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With the legalization of marijuana in several US states, increased use has been seen in pregnant and breastfeeding women for both medicinal and recreational purposes. Although national organizations like the American Academy of Pediatrics recommend breastfeeding mothers do not use marijuana, there has been a lack of current data to support any health or neurodevelopmental concerns in infants as a result of exposure to tetrahydrocannabinol (THC) or other components of marijuana via breast milk.

“Pediatricians are often put into a challenging situation when a breastfeeding mother asks about the safety of marijuana use. We don’t have strong, published data to support advising against use of marijuana while breastfeeding, and if women feel they have to choose then we run the risk of them deciding to stop breastfeeding – something that we know is hugely beneficial for both mom and baby,” said Christina Chambers, PhD, MPH, principal investigator of the study, program director of Mommy’s Milk, and co-director of the Center for Better Beginnings.

Cannabinoids, marijuana’s active compounds, such as THC, like to stick to fat, which is abundant in breast milk. This stickiness has suggested that in women who use marijuana, these compounds can end up in breast milk, raising concerns about their potential effects on nursing babies.

To better understand how much marijuana actually gets into breast milk and how long it stays there, our Mommy’s Milk team conducted a study published online today in the journal Pediatrics. We examined 54 breast milk samples from 50 women who used marijuana either daily, weekly or sporadically – with inhalation being the primary method of intake. THC, the primary psychoactive component of marijuana, was detected in 63 percent of the breast milk samples up to six days after the mother’s last reported use.

“We found that the amount of THC that the infant could potentially ingest from breast milk was relatively low, but in some mothers could be detected as long as six days after the mother last used marijuana. We still don’t know enough about the drug to say whether or not there is a concern for the infant at any dose, or if there is a safe dosing level,” said Dr. Chambers. “The ingredients in marijuana products that are available today are thought to be much more potent than products available 20 or 30 years ago.”

Dr. Chambers believes that the results are a stepping stone for future research. More studies need to be done not only to determine the long-term impact for children, if any, of marijuana in breast milk, but more specifically, “are there any differences in effects of marijuana in breast milk for a two-month old versus a 12-month old, and is it different if the mother smokes versus eats the cannabis? These are critical areas we need answers to as we continue to promote breast milk as the premium in nutrition for infants.”

Study co-authors include: Kerri Bertrand, MPH; Nathan Hanan, PharmD; Gordon Honerkamp-Smith, MS; and Brookie Best, PharmD, MAS, all with UC San Diego.

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Fetal Alcohol Spectrum Disorders (FASD) are costly, life-long disabilities that are 100% preventable, but estimates of how commonly they occur have been outdated and based on small, non-diverse samples. Not any more! With funding from the National Institute on Alcohol Abuse and Alcoholism and working with colleagues at the University of North Carolina – Chapel Hill and the University of New Mexico, our experts recently published research that provides an updated estimate of how common FASD are in the United States, including right here in Southern California. What did we find? FASD are more common than previously thought, and may be as common as (and in some cases, more common than) autism. The study was published in the Journal of the American Medical Association.

To find out how common Fetal Alcohol Spectrum Disorders (FASD) are, our research team collaborated with other researchers to evaluate first-grade children in 4 regions of the United States. A total of 6,639 children were assessed on their physical growth, key facial features, and their cognitive and behavioral development, and their mothers were interviewed about alcohol use during their pregnancy with the participating child. Across the 4 study regions, we found that about 1% to 5% of children were estimated to have FASD. This was the most conservative estimate and assumed that no additional cases of FASD would have been found in children who did not participate in the study. But when we applied an alternate approach that assumed the prevalence of FASD that we found in participating children would be the same in non-participating children in each community, the estimated prevalence of FASD was even higher, ranging from about 3% to 10% of children.

So what does this mean? These estimates suggest that harmful levels of prenatal alcohol exposure are common in the U.S. today; they also highlight the public health burden due to FASD. A well-known developmental disorder, Autism Spectrum Disorders, is estimated to affect about 1.5% of children; our study suggests that FASD may be just as common as, and in some cases more common than, autism! According to Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, “FASD is a leading cause of developmental disabilities worldwide. Understanding the prevalence of FASD in the U.S. is needed to determine the public health burden of FASD and to identify the need for resources to treat the disorders. These findings underscore the need for targeted programs for children with FASD and for interventions to prevent alcohol use during pregnancy.

