Is It Safe to Take Alcohol and Breastfeed?

Alcohol (Ethanol)

 People drink alcohol for many reasons: socializing, celebrating, relaxing, or enhancing a good meal. Alcohol can have a strong effect on people, those who drink and those who are around those who drink. The effect of alcohol depends on many factors: how much you drink, how often you drink, your age, your sex, your ethnicity, your health status, and your family history. Many of those who abuse drug substances are multi-drug users. Alcohol is often one of those substances. When one reads the reviews of drug substances that are abused, one will notice that there are additional negative health effects in combination with alcohol use. Current alcohol use among pregnant women is 8.5%, binge drinking is 2.7%, and heavy drinking is 0.3%.

Pregnancy

There is no evidence that even several episodes of drinking during the early weeks of pregnancy cause fetal effects. Fetal Alcohol Effects (FAE), which includes numerous child developmental and behavioral effects, can result from one to two drinks per day and occasional binge drinking. Fetal Alcohol Syndrome (FAS) can result from heavy drinking of four to six drinks per day. FAS encompasses CNS disorders, including mental retardation; low birthweight; high mortality rate; and structural abnormalities, which include facial dysmorphogenesis, cardiac septal defects, joint abnormalities, hearing issues, urinary problems, eye abnormalities, immune system deficiencies, and skeletal problems. There is no evidence that even several episodes of drinking during the early weeks of pregnancy cause fetal effects. If taken on rare occasions, alcohol should be consumed with food. One to two drinks per day has been linked with prematurity, increased risk of miscarriage, low birth weight, and labor and delivery complications. Therefore, it appears that there is no “safe” amount to consume, and that it is best to just abstain.

Breastfeeding

The guidelines for “safe” use during breastfeeding are different from those for pregnancy:

• Alcohol rapidly exchanges between plasma and breastmilk
• One study has shown that mothers’ alcohol resulted in a 23% reduction in the amount of milk ingested by babies, which may be due to the taste of alcohol in the breastmilk
• Prolactin production may be inhibited by alcohol but is definitely not known
• Maternal alcohol blood levels have to reach 300 mg% before significant side effects affect the baby
• The amount of alcohol presented to breastfeeding infants through breastmilk is approximately 5-6% of the weight-adjusted maternal dose (Relative Infant Dose), and even in a theoretical case of binge drinking, the breastfed child would not be subjected to clinically relevant amounts of alcohol
• Breastfeeding can be resumed after moderate alcohol use as soon as the mother feels normal
• Recommend interrupting breastfeeding for two (2) hours per drink or until the mother is sober
• Excessive chronic drinking can cause mild sedation to deep sleep and hypoprothrombinemic bleeding in breastfed children
• Intoxicated mothers should not breastfeed; chronic alcoholics should not breastfeed
• Because the rational use of alcohol is possible during breastfeeding, the use of Alcohol Breastmilk Tests is a waste of money, time, and effort

Healthcare professionals; breastfeeding recommendations range from advice to abstain from all alcohol while breastfeeding to following the recommendations above, which allow for alcohol use during breastfeeding.  A good common sense recommendation is if a breastfeeding mother would like to have a social alcoholic drink to two, she can breastfeed as soon after her last drink when she feels no effects of her alcohol intake.  When that occurs, the mother’s plasma levels are low enough, and therefore her breastmilk levels are also low enough to allow her child to breastfeed.

Standard Alcoholic Drinks

Standard drink amounts are helpful for following breastfeeding guidelines.  In the United States, one "standard" drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol
• 1.5 ounces of distilled spirits, which is about 40% alcohol

 Beer as a Galactogogue

 One other issue that often comes up is if it reasonable to have a glass of beer as a galactogogue.  Once again, there are those who say it is not appropriate to drink any alcohol while breastfeeding.  In the galactogogue beer situation, there are those who state that alcohol may decrease breastmilk production, so to makes no sense to use beer as a galactogogue,  Finally, there are those of us who know that beer is rich in malt and barley, both of which are have a history of being galactogogues.  What better way to enjoy malt and barley.  In addition, it is quite unlikely that one beer will act as an anti-galactogogue, and the consensus among most lactation consultants is a malt and barley infused beer seems to work as a galactogogue, and there is nothing to lose by enjoying a glass of beer if so desired while breastfeeding.

 So as we say in Polish, Smacznego (Enjoy)!