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Cannabis use during lactation may alter the composition of human breast milk

Pediatric Research volume 93, pages 1959–1968 (2023)Cite this article

Abstract

Background

Cannabis is often used by women to manage symptoms of morning sickness during pregnancy, and postpartum stress and anxiety. While exclusive breastfeeding has been recommended for the first 6 months of an infant’s life, the presence of cannabinoids in the milk of cannabis users complicates this recommendation. The objective of this study was to investigate the effect of maternal cannabis use on changes in the levels of macronutrients and bioactive factors in breast milk.

Methods

Milk was collected from women who were 6–8 weeks postpartum and were either using cannabis post-delivery, had used cannabis during pregnancy, or were non-users. Levels of cannabinoids, macronutrients, lactose, and SIgA were assessed in the milk of all subjects.

Results

THC was detected in the milk of women who reported cannabis use during lactation (n = 13, median: 22 ng/mL). Carboxy-THC, 11-hydroxy-THC, CBD, and CBN were also detected in the milk of women who used cannabis postpartum. Relative to non-users (n = 17), lactose levels were higher and SIgA levels were significantly lower in the milk of subjects who used cannabis during lactation (n = 14).

Conclusions

The presence of cannabinoids, along with altered lactose and SIgA levels in the milk of cannabis users, may have implications for infant health.

Impact

  • Metabolites of cannabis are found in breast milk and can accumulate in higher concentrations with ongoing consumption, which is concerning for potential exposure among infants born to mothers who consume cannabis.

  • This work reports that lactose levels are increased and SIgA levels are decreased in the breast milk of cannabis users, relative to the milk of non-users.

  • Change in levels of lactose and SIgA in the milk of cannabis users may have significant implications on infant health, which must be investigated in the future to better inform mothers.

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Fig. 1: Macronutrient levels in the milk of cannabis users were not different from the milk of non-users.
Fig. 2: Lactose levels were higher and SIgA levels were lower in the milk of cannabis users relative to non-users.
Fig. 3: Correlation of carboxy-THC and 11-OH-THC with protein and SIgA levels in the milk of cannabis users.
Fig. 4: Macronutrient, lactose, and SIgA levels in the milk of cannabis and cigarette co-users relative to non-users and cannabis users.
Fig. 5: Lactose and SIgA levels in the milk of non-users and cannabis users.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

Thank you to Nicole Gervais (Research Ethics Advisor, McMaster University) for her guidance in obtaining the ethical approval for this study. We thank the Centre for Microbial Chemical Biology Core Facility at McMaster University for their contribution to this publication. Specifically, to Nicola Henriquez, the CMCB Mass Spectrometry Technician for assistance with conducting the cannabinoid analysis for this study. We would also like to thank the following undergraduate students who provided technical assistance throughout the study: Kush Patel (BHSc), Karen Man Yee Zhao (BHSc), and Sanjum Hunjan (BHSc).

Funding

A.K.S. was supported by the Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare Hamilton. S.R. received support from the Canadian Institutes of Health Research (funding reference number 158267) and the Michael G. DeGroote Centre for Medicinal Cannabis Research. The other authors received no external funding. The funding agency had no role in the design and conduct of the study.

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Author notes

  1. These authors contributed equally: Sandeep Raha, Alison K. Shea.

Authors and Affiliations

  1. Department of Pediatrics and the Medical Science Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Chitmandeep Josan & Sandeep Raha

  2. Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada

    Samantha Shiplo

  3. Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Gerhard Fusch

  4. Department of Obstetrics and Gynecology, St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada

    Alison K. Shea

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  1. Chitmandeep Josan
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Contributions

S.R. and A.K.S. conceptualized and designed the study, acquired, and contributed funding for the study, as well as reviewed and revised the manuscript. C.J. also contributed to the conceptualization and design of the study, obtained ethics approval for the study protocol, acquired breast milk samples, performed instrumental and biochemical analysis of the samples, processed the resulting data, drafted the initial manuscript, and reviewed and revised the manuscript. S.S. facilitated recruitment, and obtained and analyzed data from the medical charts of subjects at the time of labor and delivery. G.F. coordinated and supervised macronutrient data collection, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sandeep Raha.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This research protocol (Project number: 8152) was approved by the Hamilton Integrated Research Ethics Board (HiREB). HiREB represents the institutions of Hamilton Health Sciences, St. Joseph’s Healthcare Hamilton, Research St. Joseph’s-Hamilton, and the Faculty of Health Sciences at McMaster University and operates in compliance with and is constituted in accordance with the requirements of The Tri-Council Policy Statement on Ethical Conduct of Research Involving Humans; The International Conference on Harmonization of Good Clinical Practices; Part C Division 5 of the Food and Drug Regulations of Health Canada, and the provisions of the Ontario Personal Health Information Protection Act 2004 and its applicable Regulations; For studies conducted at St. Joseph’s Healthcare Hamilton, HiREB complies with the Health Ethics Guide of the Catholic Alliance of Canada. All subjects provided consent to participate in this study.

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Josan, C., Shiplo, S., Fusch, G. et al. Cannabis use during lactation may alter the composition of human breast milk. Pediatr Res 93, 1959–1968 (2023). https://doi.org/10.1038/s41390-022-02315-1

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