Alcohol and Motherhood
by Carol Huotari
CBI Reference Librarian
From: LEAVEN, Vol. 33 No. 2, April-May 1997, pp. 30-1
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
Most expectant mothers know
that drinking alcoholic beverages is not recommended during pregnancy. Her
health care provider, radio, television, magazines, posters in health
clinics, even warnings on alcoholic beverage containers caution her.
In fact, laws in some countries require merchants to post warning signs
wherever alcohol is sold. In the unlikely event that a pregnant
woman forgets that alcohol could harm her unborn child, concerned friends
and relatives would be quick to remind her.
The case is not nearly as
clear-cut after baby has arrived and the mother is breastfeeding.
Traditionally beer and, to a lesser degree, wine have been recommended
as helpful in the making of milk--a source of B vitamins as well as
a means to help a new mother to relax. Actually, it is only the
non-pasteurized European beers that contain the beneficial B vitamins,
and these are abundant in many foods and food supplements.
Research Inconclusive
Research on breastfeeding
and alcohol is admittedly far from conclusive, and at times, even contradictory.
Julie Mennella and Gary Beauchamp
of the Monell Chemical Senses Center in Pennsylvania, USA have done
research on the effects of alcohol on the nursing baby. They found
that the odor of a mother's milk changes with her ingestion of alcohol.
The baby suckles more vigorously but takes in less milk on average.
It is interesting that the mothers in this study did not perceive this
reduction in intake, even though the babies consumed significantly less
milk.
Mennella and Beauchamp further
determined that if a mother consumed nonalcoholic beer, there was no
change in the baby's suckling pattern. This indicates that it is not
just the odor of the milk that affects the baby, it is the alcoholic
component. It is important for a mother to remember that her baby
may choose to discontinue a feeding earlier than usual if she has been
drinking.
The medical journal Lancet
published a letter by G. De Rosa in 1981 describing his efforts
to determine whether or not the ingestion of beer or an alcohol solution
would alter prolactin secretion in women. Although the study used non-lactating
women, he found that the ingestion of beer increased the levels of prolactin
in the blood within 30 minutes after it was ingested. Prolactin
is the hormone that helps synthesize milk.
Later, in 1988, a study on
suckling rats by M. G. Subramanian further defined the effect of alcohol
on lactating females. The normal body levels of prolactin did
not change when the mothers were given alcohol; however, the suckling-induced
level of prolactin was significantly inhibited. Although this
study was done on rats, it shows an inhibitory effect of alcohol on
the release of prolactin.
Another hormone in mothers'
bodies, oxytocin, is also affected by the ingestion of alcohol.
Oxytocin governs the milk-ejection reflex, among other things.
When a mother hears her baby cry, oxytocin causes her milk to let down.
Oxytocin is released by many sensory pathways including vision, touch,
smell, hearing or thinking about her infant.
Edgard Cobo, an early researcher
of oxytocin, established the normal conditions of the milk-ejecting
response. However, when a mother was given one to two grams of
ethanol (alcohol), there was a significant reduction of the milk-ejecting
response which appeared to be dose dependent. In 1992, V. Coiro studied
the effect of ethanol on non-lactating women. Breast stimulation increased
the level of oxytocin in the blood stream, but when ethanol was given,
the release of oxytocin was inhibited. Although one should always
exercise caution when comparing groups with different characteristics,
the possibility exists that when a lactating mother consumes a sufficient
quantity of alcohol, her milk let-down could be impaired.
In another study examining
the effects of lactational alcohol exposure, Gottesfeld and LeGrue used
suckling rat pups as their subjects and found long-term deficits in
cellular immunity and the nervous system. This indicates sensitivity
in early development, at least in rats.
Why consider studies on non-lactating
women and rats, you may wonder? This is, in part, the state of
the research on this subject. The Subramanian rat study has been
referenced by some of the later researchers, lending credence to its
findings. Also, it would be unethical to do research like this
on human babies. However, the research must be kept in proper
perspective. The metabolism of a substance by a lactating mother
may be different from the metabolism of non-lactating women and rats.
