POST CATEGORY: Health & Science

Should women medicate while breastfeeding?

March 06, 2013 | DR. SCOTT D. ROSE, SPECIAL CONTRIBUTOR

The science is divided. There are possible legal ramnifications. But studies showing positive health benefits means this is one debate far from over.

According to The U.S. Preventive Services Task Force, Cannabis is the most commonly used "illicit drug" among pregnant and breastfeeding women. There is much to contemplate for females who can get pregnant, who are pregnant or are breastfeeding their child and also making the decision to use Cannabis. 

Some research has shown some seemingly positive effects or no effect at all, while other studies focusing mostly on adverse findings have shown negative side effects. Major academies, groups and governmental agencies on pediatric health, disease, and toxicology have issued policy statements against the use of Cannabis during pregnancy and breastfeeding. 

In states where laws are on the books for medical Cannabis patients, women find themselves in the crossfire and may even face criminal penalties for using Cannabis during pregnancy and or while breastfeeding. The same policy statements advocating for breastfeeding infants due to breast milk's superiority over infant formula, specifically names Cannabis use as a contraindication (read: dealbreaker) for breastfeeding. 

Studies on infants fed with breast milk are few and far between. The published data is old and limited to random breast milk screening rather than controlled studies because of ethical considerations in administering Cannabis to nursing mothers. 

The screenings show that THC and other Cannabinoids, the active plant compounds found in Cannabis, are found in the breast milk of women who use Cannabis. The metabolites, or the breakdown products of these active compounds can be found in the blood, urine and feces of the infant after consumption of the Cannabinoid containing milk. This information establishes that when mom uses, baby uses too. Now the question is, is this necessarily a bad thing?

dr-rose-breastfeeding-quote1.jpgThe Endocannabinoid system is a complex set of receptors and molecules found within the human body. These receptors are like docking stations that only recognize the right molecule and when binding occurs then there is physiological activity - an effect. This activity can be brought about by the binding of what is naturally made in the body, or through the use of Cannabis. There are two types of Cannabinoid receptors found in different tissues and a handful have been found in the human body. Cannabis contains upwards of 100 Cannabinoid compounds that have been identified and only several that have been studied at all. The Endocannabinoid system is important in all animal physiology from the spark of life through the last breath perhaps.

Dr. Ester Fride's work at the Department of Behavioral Sciences at The Hebrew University of Israel notes that, in animals, the Endocannabinoid system fulfills many important developmental functions. From neural development and neuroprotection to the development of memory, and the development of motor skills, the Endocannabinoid system is clearly integral. It is even responsible for an infant's suckling instinct.  
     "A role for the Endocannabinoid system in the human infant is likely," Dr. Fride wrote in a 2004 paper, entitled "The endocannabinoid-CB receptor system: Importance for development and in pediatric disease."

Dr. Fride strongly recommends the use of Cannabinoids in pediatric medicine within the context of her work concerning non-organic failure to thrive, a rare condition where infants cannot grow because they cannot ingest food. Dr. Fride's work has shown that there is a gradual development of the CB1 receptor type in the nervous system of young organisms. CB1 receptors are the binding site for THC, the main psychoactive compound in Cannabis. In other words, infants may naturally respond positively to the medical application of Cannabinoids without undesirable psychoactive effects.

Melanie Dreher, RN, PhD has studied the Cannabis users of rural Jamaica for more than 30 years. Dreher and her team set out to identify the neurobehavioral effects of prenatal marijuana exposure on neonates and reported their findings in the Journal of Pediatrics in an article published February 1994. They compared the babies of moms who used Cannabis during pregnancy with those who didn't. Their study compared the infants using standardized testing at three days old and at one month of age. 

At the three-day mark there were no significant differences shown between the two groups. At one month, however, the Cannabis exposed babies scored higher in areas of alertness, irritability and self-regulation and were judged to be more subjectively rewarding for caregivers, had better physiological stability and required less examiner facilitation to reach goals. 

Interestingly, at four weeks old, infants born to Cannabis-using mothers had better scores on autonomic stability. These are the basic functions of the body such as blood pressure and breathing rates. These mothers likely did not cease their use after pregnancy, but they were likely breastfeeding.
 
University of Montreal researcher Dr. Peter Fried has studied the children of middle-class mothers who used only Cannabis during pregnancy alongside a control group of mothers who used no substances at all. During the first five years, Fried observed little effect. Soon, however, he started to notice a trend of slightly increased intellect in the Cannabis-using group. He called this the "earth-mother effect." 
     It seemed moms who used Cannabis spent more time with their kids and read more to them than the non-using control group. Breastfeeding and continued Cannabis use again was not taken into account.  These findings are positive and are compeling enough to warrant further investigation in the future. 
    
Research since the early 1960s has focused on finding birth defects of prenatal Cannabis use. Mainly, they have looked for differences in birth weight, birth length, head circumference, chest circumference, gestational age, neurological development and physical abnormalities. Most of these studies, including the largest study to date which involved more than 12,000 women, have found no differences between babies exposed to Cannabis prenatally and those who were not. In some studies, the babies of Cannabis users appear healthier and hardier. In others, researchers have found adverse outcomes in the babies of Cannabis users. All of the research conducted has looked at smoked Cannabis, exclusively.
    
The American Academy of Pediatrics and the Centers for Disease Control and Prevention advise nursing moms to abstain from Cannabis use in any form while breastfeeding. They tell mothers that formula must be introduced to baby instead of the "tainted" breast milk as soon as possible. These recommendations have been wholly based on research focusing on birth defects, but not how Cannabis may actually prove beneficial to the health and well-being of the baby.
     
dr-rose-breastfeeding-quote2.jpgThe Academy of Breastfeeding Medicine has a protocol that moms can use to make breastfeeding decisions. For more information about the effects of Cannabis and other medications, go to the National Libraries of Medicine's LactMed database at http://tinyurl.com/toxnetlact. For answers to this and other breastfeeding questions, call the ADHS 24-hour breastfeeding hotline at 1-800-833-4642.
     
When women are confronted with the complex issue of deciding whether to use Cannabis during their pregnancy or while breastfeeding their child, they should be open and honest with their medical team. It is widely accepted in general medicine that breast milk is far superior to formula. 
      
The comparison of breast milk containing Cannabis versus regular formula out of a can may be undeniable,  but, many policy statements say formula cannot recreate nature. And if breast milk is available? However, there are still no studies relating to the long-term effects of Cannabis exposure via breast milk. 
    
For ethical reasons, very little research has been done on the effects of Cannabis on a breastfeeding baby. Therefore, the longterm effects remain widely unknown. Cannabis has been used by many cultures worldwide for thousands of years rather safely, but is that enough when it comes to a child? 
     
As Cannabis is the most widely used substance during pregnancy and breastfeeding, moms must educate themselves of the legal implications and of the effects to their unborn or nursing child. A lot to contemplate, indeed.

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For more information
about the effects of Cannabis and other medications, go to the National Libraries of Medicine's LactMed database at www.tinyurl.com/toxnetlact

For answers
to this and other breastfeeding questions, call the ADHS 24-hour breastfeeding hotline at 1-800-833-4642.

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