317 - Marijuana Use During Pregnancy and Lactation: National Survey of Hospital Practices and Nursery Director Knowledge

Poster Number: 317

Pearl W. Chang, Seattle Children's Hospital / University of Washington, Seattle, WA, United States; Neera Goyal, Nemours Children's Hospital, Philadelphia, PA, United States; Dennis West, Academic Pediatric Association, Washington, DC, United States; Esther K. Chung, University of Washington and Seattle Children’s Hospital, Seattle, WA, United States

Background: An increasing number of states have legalized the use of marijuana, the most common substance used during pregnancy. Despite warnings from the American College of Obstetricians and Gynecologists and American Academy of Pediatrics, marijuana is often regarded by the public as safe. There is currently no consensus on best practices for the care of newborns whose mothers use perinatal marijuana.

Objective: To assess 1) hospital practices and 2) nursery director knowledge, attitudes, and behaviors related to maternal marijuana use and breastfeeding

Design/Methods: Cross-sectional survey of nursery directors via the Better Outcomes through Research for Newborns (BORN) network, administered electronically between 2/2021-11/2021. Survey assessed hospital characteristics and policies, clinician sociodemographic characteristics, and clinician knowledge, attitudes, and behaviors related to maternal marijuana use. Data were analyzed using Fisher’s exact tests.

Results: Of 110 BORN nursery directors, 69 (63%) across 38 states completed the survey. Most directors were general pediatricians or hospitalists (87%), >10 years post-training (68%), and working at teaching hospitals (94%). The majority of directors (81%) were “confident” in their knowledge of marijuana’s effects on health and almost all knew that marijuana use can cause poor judgment (96%) and impaired driving (96%), and that it can be found in the breastmilk of mothers who use (97%). However, many did not know about the potential risk of in-utero marijuana exposure causing child learning problems (15%) or child behavior problems (20%). Most directors (81%) reported practicing in states with legal marijuana use (35% for medical use only; 46% for medical and recreational use). A minority of directors (9%) work at hospitals that conduct universal maternal drug-screens; 37% of the remaining directors reported that marijuana use during pregnancy was not considered an indication for drug-screening. Most sites (83%) do not restrict breastfeeding for mothers with a positive marijuana drug screen at delivery (Figure 1). Over one-third (36%) refer mothers who have a positive marijuana drug screen to child welfare services (Figure 2). State marijuana legalization was associated with social work referral (p < 0.001) and child welfare referral (p=0.01), but not restrictions on breastfeeding. Conclusion(s): BORN network hospitals differ in their approach to mothers who use perinatal marijuana, which may relate to variation in state laws. Results suggest opportunity for standardizing practice and bolstering clinician knowledge of risks associated with marijuana use.
Figure 1. Hospital Breastfeeding Policy if Positive Maternal Marijuana Drug Screen at Time of Delivery.
Figure 2. Provider Practice Regarding Mothers With Positive Marijuana Drug Screen