Human Milk Feeding and Cannabis Use: Recommendations from the Field Post Cannabis Legalization in VT
Jessilyn Dolan with the University of Vermont
Human milk feeding is associated with many health benefits for the lactating parent and child but there is very limited scientific research regarding the effects of cannabis use during human milk feeding. Our group surveyed lactation professionals attending a 2014 lactation conference in Vermont on their recommendations regarding human milk feeding and cannabis use (Bergeria & Heil, 2015). The majority of lactation professionals reported making recommendations regarding human milk feeding and cannabis use on a case by case basis (44%) or recommended continuing human milk feeding despite cannabis use (41%). However, 15% of participants recommended parents discontinue human milk feeding if they were using cannabis. At the time of the study, only medical cannabis was legal in Vermont, but recreational cannabis was legalized in 2018. Some research suggests that cannabis legalization laws could result in reduced perceptions of harm (Cerda et al., 2017; Khatapoush & Halfors, 2004; Moreno et al., 2016) by implying cannabis safety or government approval for some people (Moreno et al., 2016).
The purpose of this study was to replicate Bergeria and Heil (2015) by surveying lactation professionals on their recommendations regarding human milk feeding Method A sample of lactation professionals was recruited at the 26th Annual Professional Lactation Conference hosted by Vermont Lactation Consultant Association, Inc. on May 9-10, 2019 in Burlington, VT. All attendees were invited to participate and complete a brief, 12-item survey regarding human milk feeding and cannabis use. Comparisons between 2014 and 2019 data were based on Chi-square tests. Analyses were performed using SAS statistical software Version 9.4 (SAS Institute, Cary, NC).
Statistical significance was determined using p <.05. 75% of 2019 respondents reported that they work with parents who human milk feed and use cannabis. This did not differ from 2014 results. The 58 participants that indicated they work with parents who human milk feed and use cannabis worked with a median of 100 human milk feeding parents in the last year. 2019 respondents estimated 20% of the human milk feeding parents they work with are also cannabis users. This did not differ from 2014 results. With respect to how participants knew that some of the parents were cannabis users, the majority said that the parents self-reported their use.
Nearly two-thirds of 2019 respondents indicated that whether parents should stop breastfeeding depends on a number of factors (e.g., the severity of their cannabis use, their parenting situation, other lifestyle factors, etc.) and many indicated that parents should continue human milk feeding because the benefits of human milk feeding outweigh the harms of cannabis use (Figure). Significantly more 2019 respondents cited a factor-dependent stance and fewer indicated stopping compared to 2014 results (ps < .05) 2019 respondents most commonly selected the AAP policy statement, their personal experience working with parents who human milk feed and use cannabis, and the ABM guidelines as sources for their stance on human milk feeding and cannabis (Table 3). The 2019 percentages for both the AAP policy statement and the ABM guidelines were significant increases compared to 2014 results (ps <.01) as was the percentage of respondents who based their stance on their state’s child protective services policies (p < .01).
The current study examining recommendations regarding human milk feeding (HMF) parents who cannot stop using cannabis found that there was an increase in the percentage of lactation professionals who reported their recommendation was factor dependent and a decrease in the percentage of respondents who recommended parents discontinue HMF when compared to recommendations made in 2014 (Bergeria & Heil, 2015), before the legalization of recreational cannabis in Vermont. There was also an increase in respondents who reported their stance was based on the AAP policy statement, the ABM guidelines, and their state’s child protective services policies when compared to responses in 2014. The shift toward less definitive answers on stance could be an indication that lactation professionals are having more nuanced discussions regarding cannabis use and HMF.
It is possible that the legalization of recreational cannabis in Vermont played a role in stimulating these discussions and required lactation professionals to address these issues in their practice directly. The changed legal status of cannabis in Vermont could also explain the increase in the percentage of respondents who reported that their recommendations were based on AAP and ABM guidelines. Cannabis legalization might have required professionals to deliberately research and become familiar with the relevant latest guidelines from their professional organizations and to formalize policies in their workplace.