Last update: Jan. 19, 2020

Cannabis

Very High Risk for breastfeeding


Very unsafe. Contraindicated.
Use of an alternative or cessation of breastfeeding.

El cáñamo (Cannabis sativa), es una planta rica en cannabinoides, siendo el principal el Δ9-TetraHidroCannabinol (THC) con propiedades psicotrópicas. Otros cannabinoides, carentes de actividad psicoactiva son cannabidiol (CBD), cannabigerol, cannabinol y Δ8-tetrahidrocannabinol (ElSohly 2017)
Contiene también numerosos flavonoides, fitoesteroles, vitaminas, ácidos grasos, aminoácidos, proteínas, enzimas, azúcares, alcaloides y aceite esencial, entre otros.
El consumo de los diversos preparados de cannabis puede ser por vía oral, inhalado por vaporización, tópico o en supositorios por vía rectal.

El aceite de cannabis es una sustancia resinosa extraída de la planta Cannabis (sativa o indica). Contiene los principales cannabinoides de la planta, entre ellos el THC y el CBD. Según el método de extracción o fabricación del aceite de cannabis, este puede contener más o menos cantidad de THC.
Hay comercializados varios medicamentos a base de CBD que contienen cantidades variables de THC, para el tratamiento de vómitos durante tratamientos anticancerosos y para tratar el dolor, espasticidad o epilepsia en determinadas enfermedades.

El Delta-9-TetraHidroCanabinol (THC) es liposoluble, se acumula en tejido graso y alcanza en la leche materna hasta 8,4 veces la concentración plasmática (Pérez 1982).
EL THC se excreta en leche materna en cantidad que podría ser significativa (RD hasta 8,7%) al tratarse de una droga psicotrópica; el CBD se excreta en muy pequeña cantidad (Bertrand 2018, Baker 2018, Marchei 2011).
El THC se detecta en leche materna hasta 3 a 6 semanas tras el último consumo (Wymore 2018).
Se ha encontrado THC en cantidad muy superior a la esperada en heces de lactantes cuyas madres fumaban marihuana, lo que sugiere absorción y metabolización posterior (la marihuana se excreta principalmente por heces) (Pérez 1982)

El THC es altamente lipofílico, por lo que se acumula en tejidos grasos, como el cerebro (Ryan 2018). Los cannabinoides, principalmente THC, pueden interrumpir el crecimiento axonal normal en cerebros en desarrollo (Tortoriello 2014).
El sistema endocannabinoide del organismo tiene un papel clave en el desarrollo del cerebro durante el embarazo, la lactancia y durante la adolescencia y se ve afectado por el aporte externo de THC, por lo que es preocupante la exposición a THC durante el embarazo y la lactancia, ya que puede provocar cambios epigenéticos en el desarrollo cerebral (Henschke 2019, Sachs 2013, Campolongo 2009, Fernández 2004).

Hay pocos estudios acerca de los efectos del consumo materno de cannabis en los lactantes amamantados y es difícil separarlos del consumo durante el embarazo.
Se ha encontrado relación entre la exposición prenatal y durante la lactancia y retraso en el neurodesarrollo, déficit cognitivo, alteraciones conductuales (incluso delictivas), consumo de drogas y trastorno de déficit de atención en la infancia y adolescencia (Smith 2016, Tortoriello 2014, Sharma 2012, Goldschmidt 2012 y 2008, Jaques 2005, Fried 2001 y 1995, Day 2011, 2006 y 1994).
Dos estudios no encontraron retraso de crecimiento ni de desarrollo psicomotor a corto-medio plazo en lactantes de madres fumadoras de marihuana (Ilett 2012, Tennes 1985).
Un estudio encontró retraso motor al año de edad en lactantes de madres fumadoras de marihuana; el retraso fue dosis-dependiente: mayor cuanto más fumaban y mayor si lo hicieron durante el primer mes (Moretti 2000, Astley 1990)
El consumo materno de cannabis durante la gestación se relaciona con menores peso y perímetro cefálico al nacimiento (El Marroun 2009, Fergusson 2002, Fried 1999).
El consumo paterno de marihuana se asoció a mayor riesgo de muerte súbita del lactante (Klonoff 2001).

El consumo de cannabis se asocia a incremento de los niveles de cortisol y a disminución de los niveles de prolactina ( Ranganathan 2009, D'Souza 2008, Mendelson 1985); otros autores no han encontrado alteraciones hormonales (Block 1991).
El consumo de cannabis se asocia a menor duración de la lactancia (Crume 2018. Ko 2018), a mayor consumo de tabaco y a depresión postparto (Ko 2018).
La alteración del juicio y la conducta y la mayor frecuencia de alteraciones mentales (Volkow 2014, Moore 2007) que produce el consumo de cannabis puede interferir con la capacidad materna de cuidados adecuados (Colorado DPHE 2017, Lawrence 2016 p604, Jansson 2015, ABM 2015, Jaques 2014, D'Souza 2008).

