Hi Pauline,

 Would this AAP Policy Statement be of help?

Kathy

Pediatrics, Volume 108, Number 3, September 2001, pp 776-789, The Transfer of
Drugs and Other Chemicals Into Human Milk, American Academy of Pediatrics

Section on Breastfeeding and Smoking

In the previous edition of this statement, the Committee on Drugs placed
nicotine (smoking) in Table 2 "Drugs of Abuse for Which Adverse Effects on
the Infant During Breastfeeding Have Been Reported." The reasons for placing
nicotine and, thus, smoking in Table 2 were documented decrease in milk
production and weight gain in the infant of the smoking mother and exposure
of the infant to environmental tobacco smoke as demonstrated by the presence
of nicotine and its primary metabolite, cotinine, in human milk.4-12 There is
controversy regarding the effects of nicotine on infant size at 1 year of
age.13,14 There are hundreds of compounds in tobacco smoke; however, nicotine
and its metabolite cotinine are most often used as markers of tobacco
exposure. Nicotine is not necessarily the only component that might cause an
increase in respiratory illnesses (including otitis media) in the nursing
infant attributable to both transmammary secretion of compounds and
environmental exposure. Nicotine is present in milk in concentrations between
1.5 and 3.0 times the simultaneous maternal plasma concentration,15 and
elimination half-life is similar-60 to 90 minutes in milk and plasma.7 There
is no evidence to document whether this amount of nicotine presents a health
risk to the nursing infant.The Committee on Drugs wishes to support the
emphasis of the American Academy of Pediatrics on increasing breastfeeding in
the United States. Pregnancy and lactation are ideal occasions for physicians
to urge cessation of smoking. It is recognized that there are women who are
unable to stop smoking cigarettes. One study reported that, among women who
continue to smoke throughout breastfeeding, the incidence of acute
respiratory illness is decreased among their infants, compared with infants
of smoking mothers who are bottle fed.16 It may be that breastfeeding and
smoking is less detrimental to the child than bottle feeding and smoking. The
Committee on Drugs awaits more data on this issue. The Committee on Drugs
therefore has not placed nicotine (and thus smoking) in any of the Tables but
hopes that the interest in breastfeeding by a smoking woman will serve as a
point of discussion about smoking cessation between the pediatrician and the
prospective lactating woman or nursing mother. Alternate (oral,
transcutaneous) sources of nicotine to assist with smoking cessation,
however, have not been studied sufficiently for the Committee on Drugs to
make a recommendation for or against them in breastfeeding
women.http://www.aap.org/policy/0063.html


Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services
















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