Alcohol consumption in pregnancy

Alcohol consumption in lactation

Is alcohol found in human breastmilk?

Yes, once a lactating parent consumes alcohol, the highest level of alcohol can be found in their breast milk approximately within 30 minutes to 1 hour after it has been consumed (The time may vary depending on factors such as food intake during alcohol consumption, body weight and percentage of body fat).

Less than 2% of the alcohol a lactating parent consumes reaches their blood and breastmilk and research has shown that lactating women appear to metabolise alcohol quicker than non-lactating women. The more alcohol that is consumed, the longer the alcohol will be detected in the breastmilk. Alcohol does not accumulate in the breastmilk and once the lactating parents’ blood alcohol levels are reduced, so are the alcohol levels in the milk.

Factors that will affect blood alcohol levels and length of time that it is detected in breastmilk

• amount of alcohol consumed

• how fast the alcohol is consumed

• whether it is consumed on an empty stomach or with food

• lactating parent’s weight and percentage of body fat

• how fast the alcohol is metabolized or broken down in the lactating parent’s body

The effects on the breastfed baby

Alcohol consumption of more than 1 standard drink per day, results in high alcohol levels of the lactating parent. This can interfere with the milk ejection reflex (the let-down) which can lead to shortened breastfeeding sessions, decreased breastmilk production and earlier weaning. Infant’s sleep patterns and early development may be negatively affected from high alcohol levels.

It is important to also consider the age of your baby when deciding when to start consuming alcohol again. A newborn baby has a very immature liver, so will be affected easily with even small amounts of alcohol. Up until a baby is 3 months of age, infants will detoxify alcohol around half the rate of an adult (slower than an adult), whereas an older baby or toddler can metabolise the alcohol faster.

Various studies have shown that daily consumption of alcohol (more than 1 drink per day) have been associated with increased drowsiness in the baby, slower weight gain in infants and a decrease in gross motor development.

Pumping/expressing breastmilk after consuming alcohol

Expressing breastmilk after a parent has consumed alcohol does not reduce the alcohol in the lactating parent’s milk. If the alcohol is in the lactating parent’s blood stream, it is also in their breastmilk. As the lactating parent’s blood alcohol level decreases over time, so will the levels decrease in their breastmilk.

Recommendations

• Pump if you are uncomfortable or engorged (for comfort- it will not make the alcohol decrease any faster)

• Pump if you are away from your baby or if it is part of your pumping schedule to maintain your supply

• There is no need to pump and dump milk after consuming alcohol- it does not speed the elimination of the alcohol from the milk. Drinking water, coffee and resting also does not speed up the elimination of alcohol from a lactating parent’s body.

• Wait 2 hours per drink before a mother breastfeeds again, this will reduce the concentration of the alcohol in the ingested milk.

• Use previously expressed milk to feed your baby in the mean-time

• Direct feeding can be resumed as soon as the lactating parent feels neurologically normal

• Minimise the amount of alcoholic beverages consumed, to no more than 0.5g alcohol per kg of lactating parent’s body weight

• Experts recommend against drinking more than 1-2 alcoholic drinks per week

• Do not bed-share with your baby if you have been drinking alcohol as your natural reflexes may be impaired and there is an increased association of sudden infant death syndrome (SIDS)

• If you become drunk (consumed alcohol to the point of vomiting and or disorientation), do not breast or chest feed until you feel sober. You can express milk (for your comfort and to protect your supply), but the milk expressed whilst you are intoxicated should not be fed to your child.

• Plan ahead

• Express and store breastmilk ahead of time

• You can choose to wait for the alcohol to clear your system (2 hours) before resuming direct breastfeeding

• If your breasts become full whilst waiting for the alcohol to clear- you can hand express or pump for comfort.

• If in doubt, choose an alternatives - see if there is a non-alcoholic drink available, that you can have and enjoy instead

• Be safe – choose where and with whom you are around- to ensure you are ok and safe. Arrange for a sober and responsible adult to take care of you and your infant

• Eat before or whilst you consume alcohol

Summary

Generally, if you are sober enough to drive, you are sober enough to breastfeed. With some thought, planning and discussion with your support structures (co-parent, family, friends, health care professionals) you can enjoy alcohol safely and responsibly, by limiting the consumption and drinking occasionally. If you are worried about your alcohol consumption, seek help from a professional.

“Reasonable alcohol intake should not be discouraged at all. As is the case with most medicinal drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.” Dr Jack Newman – More Breastfeeding Myths.

Article by Lactation Consultant Niyati Naik

References

• Academy of Breastfeeding Medicine (2015) ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder
• Centres for Disease Control and Prevention (2018) Alcohol.
• Bonyata K (2018) Breastfeeding and Alcohol. https://kellymom.com/bf/can-i-breastfeed/lifestyle/alcohol/
• Hale, Thomas. Medications and Mothers’ Milk, 2017 edition. Springer Publishing, 2017: 348-350.
• AAP Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. PEDIATRICS Vol. 129 No. 3 March 2012, pp. e827 -e841.
• Health Council of the Netherlands. Risks of alcohol consumption related to conception, pregnancy and breastfeeding. The Hague: Health Council of the Netherlands, 2005; publication no. 2004/22. (Paper is in Dutch but the executive summary is also in English.)
• Koren G. Drinking alcohol while breastfeeding: Will it harm my baby? Canadian Family Physician 2002;48:39-41.
• Little RE, Northstone K, Golding J; ALSPAC Study Team. Alcohol, breastfeeding, and development at 18 months. Pediatrics. 2002 May;109(5):E72-2.
• AAP Committee on Drugs. Policy Statement: The Transfer of Drugs and Other Chemicals Into Human Milk. PEDIATRICS Vol. 108 No. 3 September 2001, pp. 776-789.
• Mennella JA. Alcohol’s Effect on Lactation. Alcohol Research & Health 2001; 25(3):230-234.
• Coiro V, et al. Inhibition by ethanol of the oxytocin response to breast stimulation in normal women and the role of endogenous opioids. Acta Endocrinol (Copenh) 1992 Mar;126(3):213-6.
• Mennella JA, Gerrish CJ. Effects of Exposure to Alcohol in Mother’s Milk on Infant Sleep. Pediatrics 1998 (May);101(5): e2.
• Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol. 1973 Mar 15;115(6):817-21.