Is Alcohol Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Alcohol? Is Alcohol safe for nursing mother and child? Does Alcohol extracts into breast milk? Does Alcohol has any long term or short term side effects on infants? Can Alcohol influence milk supply or can Alcohol decrease milk supply in lactating mothers?

• DrLact safety Score for Alcohol is 5 out of 8 which is considered Unsafe as per our analyses.
• A safety Score of 5 indicates that usage of Alcohol may cause serious side effects in breastfed baby.
• Our study of different scientific research indicates that Alcohol may cause moderate to high side effects or may affect milk supply in lactating mother.
• Our suggestion is to use safer alternate options rather than using Alcohol .
• It is recommended to evaluate the advantage of not breastfeeding while using Alcohol Vs not using Alcohol And continue breastfeeding.
• While using Alcohol Its must to monitor child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
• Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

While breastfeeding it is recommended to avoid use of alcohol or do it occasionally and moderately (ABM 2015). Drinking beer does not increase milk production (Mennella 1993-2001, Comité Lm AEP 2012). Long term consumption may cause: sedation, failure to thrive, psychomotor delay in the infant (Little 1989, Moretti 2000, Koren 2002, Backstrand 2004, Sachs 2013), although the data are inconsistent (Little 2002, Haastrup 2014, ABM 2015). One case of Pseudo-Cushing Syndrome was reported that disappeared after alcohol stop by the mother (Moretti 2000). It is controversial that alcohol consumption is associated with shorter duration of breastfeeding (Giglia 2008, Rebhan 2009, Mgongo 2013). Despite of low increase of Prolactin serum level (Sarkola 1999), acute consumption affects the infant with sedation, and, inhibits Oxytocin secretion in the mother (Cobo 1973, Coiro 1992, Chien 2009) and hence affects the ejection reflex of breast milk with a decrease of 10% to 25% of milk production (Mennella 1991-1993-1997-1998-2001-2005). Excessive acute ingestion by the mother may induce coma, seizures and danger of death in the infant (Swiderski 2011). Both beer 0.0% and non-alcoholic (<1%) may be drunk by the nursing mother (Koletzko 2000, Schneider 2013). Increase of anti-oxidant properties of the milk have been recognized (Codoñer 2013). Elapsing time required to resume breastfeeding after occasional consumption of alcohol by the mother in order to ensure disappearance of milk and blood (Ho 2001) depends on mother's body weight (lesser weight needs longer time to wait), and, on the amount ingested (higher amount needs longer time). Stop breastfeeding for longer than two and a half hour for every 10 - 12 g of ingested alcohol: 330 mL of 4.5% beer, 120 mL (1 glass) of 12% wine, or, one cup of 40% - 50% liquor. Suggested time-periods to stop breastfeeding for a 60 kg of body weight woman are: 1 glass of wine = 2.5 hours; 660 mL of beer = 5 hours; 3 cups of liquor = 7.5 hours (ABM 2015: See reference values at Can Fam Physician 2002) Some medicinal products containing high concentrations of alcohol as an excipient should be avoided during breastfeeding (Nice 2000). Avoiding bed-sharing is recommended to mothers who have drunk alcohol (UNICEF 2006, ABM 2008, Landa 2012, UNICEF 2013). When topically used as disinfectant, alcohol is compatible with breastfeeding (WHO 2002).

The effects of maternal alcohol (ethanol) ingestion during lactation are complex and depend on the pattern of maternal drinking. Alcohol decreases milk production, with 5 drinks or more decreasing milk letdown and disrupting nursing until maternal alcohol levels decrease. Beer may increase serum prolactin levels during nursing because of polysaccharides from barley and hops. After ingestion of nonalcoholic beer, the antioxidant capacity of milk is increased, but alcohol levels in milk are negligible. Women with a family history of alcoholism have a blunted prolactin response following breast stimulation and tend to breastfeed more frequently to compensate. Breastmilk alcohol levels closely parallel blood alcohol levels. The highest alcohol levels in milk occur 30 to 60 minutes after an alcoholic beverage, but food delays the time of peak milk alcohol levels. Nursing after 1 or 2 drinks (including beer) can decrease the infant's milk intake by 20 to 23% and cause infant agitation and poor sleep patterns. The long-term effects of daily use of alcohol on the infant are unclear. Some evidence indicates that infant growth and motor function may be negatively affected by 1 drink or more daily, but other studies have not confirmed these findings. Heavy maternal use may cause excessive sedation, fluid retention, and hormone imbalances in breastfed infants. Casual use of alcohol (such as 1 glass of wine or beer per day) is unlikely to cause either short- or long-term problems in the nursing infant,[1] especially if the mother waits 2 to 2.5 hours per drink before nursing, and does not appear to affect breastfeeding duration. Daily heavy use of alcohol (more than 2 drinks daily) may affect infants negatively and appears to decrease the length of time that mothers breastfeed their infants. Nursing or pumping within 1 hour before ingesting alcohol may slightly reduce the subsequent amounts of alcohol in breastmilk.

