Cannabis Use and Breastfeeding Initiation: Associations with Patterns, Perceived Risk, and Clinical Advice in a Multistate Pregnancy Risk Assessment Monitoring System Study (2017–2021)

Introduction: Despite increasing prevalence of perinatal cannabis use, little is known about how advice about cannabis use while breastfeeding at prenatal care visits is associated with breastfeeding initiation. We examined whether breastfeeding initiation varied by (1) maternal safety perceptions of cannabis use while breastfeeding, (2) perinatal cannabis use patterns, and (3) receipt of prenatal counseling regarding cannabis use. Methods: In this repeated cross-sectional study, we used 2017–2021 Pregnancy Risk Assessment Monitoring System data for 10 states that used the Marijuana Supplement. We further restricted the analytic sample to those respondents who reported any perinatal cannabis use. We calculated weighted prevalence estimates and used survey-weighted chi-square tests to assess differences in breastfeeding initiation by cannabis use pattern (prenatal only, postpartum only, or both), perceived safety of cannabis use while breastfeeding, and receipt of prenatal advice not to breastfeed if using cannabis. Results: In the analytic sample ( N = 52,577 live births), breastfeeding initiation was highest among those who reported postpartum-only cannabis use (89.52%; 95% CI: 82.01, 94.12) and lowest among those reporting both prenatal and postpartum cannabis use (71.88%, 95% CI: 63.25, 79.16). Breastfeeding initiation differed significantly by receipt of advice among women reporting postpartum-only cannabis use, with lower initiation among women who were advised against cannabis use while breastfeeding in comparison with those who were not advised (81.95% versus 94.07%; p = 0.004). Conclusions: Our findings underscore the importance of clinician counseling about cannabis use while breastfeeding. Future studies should examine communication strategies to discourage cannabis use while breastfeeding while simultaneously promoting breastfeeding as the best infant feeding choice.