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Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. The main psychoactive component of cannabis, tetrahydrocannabinol THC , is excreted into breastmilk in small quantities. The duration of detection of THC in milk has ranged from 6 days to greater than 6 weeks in various studies. A pharmacokinetic model predicted a half-life in milk of 39 hours which is consistent with a THC clearance from milk in about 8 days. Concern has been expressed regarding the possible effects of cannabis on neurotransmitters, nervous system development and endocannabinoid-related functions. A large registry study in New Zealand suggested that postnatal use of cannabis may increase the risk of autism spectrum disorder, with male infants affected to a greater extent than female infants. Cannabis can affect serum prolactin variably and some evidence indicates that it might decrease milk supply and the duration of lactation. Because of insufficient long-term data on the outcome of infants exposed to cannabis via breastmilk, health professionals' opinions on the acceptability of breastfeeding by cannabis-using mothers varies. In general, professional guidelines recommend that cannabis use should be avoided by nursing mothers, and nursing mothers should be informed of possible adverse effects on infant development from exposure to cannabis compounds in breastmilk. In addition to possible adverse effects from cannabinoids in breastmilk, paternal cannabis use may also increase the risk of sudden infant death syndrome in breastfed infants. Cannabis should not be smoked by anyone in the vicinity of infants because the infants may be exposed by inhaling the smoke. The main active psychoactive component of cannabis is deltatetrahydrocannabinol THC , although it also contains other active compounds. THC is very fat soluble and persistent in the body fat of users and slowly released over days to weeks, depending on the extent of use. Maternal Levels. Two women who smoked marijuana daily while nursing had their randomly collected milk analyzed. A milk sample that was collected 1 hour after smoking marijuana contained This is important because of the high fat solubility of THC. A woman who admitted to smoking cannabis amount not stated donated milk for analysis at an unknown time after the previous use. Eight exclusively nursing women who were 3 to 5 months postpartum and reported previous or current cannabis smoking were studied. After 24 hours of abstinence, each smoked a mg of a standardized cannabis containing The product was smoked over 10 to 20 minutes from a glass pipe until it was fully consumed. Milk was pumped before smoking and at 20 minutes, 1, 2 and 4 hours after inhalation. THC and its metabolites, OH-deltatetrahydrocannabinol and norcarboxy-deltatetrahydrocannabinol were measured in the milk samples. The average THC concentration in breastmilk was Fifty women who reported using cannabis in the prior 14 days donated milk samples for analysis of THC and its major metabolites. Four women donated two samples each for a total of 54 samples. The median concentration of THC was 9. Of the 34 milk samples from mothers who reported using cannabis, the half-life of THC in milk was estimated to average about 27 hours. Twenty women in Oregon who admitted to using a cannabis product while breastfeeding their infants provided milk samples for analysis. The mothers reported using cannabis almost daily. All but one milk sample contained at least one cannabinoid. Three patients using edible products had similar cannabinoid levels as those who smoked cannabis. Fourteen mothers reported an increase in use of cannabis between the 2-week and 2-month visit. Median breast milk THC concentrations were The authors estimated that overall the breastfed infants received an average THC dose of 4. Seven women who used cannabis during pregnancy more than twice weekly, primarily by smoking, and were documented to be abstinent postpartum donated blood and milk levels 2 to 5 times weekly for 6 to 7 weeks. Maximum milk THC levels ranged from 2. Ninety lactating persons who reported using cannabis within the prior 48 hours donated milk samples to a milk biorepository. The median concentration of THC was Cannabidiol was measurable in 44 The number of hours since last use, route of use and number of puffs taken were significant predictors of the log of THC concentrations. Infant exposure was minimal compared to exposure from direct ingestion. Thirteen milk samples were collected from 12 women who reported cannabis use post-delivery, and one sample was collected from a woman who did not indicate the period of cannabis usage. A physiologically based pharmacokinetic model of THC following smoking of cannabis predicted relative infant dose of 0. The predicted half-life in milk was about 39 hours. After initial cannabis use. On the study day, 12 of the 20 participants used cannabis more than once. A total of milk samples were submitted. Mean baseline milk THC concentration after the hour abstention was The time of the peak concentration in milk was to minutes after cannabis use, with considerable variability. The mean THC concentration in the study population after initial cannabis use was The mean individual THC concentrations in milk after cannabis use ranged from 2. The half-life of THC in milk was estimated to be The estimated median infant THC dose was 5. Other components measured included norcarboxy-deltatetrahydrocannabinol, hydroxy- deltatetrahydrocannabinol, cannabinol, 