Breastfeeding and Cigarette Smoking

July 29, 2011. Posted in: Lifestyle choices

By Kelly Bonyata, IBCLC

Should a mother who smokes cigarettes breastfeed?

First of all, a mom who can’t stop smoking should breastfeed. Breastfeeding provides many immunities that help your baby fight illness and can even help counteract some of the effects of cigarette smoke on your baby: for example, breastfeeding has been shown to decrease the negative effects of cigarette smoke on a baby’s lungs. It’s definitely better if breastfeeding moms not smoke, but if you can’t stop or cut down, then it is better to smoke and breastfeed than to smoke and formula feed.

The more cigarettes that you smoke, the greater the health risks for you and your baby. If you can’t stop smoking, or don’t want to stop smoking, it’s safer for your baby if you cut down on the number of cigarettes that you smoke.

What happens to babies when they are exposed to cigarette smoke?

  • Babies and children who are exposed to cigarette smoke have a much higher incidence of pneumonia, asthma, ear infections, bronchitis, sinus infections, eye irritation, and croup.
  • Colic occurs more often in babies whose mothers or fathers smoke or if a breastfeeding mother smokes. Researchers believe that not only does the nicotine transferred into mother’s milk upset baby but the passive smoke in the home acts as an irritant. Babies of smoking parents fuss more, and mothers who smoke may be less able to cope with a colicky baby (due to lower levels of prolactin).
  • Heavy smoking by breastfeeding moms occasionally causes symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps and diarrhea.
  • Babies of smoking mothers and fathers have a seven times greater chance of dying from sudden infant death syndrome (SIDS).
  • Children of smoking parents have two to three times more visits to the doctor, usually from respiratory infections or allergy-related illnesses.
  • Children who are exposed to passive smoke in the home have lower blood levels of HDL, the good cholesterol that helps protect against coronary artery disease.
  • Children of smoking parents are more likely to become smokers themselves.
  • A recent study found that growing up in a home in which two parents smoked could double the child’s risk of lung cancer later in life.

How does does smoking affect breastfeeding?

Smoking has been linked to:

  • Earlier weaning. One study showed that the heaviest smokers tend to wean the earliest.
  • Lower milk production
  • Interference with milk let-down
  • Lower levels of prolactin. The hormone prolactin must be present for milk synthesis to occur.
  • One study (Laurberg 2004) indicated that smoking mothers who live in areas of mild to moderate iodine deficiency have less iodine in their breastmilk (needed for baby’s thyroid function) compared to nonsmoking mothers. The study authors suggested that breastfeeding mothers who smoke consider taking an iodine supplement.

Although smoking has been linked to milk production and let-down problems, this may be related to poor lactation management rather than physiological causes. Dr. Lisa Amir, in a review published in 2001, concluded that “Although there is consistent evidence that women who smoke breastfeed their infants for a shorter duration than non-smokers, the evidence for a physiological mechanism is not strong.”

How to minimize the risk to your baby if you smoke

  • The ideal: Stop smoking altogether.
  • Cut down. The less you smoke, the smaller the chance that difficulties will arise. The risks increase if you smoke more than 20 cigarettes per day.
  • Don’t smoke immediately before or during breastfeeding. It will inhibit let-down and is dangerous to your baby.
  • Smoke immediately after breastfeeding to cut down on the amount of nicotine in your milk during nursing. Wait as long as possible between smoking and nursing. It takes 95 minutes for half of the nicotine to be eliminated from your body.
  • Avoid smoking in the same room with your baby. Even better, smoke outside, away from your baby and other children. Don’t allow anyone else to smoke near your baby.

This article is dedicated to the memory of my mother-in-law, a long-time smoker who died of lung cancer in January 1999.

 

References and More Information

References

[most recent references listed first]

Myr R. Promoting, protecting, and supporting breastfeeding in a community with a high rate of tobacco use. J Hum Lact. 2004 Nov;20(4):415-6.

Shenassa ED, Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics. 2004 Oct;114(4):e497-505.

Dahlstrom A, Ebersjo C, Lundell B. Nicotine exposure in breastfed infants. Acta Paediatr. 2004 Jun;93(6):810-6.

Laurberg P, Nohr SB, Pedersen KM, Fuglsang E. Iodine nutrition in breast-fed infants is impaired by maternal smoking. J Clin Endocrinol Metab. 2004 Jan;89(1):181-7.

Ilett KF, Hale TW, Page-Sharp M, Kristensen JH, Kohan R, Hackett LP. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharmacol Ther. 2003 Dec;74(6):516-24.

Agostoni C, Marangoni F, Grandi F, Lammardo AM, Giovannini M, Riva E, Galli C. Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation. Eur J Clin Nutr. 2003 Nov;57(11):1466-72.

Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. 2003 Jul;11(2):19-29.

