Marijuana and Breast Feeding ????

[Lela RN]

A relative of mine just had a baby who is now only 2 weeks old. While over at their house I observed the Mom go out to the garage and smoke a "joint" and also drank a shot of tequila which was served by the father of the baby. I asked the Mom if she realized that both substances would get into her breast milk and to the baby when she feeds her. The Mom just sort of blew me off stating that her body will detoxify itself in two hours, -- which personally I know is not true cause the chemical THC found in marijuana - is stored in the body fat, the same place that the breast milk is made. I asked another relative who is staying at the house how long the Mom had been doing this, and she told me this has been going on for about a week. I'm scared for the baby's health and how she will be cared for with her mother being high off of pot. This is her 1st child too. She knows I'm a Nurse but she's not listening to me as far as this being bad for the baby. Would I be wrong if I called child protection ? What should I do ?

[mitchsmom]

Here's the writeup from Dr. Hale's "Medications and Mother's Milk" for anyone interested:

"AAP - contraindicated by the American Academy of Pediatrics in Breastfeeding Mothers.

Commonly called marijuana, the active component delta-9-THC is rapidly distributed to the brain and adipose tissue. It is stored in fat tissues for long periods (weeks to months). Small to moderate secretion into breastmilk has been documented. Analysis of breastmilk in chronic heavy users revealed an eightfold accumulation in breastmilk compared to plasma although the dose received is insufficient to produce significant side effects inthe infant. Studies have shown significant absorption and metabolism in infants, although long term sequelae have not been shown. Marijuana could produce sedation and growth delay, but it is highly dose dependant. In one study of 27 women who smoked marijuana during breastfeeding, no differences were ntoed in outcomes on growth, mental, and motor development. Studies in animals suggests that marijuana inhibits prolactin production and could inhibit lactation. Contraindicated in nursing mothers. Infants exposed to marijuana via breastmilk will test positive in urine screens for long periods (2-3 weeks).

Pregnancy risk category: C

Lactation risk category: L5 (contraindicated)

Adult concerns: sedation, weakness, poor feeding patterns. Possible decreased milk production.

Pediatric concersn: sedation

T 1/2 = 25-57hrs

Volume of distribution = high

Milk/plasma ration = 8 (high)

Protien binding = 99.9%

Oral bioavailability = complete

The kellymom.com link from before, http://www.kellymom.com/health/lifestyle/marijuana.html

is one that I would consider reliable as a breastfeeding counselor. I know that the author is experienced and reliable, and she lists references for all of her articles. Her site is very detailed and it's actually one of my favorites!

Regarding the alchohol vs. marijuana thought - many variables go into whether something is considered safe during bf or not, such as: plasma levels in mom, lipid solubility of the drug and fat content of the milk, milk pH, molecular size of the drug, protein binding, half life, molecular weight of the drug, as well as infant considerations like: age (premature & newborns are at greater risk), infant stability, pediatric approved drugs, dose, and drugs that may be ok for the baby but may alter milk production in the mom. More consideration for use of drugs during bf: avoid using meds when possible, evaluate infant dose & perform individual risk assessment, for many drugs a relative infant dose of

So, excerpts from the alcohol entry:

"AAP: Approved by the American Academy of Pediatrics for use in breastfeeding mothers

Significant amounts of alcohol are secreted into breastmilk, although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low. .... Adult metabolism of alcohol is approxiimately 1 oz in 3 hours, so that mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.

Pregnancy risk category: D

Lactation risk category: L3

And the Kellymom page: http://www.kellymom.com/health/lifestyle/alcohol.html

Information from Medications and Mothers Milk 10th edition 2002 Thomas W. Hale