Effects on Mothers
In general, women have less
body fluid and more fat tissue than men and as a result have greater
concentrations of alcohol in their blood than men of the same weight
after ingesting the same amount of alcohol. Variations in women's
weight affect alcohol detoxification, too. Lighter weight women take
longer than heavier women to metabolize the same amount of alcohol.
Since the adult liver processes alcohol at a constant rate, the more
alcohol that is consumed, the longer it takes to clear the alcohol.
Pat Schulte, in a 1995 article
in The Journal of Human Lactation, discusses these factors as
well as the fact that a woman's menstrual cycle influences her rate
of absorption of alcohol. Low levels of estrogen have been associated
with higher blood concentrations of alcohol resulting in the potential
for a greater degree of intoxication. When a woman is amenorrheic
due to breastfeeding, her estrogen levels are low. Generalizing
comparisons between non-lactating women and breastfeeding mothers, however,
leads to the assumption that a breastfeeding mother who drinks delivers
more alcohol to the baby through breastfeeding. Such comparisons
and assumptions may not be accurate as some research shows that lactating
and non-lactating women process alcohol differently.
An important finding has
come from a Brazilian team comparing lactating and non-lactating women
and how alcohol is absorbed. When matched for age, size and ethnic
group, they found that the lactating women had slower absorption of
alcohol than the controls. In addition to the increased time it
took for alcohol to be absorbed, the blood levels (which are comparable
to the milk levels) of alcohol were significantly lower in the lactating
women at last measurement. The rate of ethanol (alcohol) delivery
to the liver appears to be different in lactating women, possibly resulting
in less ethanol being circulated in the body.
Margaret Lawton of New Zealand
was one of the first to show that the elimination of alcohol from the
milk is closely related to its elimination from the blood and not affected
by breastfeeding or pumping milk. This indicates that there is
no benefit to the practice of pumping and dumping one's milk after drinking
alcohol other than to allow for the comfort of the mother whose breasts
may become engorged if she delays breastfeeding her baby.
As the alcohol clears from
a mother's blood, it clears from her milk. The Schulte article
provides a table showing the time it takes to metabolize alcohol based
on a woman's weight. If a woman weighs 100 lbs. (45 kg.) and has
one drink, it will take 3.1 hours to clear her system. If she
weighs 160 lbs. (72 kg.), it will take 1.9 hours to clear her system.
It is not known whether this information applies to the lactating woman
of the same weight as a non-lactating woman because of the research
documenting differences in the processing of alcohol. Schulte
also states that neither coffee, showers nor fresh air will hasten the
process. In another article in that same journal, Philip O. Anderson
recommends that mothers wait to breastfeed at least two hours after
one drink.
The American Academy of Pediatrics
takes a less cautious approach. They place alcohol in the category
"Maternal Medication Usually Compatible with Breastfeeding"
in their 1994 Transfer of Drugs and Other Chemicals into Human Milk.
LLLI Health Advisory Council
member and breastfeeding advocate Jack Newman has expressed concern
that nursing mothers are placed under too many restrictions. He points
out that breastfeeding mothers already feel many limitations so he prefers
not to prohibit alcohol, especially when the research does not support
any serious impact on the baby when a mother has only an occasional
drink.
Effects on the Baby
The National Institute of
Child Health and Human Development along with the Alcoholism and Drug
Abuse Institute of the University of Washington, USA sponsored a study
published in 1989 on the maternal use of alcohol during breastfeeding
and the mental and motor development of the baby at one year.
In their study of 400 infants born to members of a health insurance
plan, no difference was found in babies' cognitive development scores
(Bayley Mental Development Index) when their mothers ingested alcohol.
A slight but significant difference was detected in motor development
at one year of age in those babies subjected regularly to alcohol.
This study was submitted
to LLLI's Health Advisory Council (HAC) for their evaluation of its
significance for breastfeeding mothers. One flaw in the study,
consistently pointed out by the HAC members and others, was that the
breastfeeding group included babies who received up to 16 oz. (480 ml.)
of formula or supplemental milk per day. Also binge drinking was
not adequately taken into consideration. The collective response
of the HAC was that LLL's position--a breastfeeding mother's alcoholic
drink or two on occasion is not harmful to her baby--was acceptable.
