Breastfeeding and Alcohol

By Kelly Bonyata, IBCLC

Guidelines

• Current research says that occasional use of alcohol (1-2 drinks) does not appear to be harmful to the nursing baby.  Many experts recommend against drinking more than 1-2 drinks per week.
  • Per Hale (2019), “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”
  • The American Academy of Pediatrics Section on Breastfeeding notes: “ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, or 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.”
• There is no need to pump & dump milk after drinking alcohol, other than for mom’s comfort — pumping & dumping does not speed the elimination of alcohol from the milk.
• If you’re away from your baby, try to pump as often as baby usually nurses (this is to maintain milk supply, not because of the alcohol). At the very least, pump or hand express whenever you feel uncomfortably full – this will help you to avoid plugged ducts and mastitis.
• Alcohol does NOT increase milk production, and has been shown to inhibit let-down and decrease milk production (see below).
• Never share a bed or other sleeping surface with your baby if you have been drinking. Drinking affects your natural reflexes, and drinking and bed-sharing has an increased association with sudden infant death syndrome (SIDS).
• What if you drink too much? If you have drunk enough alcohol to make you feel disorientated or cause vomiting, do not breastfeed until you are sober. Make sure someone who is not intoxicated is present to care for your child(ren). If possible, express your milk for comfort and to help maintain your supply (milk expressed while intoxicated should not be fed to baby). Binge drinking has not been studied adequately, and is not recommended during lactation.

In general, if you are sober enough to drive, you are sober enough to breastfeed. Less than 2% of the alcohol consumed by the mother reaches her blood and milk. Alcohol peaks in mom’s blood and milk approximately 1/2-1 hour after drinking (but there is considerable variation from person to person, depending upon how much food was eaten in the same time period, mom’s body weight and percentage of body fat, etc.). Alcohol does not accumulate in breastmilk, but leaves the milk as it leaves the blood; so when your blood alcohol levels are back down, so are your milk alcohol levels. One 2007 study suggests that lactating women may metabolize alcohol more quickly compared to non-lactating women (Pepino et al 2007).

Always keep in mind the baby’s age when considering the effect of alcohol. A newborn has a very immature liver, so minute amounts of alcohol would be more of a burden. Up until around 3 months of age, infants detoxify alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.

Effects of alcohol on breastfeeding and the breastfed baby

• Alcohol does not increase milk production. In fact, babies nurse more frequently but take in less milk in the 3-4 hours after mom has had a drink, and one study showed a 23% decrease in milk volume with one drink (Mennella & Beauchamp 1991, 1993; Mennella 1997, 1999).
• 2+ drinks may inhibit let-down (Coiro et al 1992; Cobo 1974).
• One study showed changes in the infant’s sleep-wake patterning after short-term exposure to small amounts of alcohol in breastmilk — infants whose mothers were light drinkers slept less (Mennella & Gerrish 1998).
• Daily consumption of alcohol has been shown in the research to increase the risk for slow weight gain in the infant.
• Daily consumption of alcohol (1+ drinks daily) has been associated with a decrease in gross motor development (Little et al 1989).

Additional information

Drinking Alcohol & Breastfeeding, from La Leche League International

Alcohol and breastfeeding, from The Breastfeeding Network, by Wendy Jones PhD, MRPharmS

Alcohol and Breastfeeding, from the Centers for Disease Control

Beer as a Galactagogue – A Brief History by Hilary Jacobson

Malt as a Galactagogue – A Brief History by Hilary Jacobson

Alcohol and Motherhood by Carol Huotari, from Leaven, Vol. 33 No. 2, April-May 1997, pp. 30-1

Social Drugs and Breastfeeding: Handling an issue that isn’t black and white by Denise Fisher, BN, RN, RM, IBCLC. Discusses nicotine, alcohol, caffeine, marijuana, heroin, and methadone.

 

References

[most recent references listed first]

Hale, Thomas. Medications and Mothers’ Milk, 2019 edition. Springer Publishing, 2019: 275-277.

Wilson J, Tay RY, McCormack C, Allsop S, Najman J, Burns L, Olsson CA, Elliott E, Jacobs S, Mattick RP, Hutchinson D. Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Drug Alcohol Rev. 2017 Sep;36(5):667-676. doi: 10.1111/dar.12473. Epub 2017 Mar 13.

Haastrup MB, Pottegård A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol. 2014 Feb;114(2):168-73. doi: 10.1111/bcpt.12149. Epub 2013 Nov 7.

AAP Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. PEDIATRICS Vol. 129 No. 3 March 2012, pp. e827 -e841.

Pepino MY, Steinmeyer AL, Mennella JA. Lactational state modifies alcohol pharmacokinetics in women. Alcohol Clin Exp Res. 2007 Jun;31(6):909-18. Epub 2007 Apr 13.

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.

Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol. 2001 Nov;25(3):153-8.

Mennella JA. The transfer of alcohol to human milk: Sensory implications and effects on mother-infant interaction. In: Hannigan JH, Spear N, Spear L and Goodlett CR, eds. Alcohol and Alcoholism: Brain and Development . New Jersey: Lawrence Erlbaum Associates, Inc., 1999. pp. 177-198.

Mennella JA, Gerrish CJ. Effects of exposure to alcohol in mother’s milk on infant sleep. Pediatrics. 1998 May;101(5):E2.

Mennella JA. The human infant’s suckling responses to the flavor of alcohol in mother’s milk. Alcoholism: Clinical and Experimental Research 1997;21:581-585.

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.

Mennella JA, Beauchamp GK. Beer, breast feeding and folklore. Developmental Psychobiology 1993;26: 459-466.

Mennella JA, Beauchamp GK. The transfer of alcohol to human milk: Effects on flavor and the infant’s behavior. New England Journal of Medicine 1991;325: 981-985.

Little RE, Lambert MD, Worthington-Roberts B. Drinking and smoking at 3 months postpartum by lactation history. Paediatr Perinat Epidemiol. 1990 Jul;4(3):290-302.

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.