Breastfeeding: Smoking, Drugs and Alcohol

By Dr Ananya Mandal, MD

Much of what the mother takes during breastfeeding passes on to the baby. It is thus vital for breastfeeding mothers to watch what they consume.

As a neonate the effect of a harmful chemical, drug or alcohol may be profound on the baby especially during early days.

Breastfeeding and smoking

Quitting smoking helps an individual at any time or age. In breastfeeding and pregnant mothers it can benefit both the mother and the baby.

Smoking in the mother as well as inhalation of second hand smoke raises the risk of several diseases and disorders among babies. Some of these include:-

  • The risk of Sudden Infant Death Syndrome (SIDS) rises among babies whose mothers smoke while breastfeeding or inhale second hand smoke.
  • Risk of ear infections and respiratory infections are much higher among children of smokers. Here the child may be exposed to second hand smoke from their parents. Children of smokers also have more illnesses, such as asthma and bronchitis.
  • Smoking while still breastfeeding reduces the milk supply in the mother. This is due to suppression of hormones like prolactin and oxytocin that stimulate milk production.

All health agencies recommend that cigarette smoking as well as exposure to second hand cigarette smoke should be avoided if a woman is breastfeeding.

Tobacco contains nicotine and other harmful ingredients that can pass through the breast milk. Babies who have been exposed to second hand smoke or presence of nicotine in breast milk show presence of the chemical cotinine in their urine samples.  

Exposure to second hand smoke may be reduced by adopting several measures. This includes living in a completely smoke-free home. This gives the baby a smoke-free and healthy environment at home. Parents are advised not to smoke in the car while the baby is with them.

Breastfeeding and alcohol use

There are no safe levels of alcohol while pregnant. After the birth of the baby, it is best to avoid alcohol while breastfeeding.

Usually alcohol is not trapped in breast milk. However, it can lead to several complications. A mother who has had a drink before breastfeeding may note sleeping problems as well as sucking problems in the baby.

Infants whose mothers had alcohol in their milk spent less time sleeping during the subsequent 3.5 hours compared to those not exposed to alcohol in breast milk.

In addition to effects of alcohol on sleep, it gives a noticeable smell to the breast milk. This has been seen to stimulate initial sucking but overall the total milk intake is lower during a feeding.

If at all a drink is taken, a breastfeeding woman is advised to refrain from breastfeeding for at least 2 to 3 hours after the drink. This allows the alcohol level in the breast milk to drop.

The alcohol taken by the mother reaches the blood stream from which it reaches the milk. The peak levels of alcohol achieved in the milk occur at approximately 30-60 minutes after ingestion on an empty stomach and 60-90 minutes after ingestion on a full stomach.

As the level of alcohol in the blood falls, the levels in breast milk also falls. Women who have taken large amounts of alcohol are advised not to breastfeed.

It has been known from evidence that beer may act as a stimulant to breast milk production. This may be due to its ability to increase the secretion of the hormone prolactin in men and non-lactating women. This is caused by the various B vitamins or Brewer’s yeast present in beer.

However, it is known that alcohol can inhibit the milk let down reflex or the milk ejection reflex in breastfeeding mothers. This has been seen at doses of 1gm/kg of absolute alcohol.

Studies have shown that if mothers are chronic alcoholics who take in an average of 50 cans of beer per week and other alcoholic beverages, they are likely to cause hormonal damages in the infant. The baby may develop a pseudo-Cushing syndrome with features of obesity, moon-face (round face) and short stature.

Breastfeeding and use of illicit drugs

Most of the illegal drugs and street drugs can pass from the breastfeeding mother’s blood stream into the breast milk and reach the baby. All agencies and organizations recommend that a mother who is breastfeeding should avoid these drugs.

The illegal drugs that are especially harmful include:-

  • cocaine
  • heroin
  • phencyclidine (PCP)
  • amphetamines
  • marijuana etc.

In addition to damage to the central nervous system of the baby, these agents may also alter the senses, judgement and perception of the mother and hamper her ability to take care of the baby. This may lead to accidents and injury or even death of the baby.

The Academy of Breastfeeding Medicine in their Guidelines for Breastfeeding and the Drug-Dependent Woman suggest a protocol for the mothers who were using illegal drugs before pregnancy. They recommend that mothers who fulfil the following criteria should be allowed to breastfeed. The criteria include:-

  • Abstinence for the use of illicit drugs for 90 days before delivery
  • Present with a negative drug screen at delivery
  • Willingness to participate and continue in a substance abuse treatment program
  • Recipients of adequate and consistent prenatal care
  • Do not have any other factor that necessitates prevention of breastfeeding like infection with HIV etc.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Oct 17, 2013

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