7-hydroxy cannabidiol, cannabidiol, and 7-carboxycannabidiol. Infant Levels. The urine of 2 breastfed infants whose mothers smoked marijuana found none of the 9-carboxy-THC metabolite. One mother reported smoking marijuana once daily and the other reported smoking marijuana 7 to 8 times daily. Analysis of the feces of the latter mother's infant revealed a higher proportion of metabolites than THC, indicating that THC was probably absorbed from the milk, metabolized by the infant, and excreted in feces. A 6-month-old infant was exclusively breastfed by a mother who was a chronic cannabis user. She presented to the emergency department with somnolence after falling off a couch and developed seizure-like activity and minimally responsive dilated pupils. A mother reported smoking about 4 cannabis resin joints daily sometimes just before breastfeeding. She reported starting when her breastfed infant was 4 months old. A physiologically based pharmacokinetic model of THC following smoking of cannabis predicted that in the worst-case scenario of maternal cannabis use six times daily during lactation, the maximum infant plasma concentration ranged between 0. These concentrations were orders of magnitude lower than maternal plasma levels. Neonates up to 1 month old had the highest THC exposure, probably because of the incomplete maturation of metabolizing enzymes. Twenty-seven mothers reported smoking marijuana during breastfeeding. Twelve of them smoked once a month or less, 9 smoked weekly, and 6 smoked daily. Six of their infants were compared at 1 year of age to the infants of mothers who did not smoke marijuana during pregnancy or breastfeeding. No differences were found in growth, or on mental and motor development. Sixty-eight infants whose mothers reported smoking marijuana during breastfeeding were compared to 68 matched control infants whose mothers did not smoke marijuana. The duration of breastfeeding varied, but the majority of infants were breastfed for 3 months and received less than 16 fluid ounces of formula daily. Motor development of the marijuana-exposed infants was slightly reduced in a dose-dependent i. No effect was found on mental development. A small, case-control study found that paternal marijuana smoking postpartum increased the risk of sudden infant death syndrome. In this study, too few nursing mothers smoked marijuana to form any conclusion. A study of women taking buprenorphine for opiate substitution during pregnancy and lactation found that 4 of the women were also using cannabis as evidenced by positive urine screens for THC between 29 and 56 days postpartum. One was also taking unprescribed benzodiazepines. One infant was exclusively breastfed and the other 3 were mostly breastfeeding with partial supplementation. Infants had no apparent drug-related adverse effects and showed satisfactory developmental progress. Preliminary evidence found no differences in infant adverse reactions, postnatal growth, or neurodevelopmental outcomes were found between the groups with quantifiable and nonquantifiable THC in breastmilk. The infant returned to baseline in 72 hours. A 9-month-old girl was hospitalized for a first tonic-clonic seizure. Brain scan and magnetic resonance imaging showed nonspecific right focal frontal cortical hypodensity, without bleeding or traumatic lesion. The electroencephalogram was normal, and no infection was found. Her mother explained she smoked cannabis resin since her child was 4 months old, sometimes just before breastfeeding, and on average 5 joints daily. Since then, her child had three spasms. She did not report any cannabis or other drugs use during pregnancy. Breastfeeding was replaced by formula and 1. The infant of a woman who used cannabis edibles for anxiety during pregnancy and during breastfeeding had several episodes of apnea. At 1 week of age while undergoing treatment for a urinary tract infection, the infant required intubation because of apneic episodes. At 5 weeks of age, the mother noticed the infant was having irregular breathing and apneic episodes and took the infant to the hospital. There the infant was having more apneic episodes and a urine positive for THC, although the mother reported not using cannabis for the prior 3 days. Acute one-time marijuana smoking suppresses serum concentrations of luteinizing hormone and prolactin in nonpregnant, nonlactating women. Of mothers who reported smoking marijuana during pregnancy, 27 who had smoked marijuana during breastfeeding were followed-up at 1 year. No difference was found in the age of weaning between these mothers and 35 who reported not smoking marijuana during pregnancy or breastfeeding. The US state of Colorado legalized medical cannabis in and recreational cannabis in A cross-sectional survey conducted in Colorado in and found that both prenatal and postnatal cannabis use were associated with a shorter duration of breastfeeding. Both differences were statistically significant. A study using a database of postpartum women found that those who reported using marijuana were more likely to smoke cigarettes, experience postpartum depressive symptoms, and breastfeed for less than 8 weeks. Most of the women who smoked marijuana postpartum also used it during pregnancy. Among a group of 14 women who used cannabis postpartum by inhalation, lactose levels were higher in the milk of cannabis users compared to the milk of non-users. The milk of cannabis users had lower levels of sIgA relative to non-users; however, when adjusted for BMI, there