Toxicology Screening for Marijuana and Impact on Breast Milk Feeding Policies in Neonatal Intensive Care Units

<b><i>Introduction:</i></b> Tetrahydrocannabinol (THC), the major psychoactive marijuana cannabinoid, can be transferred to neonates via maternal breast milk (MBM) feeds, but available literature on the safety of concomitant breastfeeding and THC use is inconsistent. This study aimed to assess neonatal intensive care unit (NICU) policies related to toxicology screening and provision of MBM from THC-positive mothers. We hypothesized variation in policies exists across the nation and may be associated with state legalization status. <b><i>Methods:</i></b> Cross-sectional survey of U.S. NICU policies related to: (1) toxicology screening of mother-baby dyads and (2) MBM feeding limitations based on THC screening status. We assessed the impact of THC legalization status on the various MBM limitations. <b><i>Results:</i></b> Of 187 NICUs surveyed, 79% performed selective toxicology screening based on risk factors, clinical concerns, or provider discretion. Of those that specifically addressed THC exposure and MBM feeding policies, 60% had at least one limitation to MBM feeds, ranging from preventing any MBM feeding during NICU admission to limiting MBM until mother tested negative for THC. We found no significant association between state legalization status and MBM limitations. NICU and nursery policies differed in 33% of institutions. <b><i>Conclusions:</i></b> Substantial variation exists in NICU policies regarding toxicology screening and MBM limitations related to THC. These inconsistent policies are based not on THC legalization status but rather on the location of delivery. More research is needed on the effect of THC exposure on neonates, but we could limit inconsistent care by following current national medical organization guidelines of education and shared decision-making with mothers.