Batstra L, Neeleman J, Hadders-Algra M. Can breast feeding modify the adverse effects of smoking during pregnancy on the child’s cognitive development? J Epidemiol Community Health 2003 Jun;57(6):403-4.

In this study, researchers examined school results of 570 nine-year-old children who were born in a Dutch hospital between 1975 and 1978 and whose mothers smoked during the pregnancy. Per the researchers, “Our results indicate that negative effects of maternal smoking on children’s cognitive performance were limited to those who had not been breast fed.” The children who had not been breastfed had decreased cognitive performance compared to the children who were breastfed. The researchers suggested that breastmilk promoted brain development and helped to counteract the adverse effects of cigarette smoking during pregnancy.

Mohrbacher N, Stock J. The Breastfeeding Answer Book, Third Revised Edition. Schaumburg, Illinois: La Leche League International, 2003.

Letson GW, Rosenberg KD, Wu L. Association between smoking during pregnancy and breastfeeding at about 2 weeks of age. J Hum Lact. 2002 Nov;18(4):368-72.

Hale TW. Medications and Mothers Milk, Tenth Edition. Amarillo, Texas: Pharmasoft Publishing, 2002.

Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Birth. 2002 Jun;29(2):112-23.

American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk (Policy Statement). Pediatrics. 2001 Sep;108(3):776-89.

Amir LH. Maternal smoking and reduced duration of breastfeeding: a review of possible mechanisms. Early Hum Dev. 2001 Aug;64(1):45-67.

Najdawi F, Faouri M. Maternal smoking and breastfeeding. East Mediterr Health J. 1999 May;5(3):450-6.

Mennella JA, Beauchamp GK. Smoking and the Flavor of Breast Milk. N Engl J Med. 1998 Nov 19;339(21):1559-60.

Ortega RM, Lopez-Sobaler AM, Martinez RM, Andres P, Quintas ME. Influence of smoking on vitamin E status during the third trimester of pregnancy and on breast-milk tocopherol concentrations in Spanish women. Am J Clin Nutr. 1998 Sep;68(3):662-7.

Mascola MA, Van Vunakis H, Tager IB, Speizer FE, Hanrahan JP. Exposure of Young Infants to Environmental Tobacco Smoke: Breast-Feeding among Smoking Mothers. Am J Public Health. 1998 Jun;88(6):893-6.

Alm B, et al. A case-control study of smoking and sudden infant death syndrome in the Scandinavian countries, 1992 to 1995. The Nordic Epidemiological SIDS Study. Arch Dis Child. 1998 Apr;78(4):329-34.

Boshuizen HC, et al. Maternal smoking during lactation: relation to growth during the first year of life in a Dutch birth cohort. Am J Epidemiol. 1998 Jan 15;147(2):117-26.

Schafer T, Dirschedl P, Kunz B, Ring J, Uberla K. Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring. J Am Acad Dermatol. 1997 Apr;36(4):550-6.

American Academy of Pediatrics Committee on Environmental Health. Environmental Tobacco Smoke: A Hazard to Children (Policy Statement). Pediatrics. 1997 Apr;99(4):639-42.

Blair PS, et al. Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. BMJ. 1996 Jul 27;313(7051):195-8.

Klonoff-Cohen HS, Edelstein SL, Lefkowitz ES, Srinivasan IP, Kaegi D, Chang JC, Wiley KJ. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. JAMA. 1995 Mar 8;273(10):795-8.

Little RE, Lambert MD 3rd, Worthington-Roberts B, Ervin CH. Maternal smoking during lactation: relation to infant size at one year of age. Am J Epidemiol. 1994 Sep 15;140(6):544-54.

Stepans MB, Wilkerson N. Physiologic effects of maternal smoking on breast-feeding infants. J Am Acad Nurse Pract. 1993 May-Jun;5(3):105-13.

Hopkinson JM, Schanler RJ, Fraley JK, Garza C. Milk production by mothers of premature infants: influence of cigarette smoking. Pediatrics. 1992 Dec;90(6):934-8.

Schulte-Hobein B, Schwartz-Bickenbach D, Abt S, Plum C, Nau H. Cigarette smoke exposure and development of infants throughout the first year of life: influence of passive smoking and nursing on cotinine levels in breast milk and infant’s urine. Acta Paediatr. 1992 Jun-Jul;81(6-7):550-7.

Dahlstrom A, Lundell B, Curvall M, Thapper L. Nicotine and cotinine concentrations in the nursing mother and her infant. Acta Paediatr Scand. 1990 Feb;79(2):142-7.

Luck W, Nau H. Nicotine and cotinine concentrations in the milk of smoking mothers: influence of cigarette consumption and diurnal variation. Eur J Pediatr. 1987 Jan;146(1):21-6.

Luck W, Nau H. Nicotine and cotinine concentrations in serum and urine of infants exposed via passive smoking or milk from smoking mothers. J Pediatr. 1985 Nov;107(5):816-20.