Breastfeeding and Marijuana Use: Medical and Ethical Policy Analysis [10I

Abstract

INTRODUCTION: U.S. guidelines recommend breastfeeding women avoid marijuana given concerns about infant neurodevelopment. Unfortunately, this has resulted in many physicians and hospitals prohibiting women who use marijuana from breastfeeding despite inconclusive evidence of harm and well-known benefits of breastfeeding. Meanwhile, marijuana use is increasing among reproductive-aged women, and complex personal/socioeconomic factors affect feeding choices. We assess evidence and ethical justification for current practice. METHODS: We review: (1) Harm to infants from breastmilk marijuana exposure vs. avoiding breastfeeding, (2) Maternal health and psychosocial considerations, and (3) Current practices in light of principles of beneficence, justice, and autonomy. RESULTS: (1) Limited data suggests neurobehavioral changes among infants whose mothers use marijuana during breastfeeding, though socioeconomic confounders and difficulty of distinguishing in utero from breastmilk exposure hinder interpretation. Avoiding breastfeeding increases infants' risk of sudden infant death syndrome, sepsis, necrotizing enterocolitis, diabetes, asthma, and obesity. (2) Without breastfeeding, women have increased risk of cardiovascular disease, reproductive cancers, diabetes, depression and unintended pregnancy. Marijuana use is highest among underserved minority women who disproportionately suffer these health consequences and are especially vulnerable to punitive damages. (3) Benefits of breastfeeding for infants and women should be considered alongside risks of marijuana exposure through breastmilk. Lack of these considerations may exacerbate health disparities. Unbiased, culturally-informed counseling would promote open patient-provider communication and shared decision-making, and may improve long-term health. CONCLUSION: Restrictive breastfeeding policies for women who use marijuana which do not utilize an individualized, shared decision-making approach are not ethically justified, and may disproportionately undermine health of underserved women and infants.