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UC San Diego’s Center for Better Beginnings and the newly formed volunteer task force, Better Beginnings Coalition, announce the launch of Nine Months Matter Advocacy Campaign—a public awareness event to alert the community that no amount of alcohol during pregnancy is safe. Nine Months Matter will educate the community on the effects of alcohol on a developing baby with the goal to reduce the number of children born in the U.S. with Fetal Alcohol Spectrum Disorders (FASD) by 80% by the year 2025. The campaign kicked off on September 30^th at the La Jolla Beach and Tennis Club with Dr. Kenneth Lyons Jones, Center for Better Beginnings Co-Director, Dr. Miguel del Campo, Center for Better Beginnings Faculty Member and founding member of the European FASD Alliance, and Judge Marian Gaston with the Superior Court of San Diego County. The event was sponsored by the Morrison and Foerster Foundation and Quest Diagnostics.

In 1973 Dr. Jones and his mentor Dr. David Smith described Fetal Alcohol Syndrome and made the connection between brain injury in newborns and alcohol consumed during pregnancy. Children born with FASD have social, educational and behavioral disabilities. In school, these children have severe learning disabilities. In addition, they have a difficult time assessing right from wrong and don’t understand consequences; as a result, these children and young adults unfortunately often end up in the legal system.

Research has shown consuming alcohol during pregnancy is more dangerous to a developing baby than cocaine, heroin or methamphetamine. Misinformation is common; many times women are told by their physicians that having a drink or two while pregnant is safe. However, alcohol crosses the placenta and there is no time during pregnancy when it is safe to drink because the brain is constantly developing.

If you would like to join the Better Beginnings Coalition, contact campaign chair Mary Reynolds at mreynolds52@san.rr.com. Visit Nine Months Matter for more information or follow on Facebook at  https://www.facebook.com/ninemonthsmatter/.

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Working with colleagues at the UC San Diego Jacobs School of Engineering and elsewhere, our experts recently published research suggesting that an early screen looking at certain changes in a baby’s heart rate pattern, called cardiac orienting response (COR), may be a better early predictor for developmental delay following prenatal alcohol exposure (PAE) that standardized developmental testing. Why is this important? The effects of PAE on a child’s development often are not diagnosed until the child begins to struggle in school, and standardized tests for developmental delay are often costly and labor-intensive. An easy and effective screening tool like COR could make it possible to identify and treat these children much earlier in life while their brains are still developing. The study was published in the journal Alcoholism: Clinical & Experimental Research.

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One substance of rapidly growing public health interest is marijuana. With increasing access to legal recreational marijuana in the U.S., the question of the safety of its use during breastfeeding has risen in prominence.  Nearly 11% of women who are either pregnant or breastfeeding use marijuana; however, there are insufficient data on marijuana use during pregnancy and lactation or the potential developmental consequences for exposed children.

In response to the pervasive lack of data in this area, Mommy’s Milk has been awarded a three-year $110,000 grant from the Gerber Foundation to measure the concentration of cannabinoids (the various components of the Cannabis sativa plant) in human milk and to examine selected infant health related outcomes.

This work will begin to fill an important gap in public health knowledge, and will ultimately help support clinical guidance and education regarding marijuana use during lactation for obstetricians and pediatricians alike.

Mommy’s Milk was established in 2014 at the University of California San Diego’s Center for Better Beginnings with support from Rady Children’s Hospital, San Diego. It is a national resource for multidisciplinary researchers seeking to study various aspects of breast milk in relation to health, disease and medication exposures.  To date, 530 breast milk samples are stored and available for research purposes.

Breastfeeding women can learn more about study participation at www.mommysmilkresearch.org or by sending an email to milkstudy@ucsd.edu. Researchers can contact the study manager directly.

Study Principal Investigator Contact: Dr. Christina D. Chambers, 858-246-1704, chchambers@ucsd.edu

Study Manager Contact: Kerri Bertrand, 858-246-1713, kdutcher@ucsd.edu

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Miguel del Campo, MD, PhD, associate professor at UC San Diego’s Center for Better Beginnings and dysmorphologist for MotherToBaby, describes the set of observable characteristics of the Zika virus in a new paper published in the American Journal of Medical Genetics.

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