https://www.jognn.org/article/S0884-2175(24)00256-9/fulltext

In the United States, despite national efforts to increase breastfeeding initiation and continuation in recent decades, suboptimal breastfeeding rates persist and include continued disparities for people of color and those with low income (Chiang et al., 2021; Diaz et al., 2023). Coinciding with the national focus on breastfeeding promotion, the prevalence of cannabis use among women during pregnancy and the postpartum period has substantially increased (Skelton et al., 2020b; Skelton et al., 2021). Breastfeeding recommendations become more complex in the context of prenatal and postpartum cannabis use, especially when women exclusively use cannabis products and do not engage in polysubstance use. Current recommendations from clinical organizations discourage cannabis use while breastfeeding due to insufficient evidence about the potential adverse effects (American College of Obstetricians and Gynecologists, 2017; Association of Women’s Health, Obstetric and Neonatal Nurses [AWHONN], 2018; Harris et al., 2023; Ryan et al., 2018). Abstaining from breastfeeding may exacerbate existing health disparities in populations with greater rates of cannabis use, including those who are Black, younger (Alshaarawy & Vanderziel, 2022), or unmarried (Skelton & Benjamin-Neelon, 2021) or have low income (Young-Wolff et al., 2022). Furthermore, recommendations do not include guidance on managing substance use disorder or mental health conditions frequently associated with cannabis use. In this editorial, we describe the numerous benefits associated with breastfeeding and examine current disparities in breastfeeding outcomes in the United States. Next, we review how cannabis policy in the United States has changed in recent decades. Importantly, this includes an examination of current clinical guidelines for the use of cannabis while breastfeeding and how these guidelines might exacerbate disparities in health outcomes related to breastfeeding. Finally, we aim to offer guidance to perinatal nurses and clinicians on how to assist patients who use cannabis and wish to breastfeed.