423 - Racial Inequities in Breastfeeding Counseling among Pregnant People who use Cannabis

Poster Number: 423
Publication Number: 423.301

Laura R. Kair, University of California, Davis, School of Medicine, Sacramento, CA, United States; Adrienne E. Hoyt-Austin, University of California Davis Children's Hospital, Sacramento, CA, United States; Melissa Chen, University of California, Davis, School of Medicine, Sacramento, CA, United States; Brandie Bentley, University of Illinois at Urbana Champaign, Champaign, IL, United States; Karen M. Tabb, University of Illinois at Urbana-Champaign School of Social Wor, Urbana, IL, United States; Mishka Terplan, Friends Research Institute, Baltimore, MD, United States; Jennifer McAllister, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Scott Wexelblatt, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Aaron Murnan, University of Cincinnati's College of Nursing, Cincinnati, OH, United States; Chidiogo Anyigbo, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Christine Wilder, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Nichole Nidey, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Cannabis use has increased in the US among pregnant and postpartum people. Disparities in breastfeeding rates persist across racial/ethnic groups in the US with Black dyads experiencing the lowest breastfeeding initiation and continuation rates. Although professional societies (AAP and ACOG) advise against using cannabis while breastfeeding, the extent to which breastfeeding guidance given by healthcare providers to pregnant patients who use cannabis varies by maternal race and ethnicity is unknown.

Objective: 1) To examine how prenatal breastfeeding counseling for people who use cannabis differs by maternal race and ethnicity and 2) To examine the association between receipt of provider counseling not to breastfeed if using cannabis and breastfeeding initiation among people who use cannabis.

Design/Methods: We analyzed data from the population-representative 2017-18 CDC Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 9 states with data on prenatal breastfeeding advice and cannabis use using weighted logistic regression models, unadjusted and adjusted for insurance type, year of delivery, prenatal smoking, maternal education, maternal age, and state.

Results: In this study, 9.5% of respondents who reported cannabis use during pregnancy or the 3 months prior, are shown in Table 1. Of these respondents (weighted Nf51,793), 36.2% reported receiving advice from a prenatal care provider not to breastfeed if they used cannabis, and receipt of this advice was associated with decreased odds of initiating breastfeeding (OR 0.6, 95% CI 0.3,0.99). Black people were disproportionately advised not to breastfeed if using cannabis and had 4 times the odds of receiving this advice when compared with non-Hispanic white birthing people (aOR 4.1, 95% CI 2.1,8.2). Results are summarized in Table 2.Conclusion(s): In this study of birthing people who used cannabis prior to and/or during pregnancy, over one third of respondents reported being advised to avoid breastfeeding if using cannabis. Advice not to breastfeed was associated with lower odds of initiating breastfeeding, and Black birthing people were 4 times as likely as non-Hispanic white people to be advised not to breastfeed if using cannabis. As cannabis use continues to increase, practice guidelines and provider education are critical. To achieve equitable maternal-child health outcomes, interventions aimed at increasing breastfeeding initiation need to prioritize addressing structural and interpersonal racism in the context of maternal-child health care.
Table 1: Characteristics of Study PopulationTotal Weighted Sample Size n=51,793, Actual Sample Size n = 1,213, NH=non-Hispanic
Table 2: Odds of Receiving Prenatal Advice Not to Breastfeed When Using Cannabis Among Pregnant People with Self-Reported Prenatal Cannabis Use by Self-Reported Race & Ethnicity*= p < .05, **= p < .01, ***= p < .001, NH = non-Hispanic, Model 1: unadjusted, Model 2: adjusted for insurance type, state of residence, year of delivery, prenatal smoking, maternal education, and maternal age