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Is it safe for a smoker to breastfeed her baby? What about using the nicotine patch and other smoking cessation aids?

Today, most people are aware of the health risks associated with cigarette smoking, both for the smoker and those around them. Pregnancy is often a good incentive for a woman to cut down or quit entirely. If a mother smokes cigarettes, her baby can still enjoy the benefits of breastfeeding. But the more cigarettes a mother smokes, the greater the health risks for both her and her baby- whether he is breastfed or bottle-fed.

According to the LLLI publication THE BREASTFEEDING ANSWER BOOK, if the mother smokes fewer than twenty cigarettes a day, the risks to her baby from the nicotine in her milk are small. When a breastfeeding mother smokes more than twenty to thirty cigarettes a day, the risks increase. Heavy smoking can reduce a mother's milk supply and on rare occasions has caused symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps, and diarrhea. (Vorherr 1974). By keeping smoking to a minimum, a mother can decrease the risk. When a mother smokes a cigarette, the nicotine levels in her blood and milk first increase and then decrease over time. The half-life of nicotine (the amount of time it takes for half the nicotine to be eliminated from the body) is ninety-five minutes. For this reason, a mother should avoid smoking just before and certainly during a feeding.

Maternal smoking has been linked to early weaning, lowered milk production, and inhibition of the milk ejection ("let-down") reflex. Smoking also lowers prolactin levels in the blood. One study (Hopkinson et al 1992) clearly suggests that cigarette smoking significantly reduces breast milk production at two weeks postpartum from 514 milliliters per day in non-smokers to 406 milliliters per day in smoking mothers. Mothers who smoke also have slightly higher metabolic rates and may be leaner than non-smoking mothers, therefore, caloric stores for lactation may be low and the mother may need to eat more.

Smoking has been linked to fussiness. In one study, 40% of babies breastfed by smokers were rated as colicky (two to three hours of "excessive" crying) as compared with 26% of babies breastfed by nonsmokers (Matheson and Rivrud 1989). It's important to note that this link between smoking and colic has also been found with artificially fed babies with one or more smokers in the home (Lawrence, p.519).

However the baby is fed, parents should avoid exposing him to second-hand smoke by smoking in another room or preferably outside the house. Breathing second-hand or "side-stream" smoke poses health risks. Researchers have documented the health hazards to children when one or both parents smoke. In one study (Colley and Corkhill 1974) researchers monitored the respiratory health of 2,205 babies and found a significant correlation between parents' smoking habits and the incidence of pneumonia, bronchitis, and SIDS during their babies' first year of life. These increased risks are present in both breastfed and bottle-fed infants.

Bottle-fed infants have a much higher incidence of respiratory illnesses than breastfed infants. A bottle-fed baby whose mother or other household members smoke would therefore be at even higher risk of these problems. Dr. Jack Newman states "The risks of not breastfeeding are greater to the baby than the risks of breastfeeding and smoking. The decision is up to the mother and I would encourage her to breastfeed."

Due to the highly addictive nature of cigarette smoking, mothers who would like to quit may wonder about the safety of smoking cessation aids which replace nicotine. When used as directed, these products pose no more problems for the breastfeeding infant than maternal smoking does.

According to the 1999 edition of "Medications And Mother's Milk" by Thomas W. Hale, R.Ph., Ph.D., the blood level of nicotine in most smokers (20 cigarettes per day) approaches 44 nanogram per milliliter (ng/mL) whereas levels in patch users average 17 ng/mL, depending on the dose in the patch.

Dr. Hale writes, "Therefore nicotine levels in milk can be expected to be less in patch users than those found in smokers, assuming the patch is used correctly and the mother abstains from smoking. Individuals who both smoke and use the patch would have extremely high blood nicotine levels and could endanger the nursing infant. Patches should be removed at bedtime to reduce exposure of the infant and reduce side effects such as nightmares."

"With nicotine gum, maternal serum nicotine levels average 30-60% of those found in cigarette smokers. While patches (transdermal systems) produce a sustained and lower nicotine plasma level, nicotine gum may produce large variations in blood plasma levels when the gum is chewed rapidly, fluctuations similar to smoking itself. Mothers who choose to use nicotine gum and breastfeed should be counseled to refrain from breastfeeding for 2-3 hours after using the gum product."

Recommended Reading:

"Smoking and Breastfeeding" -- This informational sheet, available from the LLLI Store or from your local LLL Leader, explains how to minimize the effects of smoking on a breastfeeding baby. Includes information on nicotine gum and the nicotine patch.

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