After abstaining from alcohol for nine long months during pregnancy, many new mothers can’t wait to relax again with a long overdue drink in hand.
While the harmful effects of the use of alcohol during pregnancy are well known, much less is known about the use of alcohol while breastfeeding. There are even claims that beer stimulates milk production. An estimated 50% of breastfeeding woman in Western countries report that they drink alcohol occasionally or more often.
Little emphasis is currently being placed on educating new mothers about the effects of alcohol on breastfeeding. Makes one wonder if there are any science-based recommendations for breastfeeding moms with regard to the use of alcohol.
Effects of alcohol during pregnancy:
Guidelines from health organizations for the use of alcohol are clear that there is no known safe amount of alcohol use during pregnancy and that all types of alcohol are equally harmful, including beer and wine. Alcohol in the mother’s bloodstream passes to the growing baby through the umbilical cord. Alcohol can cause problems for the baby for the duration of pregnancy, such as abnormal facial features in the first three months of pregnancy, and central nervous system problems and brain development problems at any time.
Drinking alcohol during pregnancy can result in fetal alcohol spectrum disorder (FASD) in babies. South Africa has the highest incidences of FASD in the world, with a prevalence of between 29 and 290 per 1 000 live births.
While the effect of alcohol during pregnancy are well documented, the effects of alcohol consumption while breastfeeding are not well studied.
Effects of alcohol while breastfeeding:
Studies have shown that alcohol indeed ends up in breastmilk and remains for at least 2-3 hours – per drink consumed!
Alcohol is a small molecule that is very water-soluble and passes easily into breastmilk. Levels of alcohol in breastmilk mirror the levels of alcohol in the bloodstream, which peak 30-60 minutes after consumption. Milk alcohol levels after a single drink can still be detected 2-3 hours after consumption. When more alcohol is consumed, it will stay longer in the milk. When a second drink is consumed, the time to eliminate alcohol doubles and milk alcohol levels may still be detected 5 hours after consumption. A binge drinking episode (4 or more drinks per occasion) means that milk alcohol may still be detected for more than 9 hours.
Because of immature metabolic pathways to detoxify alcohol, infants can only metabolize alcohol at about half the rate of adults. The immature metabolism and the rapid brain growth of infants is suspected to make the infant’s brain very sensitive to alcohol.
Alcohol in breastmilk have been shown to affect the baby’s sleep, by disrupting and shortening the total duration of sleep. In addition to diminished sleep, studies found that even low amounts of alcohol-containing milk may result in arousal, rather than sedation. In the hour after consumption of alcohol-containing milk, infants were observed to be fussier, with more frequent startling and crying. Diminished sleep and increased arousal symptoms were noted in a few studies.
Contrary to the claims that beer stimulates milk production, alcohol actually decreases milk production, as it disrupts the hormones that influence lactation. In addition, alcohol inhibits the release of oxytocin (the hormone responsible for the milk ejection reflex), resulting in delays in milk letdown. The diminished milk production due to alcohol is suspected to result in infants consuming about 20% less milk during the immediate hours after the mom’s alcohol intake.
Studies found a connection between moms who drank alcohol while breastfeeding and lower cognitive scores (verbal IQ) when their children were 6-7 years old. A very comprehensive and highly scientific animal study, published in 2023, found that alcohol consumption during lactation resulted in developmental deficits in the offspring, in particular abnormal brain and behavioural development.
Interestingly, one study observed that infants consume larger amounts of milk flavoured with alcohol compared to unaltered milk when both options were offered through bottles. However, other studies found no such preference.
Conclusions:
The effects of long-term exposure to alcohol through breastmilk are not known with certainty, due to a lack of large-scale and long-term scientific studies. More research is needed to determine safe maternal practices in this regard.
To be on the safe side, a few points to keep in mind about drinking while breastfeeding, is that it should be occasional, it should be moderate, and to wait 2 hours after a drink before breastfeeding your baby. Alternatively express milk just before alcohol consumption.
References:
Alcohol while breastfeeding. Published 16 August 2023. Blog by Dr David Perlmutter. (www.drperlmutter.com)
Alcohol use during pregnancy. Reviewed 4 November 2022. National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. USA. (www.cdc.gov)
A scoping review of the determinants of fetal alcohol spectrum disorders in South Africa: An intersectional perspective. Published 11 September 2021 in the journal Health Policy and Planning, Volume 36, Issue 9. Oxford Academic. (www.academic.oup.com)
Alcohol and breastfeeding: What are the risks? Published 4 August 2021. Contemporary OB/GYN Journal. Volume 66, Issue 8. (www.contemporaryobgyn.net)
Is it safe to drink alcohol while breastfeeding? Reviewed 27 August 2019. Healthline. (www.healthline.com)
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