384 - Breastfeeding and Developmental Outcomes in Infants with Prenatal Cannabis Exposure

Human milk is important for optimal infant health and neurodevelopment. The American Academy of Pediatrics counsels against use of cannabis during pregnancy and lactation but states that cannabis is not a reason to prohibit breastfeeding. However, concerns about the impact of cannabis exposure through human milk on infant development may discourage pediatricians from supporting breastfeeding in the setting of parental cannabis use.

Objective:

We examined the relationship between breastfeeding and developmental outcomes among infants with prenatal cannabis exposure.

Design/Methods:

We utilized the Maternal Infant Data Hub, a regional perinatal data repository of maternal and infant data of all births within a large academic hospital system. Birthing people in Cincinnati, Ohio are universally tested for substances via a urine drug screen (UDS) in labor and delivery. Breastfeeding was captured from the birth certificate. An infant was considered to have developmental delay if one of three ICD9 codes for a delayed milestone or speech disorder were identified. For our analytic sample, we included only infants with a birthing parent with a UDS positive for cannabis at delivery. We used descriptive statistics to examine demographic characteristics and to compare those who breastfed versus those who did not. We then used logistic regression to model the odds of developmental delay among those who breastfed or did not, unadjusted and adjusted for preterm delivery, year of delivery, and tobacco smoking.

Results:

A total of 1,520 infant born from 2013-2019 with a maternal positive UDS for cannabis were included in the analysis. Of these, 818 (54%) were not breastfed and 702 (46%) were breastfed (Table 1). A total of 254 (17%) infants had developmental delay (Table 2). In the unadjusted analysis, breastfeeding was associated with decreased odds of developmental delay (OR 1.32, 95% CI 1.00, 1.76). After adjustment for maternal tobacco smoking, prematurity, and birth year, the findings were no longer statistically significant (OR 1.24, 95% CI 0.93, 1.67).

Conclusion(s):

In this study of infants born to a parent with a positive cannabis drug test at delivery, there was no difference in developmental outcomes by breastfeeding status. Given the multiple known health risks for both mothers and infants from not breastfeeding, this work supports the recommendation to support people who use cannabis to breastfeed their infants. Future studies with more detailed feeding data and a larger sample size are needed to assess whether breastfeeding is protective against developmental delay in this population.