was no difference in sIgA levels between the groups. Subjects who used both cannabis and cigarettes had lower carbohydrate levels and greater crude protein and true protein levels in their milk. Cannabis-using mothers reported lower levels of milk production in the first, second, fourth, and sixth weeks postpartum, compared to non-users. Most mothers Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U. Attribution Statement: LactMed is a registered trademark of the U. Department of Health and Human Services. Turn recording back on. Help Accessibility Careers. Search term. Cannabis Last Revision: September 15, Estimated reading time: 15 minutes. Drug Levels The main active psychoactive component of cannabis is deltatetrahydrocannabinol THC , although it also contains other active compounds. Effects in Breastfed Infants Twenty-seven mothers reported smoking marijuana during breastfeeding. Effects on Lactation and Breastmilk Acute one-time marijuana smoking suppresses serum concentrations of luteinizing hormone and prolactin in nonpregnant, nonlactating women. References 1. N-acylethanolamines in human reproductive fluids. Chem Phys Lipids ; Cannabinoids and gene expression during brain development. Neurotox Res ; Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol ; Marijuana: Prenatal and postnatal exposure in the human. Exposure to maternal cannabis use disorder and risk of autism spectrum disorder in offspring: A data linkage cohort study. Psychiatry Res ; Maternal cannabis use during lactation and potential effects on human milk composition and production: A narrative review. Adv Nutr ; Postpartum marijuana use, perceptions of safety, and breastfeeding initiation and duration: An analysis of PRAMS data from seven states, J Hum Lact ; Cannabis use during lactation may alter the composition of human breast milk. Pediatr Res ; Medicinal plants traditionally used to increase breast milk in Turkey: An ethnobotanical review. J Herbal Med ; Committee Opinion No. Obstet Gynecol ;ee9. Marijuana use during pregnancy and breastfeeding: Implications for neonatal and childhood outcomes. Pediatrics ;e Marijuana use in pregnancy and while breastfeeding. Obstet Gynecol ; Academy of Breastfeeding Medicine Clinical Protocol Breastfeeding in the setting of substance use and substance use disorder Revised Breastfeed Med ; Presence of delta 9-tetrahydrocannabinol in human milk. N Engl J Med ; Bennett PN. Drugs and human lactation, 2nd ed. Amsterdam: Elsevier; Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal ; Transfer of inhaled cannabis into human breast milk. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Cannabis use and measurement of cannabinoids in plasma and breast milk of breastfeeding mothers. JAMA Pediatr ; Birth Defects Research ; Cannabidiol exposures in breastfed infants compared to children as predicted by physiologically based pharmacokinetic modeling. Predicting maternal and infant tetrahydrocannabinol exposure in lactating cannabis users: A physiologically based pharmacokinetic modeling approach. Pharmaceutics ; Elucidating new cannabinoid-associated neurotoxicity objectively. Clin Toxicol ; Recreational cannabis use during breastfeeding is not without risk! Fundam Clin Pharmacol ; Maternal and paternal recreational drug use and sudden infant death syndrome. Arch Pediatr Adolesc Med ; Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Infant adverse reactions, postnatal growth and neurodevelopmental outcomes in infants and toddlers breastfed by mothers who use marijuana. Birth Defects Res ; Association of cannabis with apneic episodes in a breastfed infant: A case study. Acute effects of marihuana smoking on prolactin levels on human females. J Pharmacol Exp Ther ; Marihuana smoking suppresses luteinizing hormone in women. Function of cannabinoid receptors in the neuroendocrine regulation of hormone secretion. Neurobiol Dis ;5 6 Pt B Effects of chronic marijuana use on testosterone, luteinizing hormone, follicle stimulating hormone, prolactin and cortisol in men and women. Drug Alcohol Depend ; Endocrine effects of marijuana. J Clin Pharmacol ;S-6S. The effects of cannabinoids on serum cortisol and prolactin in humans. Psychopharmacology Berl ; Olusi SO. Hyperprolactinaemia in patients with suspected cannabis-induced gynaecomastia. Lancet ; Harmon J, Aliapoulios MA. Gynecomastia in marihuana users. Rizvi AA. Hyperprolactinemia and galactorrhea associated with marijuana use. Endocrinologist ; Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: The association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr ; Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Perceptions of cannabis use and its benefits and risks among breastfeeding mothers. Womens Health Rep New Rochelle ; Substance Identification Substance Name Cannabis. In this Page. Drug Levels and Effects Substance Identification. Bulk Download. LactMed Support Resources. Related information. 