User:Nancepants2/sandbox

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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Cannabis Use Disorder

Assignment 2
Information to add: The effect of cannabis use in new mothers, specifically whether it is safe to breastfeed.

Search strategy and sources identified

I first searched PubMed using the following search:

"Breast Feeding"[Mesh] AND "Marijuana Abuse"[Mesh] AND Review[ptyp]

And found the following two articles:

1.     Metz, T. D., & Stickrath, E. H. (2015). Marijuana use in pregnancy and lactation: a review of the evidence. American journal of obstetrics and gynecology, 213(6), 761-778.

2.     Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., ... & Oei, J. L. (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, 34(6), 417.

I then searched google scholar with the following terms:

Cannabis use breast feeding review

And found the following relevant article in addition to the two that I found through PubMed:

3.     Hill, M., & Reed, K. (2013). Pregnancy, breast-feeding, and marijuana: a review article. Obstetrical & gynecological survey, 68(10), 710-718.

Why these sources were chosen

1. Metz, T. D., & Stickrath, E. H. (2015). Marijuana use in pregnancy and lactation: a review of the evidence. American journal of obstetrics and gynecology, 213(6), 761-778.

-This source is a review and the section on breast feeding includes information from primary sources in both animal and human studies as well as information from practice guidelines from the American Academy of Pediatrics’ policy on breastfeeding.

-This review article is relatively recent (2015), is a secondary source (review article), and is published in a well-cited and reputable peer reviewed journal. Additionally, it was not published as part of a special edition and was not an invited article.

-The authors of this article did not have any declared conflicts of interest.

-The quality of the primary sources also appears high, since they were well-cited studies that were published in reputable journals.

2. Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., ... & Oei, J. L. (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, 34(6), 417.

-This source is a review and the section on lactation includes information from primary sources in both human studies as well as information from practice guidelines from the Academy of Breastfeeding Medicine.

-This review article is relatively recent (2014), is a secondary source (review article), and is published in a well-cited and reputable peer reviewed journal. Additionally, it was not published as part of a special edition and was not an invited article.

-The authors of this article did not have any declared conflicts of interest.

-The quality of the primary sources also appears high, since they were published in reputable peer-reviewed journals.

3. Hill, M., & Reed, K. (2013). Pregnancy, breast-feeding, and marijuana: a review article. Obstetrical & gynecological survey, 68(10), 710-718.

-This last article is probably the lowest quality article of the three that I’ve selected, but I chose to include it to see if there are any other insights or information that I may have missed from the previous articles.

-This article is relatively older (2013), and published in a lower impact peer-reviewed journal.

-This article was interesting because it was written when cannabis use was still illicit in the United States, so it has given great insight into how attitudes towards use, publications, and recommendations have changed since legalization.

-The article summarizes information from research conducted in humans. These studies are published in peer-reviewed journals.

-This article is a review article (secondary source) and is published in a peer-reviewed journal. It was not published as part of a special edition and was not an invited article.

-The authors of the article do not have any conflicts of interest.

Assignment 3
Proposed changes

Original: none, this proposed change will be added to a new section under the subheading “High risk groups” in a separate section about pregnancy (see Milena Bullen’s proposed changes)

New: The active ingredient in cannabis (D9-tetrahydrocannabinol, THC) is fat soluble and can be excreted into breastmilk during lactation. THC in breastmilk can then subsequently be absorbed and metabolized by a breastfeeding infant, as shown by the presence of THC metabolites in the infant’s feces. However, the evidence for long-term effects of exposure to THC through breastmilk is inconclusive.

Rationale for proposed change

The original Wikipedia article does not include any information about cannabis use in pregnant or post-partum women. This is an important high-risk population that should be included in this article since studies have found that cannabis use post-partum can result in the accumulation and secretion of THC into breastmilk, which can then be absorbed and metabolized by the infant, as evident by the presence of THC metabolites in infant feces. These findings make post-partum women a high-risk population, since their cannabis use could have implications for the health of their children.

While it is agreed upon that cannabis use can result in THC in breastmilk, the long-term effects of THC exposure through breastmilk are more controversial. Results from animal studies that control for confounding factors (such as alcohol use, illicit drug use, etc.) indicate that cannabis exposure during lactation can lead to long-lasting behavioral abnormalities. However, the implications in humans are less clear since some studies have found no effect, while others have found adverse effects such as delayed motor development as measured by the Bayley index. Since more research on the topic is required, the decision for cannabis use while breastfeeding should involve a risk-benefit discussion between a patient and their healthcare provider.

The sources used to obtain this information are the following articles:

1.     Jansson, L. M. (2009). ABM clinical protocol# 21: Guidelines for breastfeeding and the drug-dependent woman. Breastfeeding Medicine, 4(4), 225-228.

2.     Metz, T. D., & Stickrath, E. H. (2015). Marijuana use in pregnancy and lactation: a review of the evidence. American journal of obstetrics and gynecology, 213(6), 761-778.

3.     Ordean, A. (2014). Marijuana Exposure During Lactation: Is It Safe?. Pediatrics Research International Journal, 2014, c1-6.

4.     Seabrook, J. A., Biden, C., & Campbell, E. (2017). Does the risk of exposure to marijuana outweigh the benefits of breastfeeding? A systematic review. Canadian Journal of Midwifery Research and Practice, 16(2), 8-16.

Critique of source

None of the authors disclosed any conflicts of interest. The articles are systematic reviews (2 -4) or a practice guideline (1), all published in peer-reviewed journals. All the articles are relatively recent, with the exception of the practice guideline; however, the more recent reviews did not identify any more recent primary sources that were not cited in the practice guideline. None of the articles above were written as part of a special issue or were invited articles. All systematic reviews had clearly defined search strategies, stated inclusion and exclusion criteria, and each had at least two independent researchers verify the validity of primary sources.

However, since there are few primary sources investigating this specific research question, the above sources all cite the same few original research articles, with the oldest one published in 1985 and the most recent in 2001. As such, these studies could be outdated, and more modern techniques and assessments could be more sensitive. These are also smaller studies which could be underpowered to detect behavioral and developmental differences between infants exposed to THC through breastmilk and those that were not exposed. Moreover, human studies are subject to confounding factors, since women who use cannabis during pregnancy or post-partum are also more likely to use alcohol and illicit drugs. Animal studies on this topic are better for controlling for confounding factors but have been conducted in mice and rats. The applicability of results from studies in rodents to humans are also unclear since the developmental trajectories of rodents significantly differ from that of humans.