if you quit, don't breastfeed for at least 90 days. In the meantime, express and discard your milk if you plan to breastfeed once you are clean.
American Academy of Pediatrics "Policy Statement: Breastfeeding and the Use of Human Milk." Pediatrics 129:e827-e841.
Academy of Breastfeeding Medicine Protocol Committee. "ABM Clinical Protocol #21: Guidelines for Breastfeeding and the Drug-Dependent Woman." Breastfeeding Medicine 4:225-228. 2009.
Astley, S. & Little, R. "Maternal marijuana use during lactation and infant development at one year." Neurotoxicology And Teratology 12:161-8. 1990.
Bartu, A., Sharp, J., Ludlow, J. & Doherty, D. "Postnatal Home Visiting for Illicit Drug-Using Mothers and Their Infants: A Randomised Controlled Trial." Australian and New Zealand Journal of Obstetrics and Gynaecology 46:419-426. 2006.
Djulus, J., Moretti, M. & Koren, G. "Marijuana use and breastfeeding." Can Fam Physician 349-50. 2005.
England, L., Brenner, R., Bhaskar, B., Simons-Morton, B., Das, A., Revenis, M. & Clemens, J. "Breastfeeding Practices in a Cohort of Inner-City Women: the Role of Contraindications." Biomed Central Public Health 3:28-37. 2003.
Campolongo, P., Trezza, V., Ratano, P., Palmery, M. & Cuomo, V. "Developmental Consequences of Perinatal Cannabis Exposure: Behavioral and Neuroendocrine Effects in Adult Rodents." Psychopharmacology 214:5-15. 2011.
Djulus,J, Moretti, M. & Koren, G. "Marijuana use and breastfeeding." Canadian Family Physician 5:349-350. 2005.
Liston, J. "Breastfeeding and the Use of Recreational Drugs -- Alcohol, Caffeine, Nicotine and Marijuana." Breastfeeding Review 6:27-30. 1998.
Wilton, J. "Breastfeeding and the Chemically Dependent Woman." NAACOG's Clinical Issues in Perinatal and Women's Health Nursing 3:667-7. 1992.