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At this point, t he medical use of cannabis is legal in 37 states and the District of Columbia D. The recreational use of cannabis has been legalized in 21 states and D. The downstream effect of these changes has been a significant uptick in the use of cannabis among women of childbearing age. According to data collected from the National Survey on Drug Use and Health , the use of cannabis in pregnant women rose from 2. While we have data to indicate that the use of cannabis during pregnancy may negatively affect fetal growth and brain development , we have less information on how the cannabis and its byproducts, which are secreted into the breast milk, may affect the nursing infant. Here are some important things we do know:. Figuring out how much is passed into the breast milk is complicated because how women use cannabis varies considerably. For example, the kinetics of smoking vary considerably from ingesting. Both cannabidiol CBD and the psychoactive component, deltatetrahydrocannabinol or THC, have been detected in breast milk. Cannabis concentrations in breast milk are variable and are related to maternal dose and the frequency of use, as well as how the cannabis is consumed. However, there are some things that make cannabis a little different than alcohol or other recreational drugs. Cannabis and its byproducts are very fat-soluble or lipophilic. Furthermore, there is an especially long washout period in those who have been daily users. Long after the psychoactive effects have faded, THC and its metabolites can be detected in the blood, urine, and breast milk of mothers who have used cannabis. Studies focusing on the detection of THC in milk have yielded variable results, with duration of detection ranging from 6 days to greater than 6 weeks in various studies. T A study from Wymore and colleagues collected data on self-reported use of marijuana and measured levels of THC in maternal plasma and breast milk samples several times a week. In all 25 participants reporting marijuana use, THC was detectable in breast milk throughout the six week duration of the study. Based on this estimate, they calculated that it would be possible to detect THC in breast milk for longer than 6 weeks in some users. In addition, the researchers were able to calculate a milk:plasma partition coefficient for THC, which was approximately There are conflicting data regarding the outcomes of infants exposed to cannabis during breastfeeding and very few studies have focused on child outcomes. These studies are not easy to conduct. First of all, recreational use of cannabis continues to be illegal in many states, and thus research on cannabis use is prohibited in many areas. Furthermore, it is difficult to disentangle the direct effects of cannabis delivered in the breast milk from the indirect effects of cannabis on the quality of childcare and parenting, especially in heavy, chronic users or when cannabis is combined with other substances. In one study Whymore et al, , breastfeeding infants were assessed at one year of age. In the 68 infants exposed to cannabis during the first month of life, there was evidence of decreased motor development at one year, when compared with matched infants who were not exposed to cannabis. Specifically, there was a point decrease in the Bayley index of infant motor development. However, the authors of this study cannot conclude that these findings were entirely due to exposure via breastfeeding, as many of the women also used marijuana during pregnancy. The researchers observed no differences in infant adverse reactions, growth, or neurodevelopmental outcomes between the groups with quantifiable THC versus those with non-quantifiable THC levels in breastmilk. In another study Tennes et al, , 27 breastfed infants exposed to cannabis were compared to 35 unexposed breastfed infants. At one year, no differences were noted for motor and mental development using the Bayley Scales of Infant Development. However, the small size of this study limited statistical analysis. So the jury is still out regarding the effects of cannabis on the nursing infant. All women should be screened for drug use as a component of standard prenatal care. Screening for substance use should occur during the course of pregnancy with the goal of providing information regarding the potential adverse effects of cannabis and to ensure referral to appropriate resources for treatment as needed. Because many women are able to abstain from substances during pregnancy but resume use after delivery, screening must be repeated during the postpartum period. Because of the persistence of cannabis and its byproducts in the breast milk for days to weeks, using cannabis and waiting for it to clear out of the breast milk is not a viable option in terms of limiting exposure. For women who use cannabis for medical indications, alternative therapies with more safety data during breastfeeding should be considered. While we continue to support and encourage exclusive breastfeeding in women for children up to one year of age, this recommendation must include information regarding the use of cannabis and other substances while breastfeeding. Infant adverse reactions, postnatal growth and neurodevelopmental outcomes in infants and toddlers breastfed by mothers who use marijuana. Birth Defects Res ; Hosp Pediatr. Mourh J, Rowe H. Breastfeed Med. Marijuana Use in Pregnancy and While Breastfeeding. Obstet Gynecol. This article is free online and a very good review of this topic. Ordean A, Kim G. J Obstet Gynaecol Can. Marijuana: Prenatal and postnatal exposure in the human. JAMA Pediatr. Essential Reads: Cannabis and Breastfeeding. Previous Next. View Larger Image. Here are some important things we do know: Can cannabis be found in breast milk? If cannabis is consumed, how long does it persist in the breast milk? What are the effects of exposure to cannabis in the nursing infant? Clinical Recommendations All women should be screened for drug use as a component of standard prenatal care.

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