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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 1: Practices: Antenatal Consultation, Substance Use, Potpourri

724 - Short Term Outcomes of Unit Policy Change on Provision of Mother’s Own Milk in the Setting of Maternal Marijuana Use

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 724
Publication Number: 724.244

Amy C. Blake, Baystate Children's Hospital, Springfield, MA, MA, United States; Laura Madore, Baystate Children's Hospital, Springfield, MA, United States; Jixi He, Baystate Children's Hospital, Springfield, MA, United States

Presenting Author(s)

Amy C. Blake, MD (she/her/hers)

Assistant Professor of Pediatrics
Baystate Children's Hospital
Springfield, MA, Massachusetts, United States

Background: Marijuana (MJ) has been legalized for medical and/or recreational use in many states, including Massachusetts as of 2016, and is now the most used nonprescription drug in lactation. Due to lack of consensus given infant benefits of mother’s own milk (MOM) but potential risks with MJ exposure, hospital-based policies vary widely regarding provision of MOM in the setting of maternal MJ use (MOM-MJ). In January 2020, our Neonatal Intensive Care Unit (NICU) policy changed from requiring negative maternal urine toxicology for MJ prior to use of MOM, to allowing MOM-MJ after documented parental education to discourage MJ use.

Objective: To evaluate effect of MOM-MJ policy change for preterm infants in our NICU on 1) time to first feeds; 2) time to MOM provision; 3) rates of MOM feeding on day of life 7 (DOL 7) and discharge; 4) rates of combined neonatal morbidities in NICU.

Design/Methods: We performed an observational cohort study via retrospective chart review of inborn infants < 33 weeks gestation admitted to the NICU at Baystate Medical Center in Springfield, MA between January 2013 and September 2022 with known maternal use of MJ, excluding those with exposure to other illicit substances. Infants were divided into two epochs: Epoch 1 (E1, 1/2013-12/2019) was prior to policy change; Epoch 2 (E2, 1/2020-9/2022) was after policy change. Data collected in REDCap included demographic, feeding, growth and morbidity variables. Data was analyzed via Chi-Square, Fisher Exact, and Student’s t-tests.

Results: From 1/2013-9/2022, 1349 infants < 33 weeks were admitted to our NICU; 133 (9.8%) had documented MJ exposure. Of these, 90 were inborn (E1: n=67; E2: n=23). Demographics were similar between epochs (Table 1). Infants in E2 had faster time to first feed (1.3±0.7 vs 2.0±1.9 days, p< 0.05) and to first MOM feed (6.2±9.8 vs 15.5±12.9 days, p< 0.05). Time to goal feeds, time to regain birth weight and average daily weight gain in NICU were similar in E1 and E2. More infants in E2 vs E1 received MOM on DOL 7 (47.8 vs 7.6%, p< 0.01) and discharge (43.5 vs 12.9%, p< 0.05). Among survivors, incidence of total and any morbidities were lower in E2 than E1: 30% vs 76% (p< 0.05) and 26.1% vs 56.5% (p< 0.05), respectively (Figure 1).

Conclusion(s): In our NICU, a policy allowing use of MOM-MJ after parental education to discourage continued MJ use increases provision of MOM to preterm infants. Morbidity rates were also lower, consistent with studies showing improved outcomes with MOM feedings outside the setting of maternal MJ use. Additional research is warranted to evaluate long term outcomes of postnatal MJ exposure.