Diversas sociedades médicas, expertos y consensos de expertos consideran contraindicado el uso de cannabis, tanto de modo recreativo como medicinal, durante el embarazo y la lactancia ( Adashi 2019, van den Elsen 2019, Thompson 2019, Hale 2019, Ryan 2018, Jansson 2018, Krening 2018, Metz 2018 y 2015, Committee Obs-Gyn 2017, Jansson 2015, Briggs 2015, Warner 2014, Rowe 2013, Garry 2009, Schaefer 2007). Hasta conocer más datos publicados en relación con la lactancia sobre los productos de cánnabis de uso medicinal, son preferibles alternativas farmacológicas conocidas más seguras.

Otros autores, dados los riesgos de la alimentación con fórmula y la falta de datos precisos sobre los efectos del cannabis en la lactancia, optan por aconsejar a madres que no renuncian al consumo, que sigan amamantando reduciendo al máximo el consumo de cannabis, evitando consumir en la misma habitación y monitorizando los posibles efectos en los lactantes (Anderson 2017, ABM 2015, Djulus 2005).

La proporción de THC en los diversos productos derivados de la marihuana se ha ido incrementando progresivamente a lo largo de los últimos años (Metz 2015)

Se debe prevenir a las madres que amamantan de los posibles efectos negativos del THC en el desarrollo cerebral y neuroconductual de su bebés a corto y largo plazo, aconsejándoles que eliminen el consumo de marihuana en cualquiera de sus formas durante la lactancia

No se recomienda compartir cama con el bebé si se está consumiendo esta droga debido a riesgo incrementado de asfixia o muerte súbita del lactante (UNICEF 2018, 2017, 2014 y 2013, Landa 2012, ABM 2008, UNICEF 2006).


See below the information of this related product:

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Cannabis belongs to this group or family:

Tradenames

Main tradenames from several countries containing Cannabis in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. THC: 10 - 35 %
Molecular weight THC: 314 daltons
Protein Binding THC: 99 %
VD THC: 4 - 19 l/Kg
Tmax THC: 0,1 - 4; CBD: 1,6 - 2,8 hours
T1/2 THC: 28 - 56; CBD: 1,4 - 1,8 hours
M/P ratio THC: 8 -