A nursing mother was drinking large amounts of quinine wine, wine, champagne, beer and liquors. Her infant had been gaining 30 g of weight daily until he weighed nearly 6 kg at 5 weeks of age. The infant had been restless and sleepless for several days when he suffered from violent fits and tonic-clonic seizures that required medical treatment. After he was taken off the mother's breast and began to be nursed by a wet nurse, his weight quickly dropped by 200 g in 3 days and fell into a pattern of calm sleep.[15] A similar case of chronic heavy alcohol use by a nursing mother resulted in pseudo-Cushing syndrome in her 4-month-old breastfed infant. The infant had a bloated appearance, excessive wight gain and diminished length for age. The mother reported drinking 50 cans of beer weekly and "generous" amounts of other alcoholic beverages to increase her milk supply. The infant's symptoms resolved and growth pattern returned to normal after her mother stopped consuming alcohol.[16] A series of 23 cases of severe thrombocytopenia and bleeding were reported among 21- to 60-day old breastfed infants of Chinese women in Singapore over a 5-year period. None of the infants had received prophylactic vitamin K at birth and all of their mothers had been taking alcohol tonics after each meal beginning at 7 to 10 days after delivery which was a common practice among only the Chinese in the mixed ethnic population delivering at the hospital. Most of the infants had also been receiving 5 to 15 mL daily of "gripe water" which had an alcohol content of about 5%. The authors attributed these cases to the lack of prophylactic vitamin K (which was common practice at the time) and increased clotting factor degradation caused by alcohol.[17] A woman who drank 750 mL of port wine in 24 hours noticed that her breastfed 8-day-old had a deep unarousable sleep, snoring, pain insensitivity, inability to suck, excessive perspiration and a feeble pulse. These symptoms were attributed to the very young age of the infant and the large amount of alcohol consumed.[18] In a series of studies, investigators measured the effect of maternal alcohol use on their breastfed infants. In one study, 12 nursing mothers with infants 25 to 216 days of age drank 0.3 grams/kg of alcohol (about 1.5 drinks for a 60 kg woman) in orange juice over 15 minutes in the morning. On a separate occasion, they drank an equal volume of orange juice.[5] In another study, 12 nursing mothers nursing infants with a median age of 150 days drank 0.3 grams/kg of alcohol as beer or the same volume of nonalcoholic beer on a separate occasion.[19] In a third study, 12 nursing mothers with infants averaging 3.1 months of age drank 0.3 grams/kg of alcohol in orange juice over 15 minutes in the morning. On a separate occasion, they drank an equal volume of orange juice In both studies, infants who drank milk that contained alcohol consumed 20 to 23% less milk during the 3- or 4-hour testing session, even though the time spent at the breast and number of sucks was unchanged. Mothers could perceive no difference in milk production or nursing behavior in their infants. Infants sucked more vigorously on a bottle containing their mothers' milk spiked with alcohol than on mothers' milk alone.[20] In a study in which infants were weighed by the mothers before and after each feeding for the next 16 hours (20 hours total), infants increased the number of nursings during the period of 8 to 12 hours after the alcohol intake such that the total amount of milk consumed during the 20-hour period did not differ between the alcohol and non-alcohol days.[21] In studies that measured infant sleep, infants slept more frequently for shorter periods of time during the 3.5 to 4 hours after alcohol intake, whether it was after mothers drank 0.3 grams/kg of alcohol before breastfeeding or infants were given their mothers' milk spiked with an amount of alcohol (32 mg/100 mL) equivalent to that at 1 hour after maternal ingestion of 0.3 grams/kg of alcohol.[5][22][23] After ingesting the alcohol-containing milk after maternal consumption of 0.3 grams/kg of alcohol, 14 infants from 4 to 11 weeks of age infants were observed for 1 hour after milk ingestion. Their behavioral state changed more frequently, they slept less, cried more and startled more than after consuming milk without alcohol. Mother-infant interactions were more conflictive after alcohol intake which may partially explain increased infant arousal after maternal and infant alcohol ingestion.[24] A study that monitored the infants during the 24-hour period after maternal alcohol ingestion revealed that the infants compensated by spending more time in active (rapid eye movement) sleep from 3.5 hours to 24 hours with no further alcohol intake.[23] Long-term effects of alcohol ingestion during breastfeeding were studied in 2 separate populations by one group of investigators. In the first study, alcohol intake of more than 1 drink daily durin

