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Subject:
From:
Nancy Mohrbacher <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 9 Oct 2003 22:02:43 -0500
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Lesley,

You raised some excellent questions in your post, and I'd like
to share some information you may find of interest.  I am co-author of The
Breastfeeding Answer Book (2003), and I reviewed the research on smoking
and breastfeeding and wrote a section of the book on this subject.

Despite the studies you cite, the research is conflicting on whether
smoking affects milk supply , age of weaning, and infant growth.  In fact,
one study found that babies of smoking breastfeeding mothers were heavier
at one year than the babies of breastfeeding mothers who didn't smoke
(Little, R. et al.  Maternal smoking during lactation: relation to infant
size at one year of age.  Am J Epidemiol 1994; 140(6): 544-54.).  I would
highly recommend reading:  Amir, L.  Maternal smoking
and reduced duration of breastfeeding: a review of possible mehanisms.
Early Human Dev 2001; 64(1):45-67.  In it, Lisa Amir reviews the literature
and concludes that the evidence for a physical link between smoking and
early weaning was not strong.

The American Academy of Pediatrics' Committee on Drugs recently changed its
recommendations on smoking and breastfeeding.  In its 1994 recommendations
the committee considered smoking a contraindication for breastfeeding,
while in 2001 it wrote: "it may  be that  breastfeeding and smoking is less
detrimental to the child than bottle-feedig and smoking."

When a woman is addicted to nicotine, it can be a difficult choice.  We've
always told mothers that it is best to cut back on smoking as much as
possible while breastfeeding and whether they are breastfeeding or not to
always smoke in another room from the child.  But for the many women who
cannot see their way clear to quitting smoking altogether, the question is
not "Should I stop smoking?" (I think that nearly all smokers agree
intellectually that this is ideal), but rather "Since I can't stop smoking,
is it better to breastfeed or not to breastfeed?"

In one study, researchers concluded that earlier weaning in smoking mothers
may have less to do with the effect of smoking on milk production than the
mothers' anxiety about how smoking affects their milk, leading them to wean
to formula ealier because they think it is "safer"  (Ratner, P. et al.
Smoking relapse and early weaning among postpartum women: is there an
assocation?  Birth 1999; 26(1):76-82.

Many women who feel pressured to quit smoking while they're breastfeeding
for the good of their baby will choose instead to quit breastfeeding.  That
is the difficult balancing act we face.  Here's hoping that some of
Lactnet's best minds can wrestle with this one and provide some useful
insights.

Good luck with your work!

Nancy Mohrbacher, IBCLC
Chicago suburbs, Illinois USA (where it feels like the middle of summer!)


> Hello, my name is Lesley Kurowski and I am a student nurse at the
> University of North Dakota. The topic I am interested in is the effects of
> nicotine and smoking on breastfeeding infants. I have found in studies that
> nicotine can decrease a mothers milk production which decreases the infants
> weight gain (Ward, Bates, Benitz, and Burfield, 2001). It is thought that
> nicotine increases the dopamine levels in the hypothalamus which reduces
> prolactin levels. Prolactin stimulating or suppressive drugs can either
> increase or decrease the mothers milk production (Horta, Kramer, and Platt,
> 2001). Also I have found that women who smoke during the postpartum period
> tend to wean their infants off breastmilk earlier. Ratner, Johnson, and
> Bottorff (1999), reported that approximately 65.1% of women who return to
> smoking postpartum wean their infants off breastmilk before 26 weeks, where
> as only 33.8% of women who did not smoke weaned their infants before 26
> weeks. The early weaning may be due to the low fat concentrations in the
> milk of smoking mothers which contributes to their infants decrease in
> weight gain (Horta, Kramer, and Platt, 2001). This is an important issue
> and I feel that stressing smoking cessation at every postpartum clinic
> visit is extremely important for the infant and mothers well being.
> Education should be aimed at stressing the many benefits of breastfeeding
> and infant up to one year and the health risks that smoking imposes on both
> the mother and child.
>

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