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Legalization of marijuana for recreational use has increased the overall consumption of Cannabis spp. in Alaska, Colorado, Washington, and Oregon. We review the evidence regarding the impact of marijuana use during pregnancy and breastfeeding including evidence for adverse effects on infant and child neurodevelopment maturation and cognitive function. Based on animal and limited human studies of fetal brain tissue epigenetic effects of marijuana exposure during pregnancy on brain development have been documented. The recommendations from several professional organizations which advocate for the avoidance of marijuana by mothers during pregnancy, and the potential for adverse effects during breastfeeding, are reviewed. Studies find a positive association between parental drug use and child maltreatment. States with recreational marijuana have enacted laws regarding use of marijuana while driving a motor vehicle. There are existing laws regarding child endangerment in the context of driving under the influence. Legal marijuana use by parents is still in its infancy and questions of children endangerment have not been yet been fully answered. As more states legalize marijuana for recreational use the impact of prenatal exposure to cannabis and infant exposure, both Second-hand Smoke and through ingestion of contaminated breast milk during lactation needs to be carefully documented with a focus on the relationship between marijuana consumption and outcomes of pregnancy including infant and child psychomotor and cognitive development. In Colorado more than twice as many infants 1-24 months hospitalized for bronchiolitis in 2015 were found to have THC in their urine in after legalization indicating that recreational use contributed to secondhand marijuana smoke exposure in theses infants and thus, a growing health concern. Parenting skills and capacities may be altered with chronic marijuana use and rates of child abuse and endangerment will require systematic evaluation with broader use of marijuana after legalization. Broader availability of edible marijuana and its distillates that can be consumed by children pose significant health risks to children increasing healthcare utilization.

Maternal Use of Marijuana during Pregnancy and Lactation: Implications for Infant and Child Development and Their Well-Being