Studies in mothers who were 2 to 8 days postpartum found that acute doses of alcohol infused intravenously reduced the oxytocin-mediated milk ejection reflex following infant sucking. The effect could be overridden by administration of exogenous oxytocin, indicating that alcohol inhibits oxytocin release, not its effect on the breast.[36] Alcohol doses of 0.5 to 0.99 grams/kg reduced oxytocin response to infants sucking by 18%; doses of 1 to 1.49 grams/kg reduced the response by 62%; and doses from 1.5 to 1.99 grams/kg reduced the response by 80%. Alcohol also increased the time for letdown to occur after nipple stimulation, from 29 seconds to 64 seconds with doses of 1 to 1.49 grams/kg and from 38 seconds to 331 seconds with doses of 1.5 to 1.99 grams/kg.[37] Other investigators found that drinking 100 mL of whiskey containing a total of 50 mL of absolute alcohol (about 4 drinks in a 60 kg woman) abolished the rise in serum oxytocin in response to breast stimulation with a breast pump in 16 nonpregnant, nonlactating women. Pretreatment with naloxone blunted alcohol's inhibitory effect on oxytocin release.[38] Acute alcohol ingestion can either increase, decrease or have no effect on serum prolactin in nonpregnant, nonlactating women.[39][40][41] Drinking 100 mL of whiskey containing a total of 50 mL of absolute alcohol lessened the increase in serum prolactin in response to breast stimulation with a breast pump in 11 nonpregnant, nonlactating women. Serum prolactin rose by 71% over baseline 20 minutes after stimulation without alcohol and only by 25% after alcohol consumption. Pretreatment with naloxone blunted alcohol's inhibitory effect, with the combination resulting in a 46% rise in serum prolactin over baseline.[42] It is not clear how these finding apply to lactating women. A study on 28 lactating women who were 2 to 5 months postpartum found that the normal rise in serum prolactin was enhanced when alcohol in a dose of 0.4 grams/kg was taken 35 minutes before breast stimulation with a breast pump. In subjects with a first-degree relative with a history of alcoholism, the increase in serum prolactin was blunted in magnitude, rapidity, and duration both with and without prior alcohol consumption.[43] Nursing mothers who ingested a 0.3 grams/kg dose of alcohol produced an average of 9.3% less milk 2 hours after the alcohol intake using a breast pump than they did when a nonalcoholic beverage was taken. The caloric content and composition of milk were not different during the two test periods.[44] A 1-year long survey of 587 new mothers in Australia found that women who drank more than 2 standard drinks (10 grams or 12.5 mL of absolute alcohol) daily were twice as likely to discontinue breastfeeding by 6 months postpartum than mothers who reported use below this amount.[45] Beer specifically has a reputation for increasing milk supply. A small crossover study found that ingestion of 1 liter of beer containing 6% alcohol by 11 nonpregnant, nonlactating women increased serum prolactin by nearly 2.5-fold 30 minutes after ingestion, but sparkling water with an equivalent amount of alcohol did not.[46] In another study, 7 nonpregnant, nonlactating women were given 800 mL of beer. Six drank beer containing 4.5% alcohol and 1 woman drank nonalcoholic beer. Their average peak serum prolactin increased to 2.4 times the baseline value between 60 and 105 minutes after ingestion. The one woman who drank nonalcoholic beer had an equivalent prolactin response. Pretreatment with naloxone had no effect on the prolactin response.[47] Studies in animals indicate that a polysaccharide found in barley and malt is apparently responsible for the increase in prolactin after beer ingestion.[48][49] The interaction between alcohol ingestion and breast pumping was investigated in a double-blind crossover study of 13 lactating women who were exclusively nursing 2- to 5-month-old infants. Compared to placebo, ingestion of 0.4 grams/kg of alcohol increased serum prolactin during the ascending phase of blood alcohol concentrations. Pumping milk from the breasts during the ascending phase of blood alcohol enhanced the prolactin response, but pumping during the descending phase of blood alcohol blunted the prolactin increase. Milk production was lower after alcohol ingestion, but unrelated to serum prolactin or alcohol blood concentrations.[50] Twenty-three Taiwanese nursing mothers received a chicken-based soup following a cereal snack twice during the first 15 days postpartum. On one occasion the soup contained a dose of 0.3 grams/kg of alcohol (about 1.5 drinks for a 60 kg woman) and on the other occasion the soup was alcohol free. The time for the first drops of milk to be ejected after breast stimulation with a pump was longer (4.4 vs 2.9 seconds) after the alcohol-containing soup than with the nonalcoholic soup. In addition, the triacylglycerol (14.8 vs 12.3 mg/dL) and lactate (0.8 vs 0.6 mg/dL) content of breastmilk we