Cannabis Use During Lactation: Literature Review and Clinical Recommendations

Ordean, Alice; Kim, Gloria

doi:10.1016/j.jogc.2019.11.003

Cited by 33 publications

(13 citation statements)

References 10 publications

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“…[22][23][24]32,33 Very few studies have analyzed the outcomes associated with cannabis exposure through breastmilk, with 1 study suggesting decreased infant motor development and another showing no effects on developmental outcomes. [34][35][36] Given the potential harms identified, and in the absence of high-quality evidence available to guide practice, most clinical guidelines recommend abstinence from cannabis during pregnancy and lactation. [37][38][39] People who perceive benefits from cannabis may wish to or may be motivated to continue using it through pregnancy and lactation, however.…”

mentioning

confidence: 99%

Reasons for cannabis use during pregnancy and lactation: a qualitative study

Vanstone

Taneja

Popoola

et al. 2021

CMAJ

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annabis use by pregnant and lactating people is increasing, though it is difficult to establish the prevalence of cannabis use in pregnancy. Reported prevalence varies from 2% to 36%, depending on the methodology used to detect use, the population studied and the definition of use. [1][2][3][4][5][6][7][8][9][10][11][12] Pregnant people have reported using cannabis to manage pregnancy-related conditions (e.g., nausea, weight gain, sleep difficulty) [13][14][15][16][17][18][19] and pre-existing conditions (e.g., mental health, insomnia, chronic pain), 13,14,18 as well as to improve mood, mental, physical and spiritual well-being, 16,18 provide pleasure and manage stress. [13][14][15][16] Recent systematic reviews have not found empirical data on reasons for cannabis use during lactation. 20,21 Evidence is still emerging about clinical outcomes related to cannabis use during pregnancy and lactation, and wellcontrolled studies are lacking. [22][23][24] The available evidence is limited by reliance on self-reported data about dose, composition and timing of exposure, the changing nature of tetrahydrocannabinol levels in cannabis over time, and a lack of studies that control for known confounders such as polysubstance and tobacco use. [25][26][27][28][29][30][31] The available evidence does suggest that cannabis use during pregnancy may be associated with complications such as low birth weight, childhood neurodevelopmental outcomes and preterm birth. [22][23][24]32,33 Very few studies have analyzed the outcomes associated with cannabis exposure through breastmilk, with 1 study suggesting decreased infant motor development and another showing no effects on developmental outcomes. [34][35][36] Given the potential harms identified, and in the absence of high-quality evidence available to guide practice, most clinical guidelines recommend abstinence from cannabis during pregnancy and lactation. [37][38][39] People who perceive benefits from cannabis may wish to or may be motivated to continue using it through pregnancy and lactation, however. Counselling that explores the reasons

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mentioning

confidence: 99%

Reasons for cannabis use during pregnancy and lactation: a qualitative study

Vanstone

Taneja

Popoola

et al. 2021

CMAJ

View full text Add to dashboard Cite

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“…A recent systematic review identified only 2 studies on the topic, both published more than 30 years ago. 23…”

Section: Health Outcomes Of Cannabis Use During Pregnancymentioning

confidence: 99%

Pregnant People's Perspectives On Cannabis Use During Pregnancy: A Systematic Review and Integrative Mixed‐Methods Research Synthesis

Vanstone

Panday

Popoola

et al. 2022

J Midwife Womens Health

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Introduction: Rates of perinatal cannabis use are rising, despite clinical evidence about the potential for harm. Accordingly, pregnant and lactating people who perceive a benefit from cannabis use may have a difficult time making informed decisions about cannabis use. Methods:We conducted a systematic review of mixed-methods research to synthesize existing knowledge on the perspectives of pregnant people and their partners about cannabis use in pregnancy. Six health and social science databases were searched up until May 30, 2021. There were no methodological, time, or geographic limits applied. We employed a convergent integrative approach to the inductive analysis of findings from all studies. Results:We identified 26 studies describing views of 17,781 pregnant and postpartum people about cannabis use in pregnancy. No studies describing the views of partners were identified, and only one study specifically addressed the perspectives of lactating people. Comparative analysis revealed that whether cannabis was studied alone or grouped with other substances resulted in significant diversity in descriptions of participant decision-making priorities and perceptions of risks and benefits. Studies of cannabis alone demonstrated a complex decision-making process whereby perceived benefits are balanced against the available information about risk, which is often unclear and uncertain. Clear and helpful information was difficult to identify, and health care providers were not described as a helpful and trusted resource for decision-making.Discussion: Decision-making about cannabis use is difficult for pregnant and lactating people who perceive a benefit from this use, although this decisional difficulty is seldom reflected in studies that examine cannabis as one of multiple substances that pregnant or lactating people may use. Our review suggests several approaches clinicians may take to encourage open and supportive conversations to facilitate informed decisions about cannabis use during the perinatal period.

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“…As studies (the majority of which are animal rather than human 68 ) indicate conflicting outcomes, women who are unable to abstain are advised not to breastfeed within 1 h of inhaling or consuming cannabis, with the aim of reducing the infant's exposure to the highest concentration of cannabis in breast milk. 69 The long-term effect of cannabis use should also be borne in mind as intrauterine exposure to cannabis has been found to increase the likelihood of initiation of cannabis and other substance use in adolescents. 70 Prenatal exposure may also be linked to developing psychosis-like and affective disorders 71,72 and ADHD.…”

Section: Impact Of Cannabis Use In Pregnancymentioning

confidence: 99%

The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review

Towobola

Nair

et al. 2021

BJPsych Bull

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Aims and method As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006–2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. Results Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. Clinical implications This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.

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Cannabis Use During Lactation: Literature Review and Clinical Recommendations

Cited by 33 publications

References 10 publications

Reasons for cannabis use during pregnancy and lactation: a qualitative study

Reasons for cannabis use during pregnancy and lactation: a qualitative study

Pregnant People's Perspectives On Cannabis Use During Pregnancy: A Systematic Review and Integrative Mixed‐Methods Research Synthesis

The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review

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