Hi, 'netters: Pardon me if anyone has posted on this. I've been nomail
and have not had a chance to see whether or not this has been discussed.
Recently, someone posted about an article showing a higher level of
cotinine (metabolite of nicotine) in the urine of breastfed babies of
smoking mothers than the urine of bottle-fed babies of smoking mothers.
The authors concluded that this increased amount of nicotine in
breastfed babies of smoking mothers could be a significant public
health problem. Of course, I went right to the article itself, and here
is what I found:
Mascola MA, Van Vunakis H, Tager IB, Speizer FE, Hanrahan JP. Exposure of
young infants to environmental tobacco smoke: breast-feeding among smoking
mothers.
The authors used 330 mother-infant pairs enrolled in "a longitudinal study
of the effects of prenatal and postnatal smoking on the pulmonary function
and respiratory illness experience of infants and children." They defined
smoking mothers as those who reported smoking at least 1 cigarette per day
at the time of the visit or those whose urinine cotinine level was over a
level that could be from environmental tobacco smoke exposure alone.
Breastfeeding was not separated between exclusive and partial.
Here are some of the infant urine cotinine levels:
Non-smoker, bottle-feeding, total -- 60 (interquartile range 22-140)
" " " , other smokers in the home -- 127 (47-263)
" " " , no other smokers in home -- 42 (18-125)
Non-smoker, breastfeeding, total -- 50 (29-98)
" " , other smokers in home -- 65 (39-194)
" " , no other smokers in home -- 41 (13-74)
Smoker, bottle-feeding, total -- 361 (239-593)
" " " , other smokers --464 (291-619)
" " " , no other smokers -- 250 (167-400)
Smoker, breastfeeding, total -- 4207 (1350-4700)
" " , other smokers -- 4207 (1740-4667)
" " , no other smokers -- 3025 (1333-4796)
Of interest, the differences between levels in babies whose mothers didn't
smoke and those who did were significant regardless of whether the mothers
breast- or bottle-fed. In babies of non-smoking mothers, there was no
significant difference in the levels unless other smokers were in the home
(both breast- and bottle-fed babies of nonsmoking mothers had
significantly higher levels if there were other smokers in the home). In
the groups with smoking mothers, neither breast- nor bottle-fed babies had
significantly higher levels if there were other smokers in the home.
They further looked at the infants' levels dependent on whether mother
smoked in the same room or not:
Type of feeding Mother smoked in the room Mother didn't smoke in room
bottle 413 (280-608) 350 (239-486)
breast 4667 (1740-4797) 2018 (1038-4207)
These differences were not significant in either group.
Clearly, there is a significant difference between the nicotine levels in
babies whose smoking mothers breastfed and those whose smoking mothers
bottle-fed. The clinical significance of this finding is very difficult
to determine, because *they only had 13 breastfeeding smoking mothers*,
and because there are no data about the incidence of respiratory
infections or other clinical data about the babies.
I find it a ridiculous leap from their data to the concluding statement of
their article: "In summary, we found that infants of smoking mothers have
significantly more exposure to the products of tobacco smoke than do
infants whose mothers do not smoke and that breast-feeding dramatically
increases this exposure. It is possible that adverse health consequences
in children previously attributed only to environmental tobacco smoke
exposure by inhalation may also result from exposure to both environmental
tobacco smoke and the breast milk of smoking mothers. [With only 13
babies out of 330 and no data as to whether these babies actually have
more respiratory or other illnesses than their environmentally exposed
bottle-fed counterparts, I think that they are on very shaky ground with
this statement] The relative importance of inhalational environmental
tobacco smoke exposure vs ingestion via breast milk in predicting
respiratory illness and other conditions in infants associated with
early-life smoking exposure is an important public health issue that
merits further exploration. [Considering the relatively minute number of
breastfeeding mothers who smoke, I wonder why that particular issue is of
such importance in public health, although I do agree that it merits
further exploration -- I would suggest actual clinical evaluation of
outcomes such as respiratory illnesses, etc] Health care providers need
to be as diligent in encouraging mothers to stop smoking after birth as in
the prenatal period [AMEN!], especially those mothers who intend to
breast-feed, and those mothers unable to stop smoking should be informed
of the possibility that harmful chemicals derived from tobacco smoke may
be transmitted to their infants via breast milk [of course, the many vital
immunoprotective substances in human milk are not considered, nor are the
potentially harmful chemicals of formula].
IMNSHO, this is another example of researchers far exceeding the scope of
their data in forming conclusions that can be used to make clinical
decisions. Although it's important to look at the nicotine levels in
breastfed babies, it's more important to look at their health outcomes
before making such sweeping statements. It's sad to think that some
smoking mothers will be told they must not breastfeed as a result of this.
Regards, Alicia Dermer, MD, IBCLC, in Central New Jersey, USA.
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