Hello, my name is Jennifer Yatskis Dukart and I am currently a nursing
student at the University of North Dakota. I have been researching the
effects of alcohol on breastfeeding and current recommendations regarding
this topic. This topic is somewhat related to some of the current lact-net
discussion regarding what is transmitted into breastmilk. I have
discovered that many professionals and agencies have widely differing views
about alcohol intake and breastfeeding. However, I have found that the
research supporting the "Complete Abstinence" recommendation is not
conclusive. In fact, as you probably know, many health professionals have
taken a more "middle of the road" approach to alcohol and breastfeeding.
However, many women are still being told that in order to
breastfeed, they must refrain from alcohol entirely. For example, the March
of Dimes recommends that mothers refrain from ingesting alcohol while they
are breastfeeding (March of Dimes, 1997). As a reference, the March of
Dimes quoted two studies, one which found that motor development was
decreased in babies of breastfeeding mothers who drank two or more drinks
per day. The other study results were that large amounts of ethanol
interfered with milk ejection.
Since the web-site doesn't state the names of the researchers, one
can only speculate that the motor development study is referring to the
study by Little et al (1989). In this study, while the researchers did find
that alcohol "had a slight but significant detrimental effect on motor
development, but not mental development, in breast fed infants", the
researchers acknowledge that the impact on the individual child probably has
no important significance. The researchers also state that the "amount of
alcohol ingested is apparently only a fraction of that taken in by the
mother". In addition, even if infants are not able to eliminate ANY of the
alcohol, it would take over three months of consuming over 4 drinks per day
to accumulate a significant amount (Little, et al., 1989).
Little et al., discussed the study's limitations, as noted above.
Other professionals have pointed out additional limitations to the study.
For example, Breastfeeding: A Guide for the medical profession, (Lawrence,
1994) points out that the infants in the study were exposed to alcohol in
utero as well as during breastfeeding, which obviously compromises the
results. Also, The Breastfeeding Answer Book (Mohrbacher & Stock, 1997)
pointed out another flaw in the study, "breastfed" was defined as receiving
up to 16 ounces of supplemental formula per day.
Another commonly cited study to discourage breastfeeding mothers
from ingesting any alcohol is the Mennella & Beauchanmp (1992) study which
discovered increased odor to breastmilk after the mothers consumed alcohol.
Infants in the study were found to suck more vigorously, but consume less
milk. Lawrence discusses that the research setting which the subjects were
in might have contributed to the decrease in milk let down, while in a
relaxed home environment, the effects might be different. Lawrence also
points out the very important fact that completely abstaining from an
occasional beer or glass of wine might discourage some mothers from
breastfeeding, when the small risks to their infant would be outweighed by
the benefits of breastfeeding.
These two studies, while important, do not justify advising
breastfeeding mothers to abstain from alcohol or give up breastfeeding. As
I've stated, many respected health professionals have advocated less harsh
guidelines for breastfeeding women. For example, in Medications and
Mother's Milk (Hale, 1996), the author advocates avoiding breastfeeding
while ingesting alcohol and for two to three hours after consumption. Karp
(1997), states breastfeeding is only contraindicated when the mother
consumes greater than .5 grams per kilogram of body weight. The American
Academy of Pediatrics Committee on Drugs (1994) considers alcohol compatible
with breastfeeding, although it does point out risks especially with high
consumption.
Another fact of interest is the amount of alcohol in the breastmilk
relates to the amount in the bloodstream, so as the body metabolizes
alcohol, the amount of alcohol in the breastmilk decreases (Lawton, 1985).
This physiological fact supports that breastfeeding can resume after the
body has had a chance to metabolize the alcohol. Also, the breastmilk need
not be "pumped and dumped".
In conclusion, research supports that a small to moderate amount of
alcohol does not contraindicate breastfeeding and the risks to the infants
do not outweigh the benefits of breastfeeding. From what I've seen in my
clinical experience, mothers do not always receive this message. I am
guessing that based on the range of recommendations I have found in my
research, policies range across the country and world. Has anyone
experienced different recommendations or opinions?
Jennifer Yatskis
Student Nurse
University of North Dakota
References
Hale, T. (1996). Medications and mothers milk (5th ed.). Amarillo, Texas:
Pharmasoft.
Karp, W. B. (1997). Available:
http://www.mcg.edu/PedsOnL/ForHealthProf/PedNutrition/brstfeed.html
Lawton, M. E., (1985). Alcohol in breastmilk. Australian-New England
Journal of Obstetrics & Gynecology, 25(1), 71-73.
Little, R. E., Anderson, K. W., Ervin, C. H., Worthington-Roberts, B.,
Clarren, S. K. (August 17, 1989). Maternal alcohol use during breast-feeding
and infant mental and motor development at one year. New England Journal of
Medicine, 321(7), 425-430.
Lawrence, R. A. (1994). Breastfeeding: A guide for the medical profession.
(4th ed., p. 343.). St. Louis: Mosby.
March of Dimes. (1997). Available:
www.noah.cuny.edu/pregnancy/march_of_dimes/substance/drinking.html#Is it
safe to drink while breastfeeding
Mennella, J. A., & Beauchamp, G. K. (November, 1992). The transfer of
alcohol to human milk: effects of flavour and the infant's behaviour.
Breastfeeding Review, 2(6), 286-290.
Mohrbacher, N., & Stock, J. (1997). The breastfeeding answer book. (5th
ed., pp. 509-510). Schaumburg, Illinois: La Leche League.
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