References

  1. Hale TW. Hale's Medications & Mothers' Milk. Springer Publishing Company. 2019
  2. Thompson R, DeJong K, Lo J. Marijuana Use in Pregnancy: A Review. Obstet Gynecol Surv. 2019 Jul;74(7):415-428. Abstract
  3. van den Elsen GAH, In 't Hout FEM, de Vries M, Olde Rikkert MGM, Kramers C, Verkes RJ. [Medicinal cannabis]. Ned Tijdschr Geneeskd. 2019 May 3;163. pii: D3629. Dutch. Abstract
  4. Henschke P. Cannabis: An ancient friend or foe? What works and doesn't work. Semin Fetal Neonatal Med. 2019 Apr;24(2):149-154. Abstract
  5. Adashi EY. Brief Commentary: Marijuana Use During Gestation and Lactation-Harmful Until Proved Safe. Ann Intern Med. 2019 Jan 15;170(2):122. Abstract
  6. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  7. Wymore E, Bunik M, Levek C, Wang G, Metz T, Bourne D, Sempio C, Klawitter J. Duration of marijuana excretion in human breast milk. Breastfeed Med. 2018;13 (S-2):S-40. Abstract 92. Full text (link to original source) Full text (in our servers)
  8. Krening C, Hanson K. Marijuana-Perinatal and Legal Issues With Use During Pregnancy. J Perinat Neonatal Nurs. 2018 Jan/Mar;32(1):43-52. Abstract
  9. Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabis Use During the Perinatal Period in a State With Legalized Recreational and Medical Marijuana: The Association Between Maternal Characteristics, Breastfeeding Patterns, and Neonatal Outcomes. J Pediatr. 2018 Jun;197:90-96. Abstract
  10. Ko JY, Tong VT, Bombard JM, Hayes DK, Davy J, Perham-Hester KA. Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Drug Alcohol Depend. 2018 Jun 1;187:72-78. Abstract
  11. Baker T, Datta P, Rewers-Felkins K, Thompson H, Kallem RR, Hale TW. Transfer of Inhaled Cannabis Into Human Breast Milk. Obstet Gynecol. 2018 May;131(5):783-788. Abstract
  12. Jansson LM, Jordan CJ, Velez ML. Perinatal Marijuana Use and the Developing Child. JAMA. 2018 Aug 14;320(6):545-546. Abstract
  13. Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk. Pediatrics. 2018 Sep;142(3). pii: e20181076. Abstract
  14. Ryan SA, Ammerman SD, O'Connor ME; COMMITTEE ON SUBSTANCE USE AND PREVENTION.; SECTION ON BREASTFEEDING.. Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes. Pediatrics. 2018 Sep;142(3). pii: e20181889. Abstract
  15. Ryan SA. A Modern Conundrum for the Pediatrician: The Safety of Breast Milk and the Cannabis-Using Mother. Pediatrics. 2018 Sep;142(3). pii: e20181921. Abstract
  16. Metz TD, Borgelt LM. Marijuana Use in Pregnancy and While Breastfeeding. Obstet Gynecol. 2018 Nov;132(5):1198-1210. Abstract
  17. Colorado Department of Public Health and Environment. Marijuana pregnancy and breast-feeding guidance for Colorado health care providers. https://www.colorado.gov/ pacific/sites/default/files/MJ_RMEP_ Marijuana pregnancy and breast-feeding guidance for Colorado health care providers. Published 2017. Accessed January 2, 2018. Pregnancy-Breastfeeding- Clinical-Guidelines.pdf. 2017 Full text (link to original source) Full text (in our servers)
  18. Ball H, Blair PS. (For UNICEF UK). Caring for your baby at night. Health professional´s guide. 2017 Full text (link to original source) Full text (in our servers)
  19. Committee on Obstetric Practice.. Committee Opinion No. 722: Marijuana Use During Pregnancy and Lactation. Obstet Gynecol. 2017 Oct;130(4):e205-e209. Abstract
  20. Anderson PO. Cannabis and Breastfeeding. Breastfeed Med. 2017 Dec;12(10):580-581. Abstract
  21. ElSohly MA, Radwan MM, Gul W, Chandra S, Galal A. Phytochemistry of Cannabis sativa L. Prog Chem Org Nat Prod. 2017;103:1-36. Abstract
  22. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. 11th edition (acces on line) 2017
  23. Smith AM, Mioduszewski O, Hatchard T, Byron-Alhassan A, Fall C, Fried PA. Prenatal marijuana exposure impacts executive functioning into young adulthood: An fMRI study. Neurotoxicol Teratol. 2016 Nov - Dec;58:53-59. Abstract
  24. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  25. Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. Am J Obstet Gynecol. 2015 Dec;213(6):761-78. Abstract
  26. ABM Protocolo clínico de la ABM n.º 21: Pautas para la lactancia y el consumo de sustancias o trastorno por consumo de sustancias, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  27. Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  28. Jansson LM, Bunik M, Bogen DL. Lactation and the Marijuana-Using Mother. Breastfeed Med. 2015 Jul-Aug;10(6):342-3. Abstract
  29. Tortoriello G, Morris CV, Alpar A, Fuzik J, Shirran SL, Calvigioni D, Keimpema E, Botting CH, Reinecke K, Herdegen T, Courtney M, Hurd YL, Harkany T. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014 Apr 1;33(7):668-85. Abstract
  30. Jaques SC, Kingsbury A, Henshcke P, Chomchai C, Clews S, Falconer J, Abdel-Latif ME, Feller JM, Oei JL. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol. 2014 Abstract
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  32. UNICEF UK. Statement on co-sleeping following publication of new NICE postnatal guidance. Infosheet. 2014 Full text (link to original source) Full text (in our servers)
  33. Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol. 2014 Dec;41(4):877-94. Abstract
  34. UNICEF UK Baby Friendly Initiative statement on Bed-sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. 2013 Full text (link to original source) Full text (in our servers)
  35. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  36. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
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  39. L.Landa Rivera, M.Díaz-Gómez, A.Gómez Papi, J.M.Paricio Talayero, C.Pallás Alonso, M.T.Hernández Aguilar, J.Aguayo Maldonado, J.M.Arena Ansotegui, S.Ares Segura, A.Jiménez Moya, J.J.Lasarte Velillas, J.Martín Calama, M.D.Romero Escós. El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres. Rev Pediatr Aten Primaria. 14:53-60 2012 Full text (link to original source) Full text (in our servers)
  40. Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med. 2012 Aug;7:269-74. Abstract
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  42. Marchei E, Escuder D, Pallas CR, Garcia-Algar O, Gómez A, Friguls B, Pellegrini M, Pichini S. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal. 2011 May 15;55(2):309-16. Abstract
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  50. ABM - Comité de protocolos de la Academia médica de lactancia materna (Academy of Breastfeeding Medicine). Protocolo Clínico de la ABM #6: Lineamientos sobre la práctica de dormir al bebé junto con la madre y la lactancia materna Revisión, marzo de 2008. Breastfeeding Medicine 2008 Full text (link to original source) Full text (in our servers)
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