Background:
Greater societal perception of marijuana (MJ) safety has been associated with increasing use during pregnancy. Yet, mother's intention to breastfeed (ITBF) when using MJ and in the context of paternal use is unclear.
Objective:
To describe ITBF among mothers exclusively using either MJ, electronic cigarettes (Ecig), or tobacco products (Tob), compared to multi-substance (MS), and non-users (NU) around the time of pregnancy. Secondary objective was to assess the effects of paternal presence and substance use (Ecig, MJ, Tob, MS) on mother's ITBF.
Methods:
Cross-sectional analysis (2016 – 2020) of parental survey data merged with electronic birth certificate data, administered to all parents (≥18 years) of singleton live-born infants at Westchester Medical Center, Valhalla, NY, and 6 affiliate birthing hospitals. Exposure groups included exclusive use of MJ, Ecig, or Tob, NU and MS (any combination of MJ, Ecig, Tob). Primary outcome was maternal ITBF. Primary analysis included all mothers, and subgroup analysis was performed based on paternal presence in the immediate postpartum period and accounted for both maternal and paternal substance use.
Results:
Of 1073 mothers, 2% were ecig users, 3% MJ users, 9% Tob users, 9% MS and 78% NU. In adjusted models, exclusive maternal MJ users had lower odds of ITBF compared to NU among all mothers (OR 0.38, C.I. 0.17 – 0.85); as well as in mothers without paternal presence (OR 0.15, C.I. 0.04 – 0.55). However, in mothers with paternal presence, odds of ITBF (OR 1.64, C.I. 0.29 – 9.33) were no different than NU controlling for covariates including paternal use (MJ, Tob, Ecig, or MS), and parental adverse life events.
Conclusions:
Women exclusively using MJ have lower ITBF compared to NU. However, father's presence mitigated this effect independent of paternal MJ use. Hence the presence of fathers may represent a unique risk factor for increased ITBF in MJ using mothers. As decisions involving breastfeeding are frequently made prior to birth, prenatal counselling regarding potential risks of MJ exposure via human milk should involve the fathers.