It is important to keep a
few things in mind when answering a mother's questions about the use
of alcohol while she's breastfeeding.
- The age of the baby is
important. A newborn with an immature liver will be more easily
affected than an older baby.
- The size of the woman
could have a bearing on how her system processes alcohol. Likewise,
the amount of alcohol she consumes is relevant. Diluting a glass
of wine and sipping it slowly is one way to limit intake. It
is also common to see people choose the new bottled waters or soda
water, sometimes with lemon added. Eating while drinking decreases
the rate of absorption. High-fat foods, in particular, delay
the absorption of alcohol.
- Alternatives can be considered.
A mother can choose a non-alcoholic beverage. If she does choose
alcohol, she can wait for the alcohol to clear her system before nursing
her baby. This works well if her baby is sleeping through the
night. If she becomes engorged, she can pump her breasts as
a means to comfort. She can plan ahead and have expressed breast
milk stored for the occasion. She should feel confident breastfeeding
her baby if her intake was minimal, rather than subject her baby to
the alternative of artificial baby milk. There are documented
hazards connected with infant formula, but no research proves there
is harm to a breastfeeding baby if his mother has a glass of wine
at a wedding!
Since current research does
not show that occasional use (1-2 drinks) of alcohol is harmful to the
nursing baby, La Leche League continues to support the opinion that
occasional use of alcohol in limited amounts is compatible with breastfeeding.
LLLI References
Mohrbacher, N. &Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois:
LLLI 1997; 509-101.
THE WOMANLY ART OF BREASTFEEDING.
Schaumburg, Illinois: 1991; 234-35.
Other References
AAP Committee on Drugs. The
transfer of drugs and other chemicals into human milk. Pediatrics
1994; 93(1): 137-50.
Anderson, RO. Alcohol
and breastfeeding. The Journal of Human Lactation 1995;11(4):
321-22.
Cobo, E. Effect of
different doses of ethanol on the milk-ejecting reflex in lactating
women. American Journal of Obstetrics & Gynecology
1973; 115: 817-21.
Coiro, V. et al. Inhibition
by ethanol of the oxytocin response to breast stimulation in normal
women and the role of endogenous opioids. Acta Endocrinol 1992;
126:21 3-16.
DaSilva, V.A. et al. Ethanol
pharmacokinetics in lactating women. Brazil Journal of Medical Biology
1993; 26(10): 1097-1103.
De Rosa, C. et al.
Prolactin secretion after beer (letter), Lancet 1981; 934.
Gottesfeld, Z. & LeGrue,
S.J. Lactational alcohol exposure elicits long-term immune deficits
and increased noradrenergic synaptic transmission in lymphoid organs.
Life Sciences 1990; 47: 457-64.
Lawrence, R.A. Breastfeeding:
A Guide for the Medical Profession, 4th ed. St. Louis, Missouri:
Mosby-Year Book, Inc. 1994.
Lawton, M.E. Alcohol
in breast milk. Australian-New Zealand Journal of Obstetrics
& Gynecology 1985; 25(1 ): 71 -73.
Little, R.E. et al.
Maternal alcohol use during breastfeeding and infant mental and motor
development at one year. New England Journal of Medicine
1989; 321(7): 425-30.
Mennella, J.A. and Beauchamp,
G.K. Effects of beer on breastfed infants (letter). Journal
of the American Medical Association 1993; 269(13): 1637A.
Mennella, J.A. and Beauchamp,
G.K. The transfer of alcohol to human milk: Effects on flavor
and the infant's behavior. The New England Journal of Medicine
1991; 325(14): 981-85.
Newman, J. Is alcohol so
bad for breastfeeding mothers? The Journal of Human Lactation
1996; 12(2): 93.
Schulte, P. Minimizing
alcohol exposure of the breastfeeding infant. The Journal of
Human Lactation 1995; 11(4): 317-19.
Page last edited Sun Oct 14 09:31:26 UTC 2007.
