Breastfeeding taskforce

Breastfeeding and alcohol: do they mix?

Because August is National Breastfeeding Month, we have a cover story about it. AT Contemporary OB/GYN®, our editorial meetings include an analysis of the top performing articles in online metrics. One that is consistently at the top is the 2018 article titled “Alcohol and breastfeeding: what are the risks?1

We wanted to dig deeper and provide an update.

Breastfeeding is associated with numerous health benefits for both mother and child and has been identified as a strategy for improving public health. For women, this includes reducing postpartum bleeding, anemia, urinary tract infections, and promoting postpartum weight loss.

For infants, breastfeeding is associated with a reduction in ear, gastrointestinal, and urinary tract infections; higher IQ, lower rates of asthma, eczema, diabetes and obesity.

The Centers for Disease Control and Prevention tracks breastfeeding rates with a semi-annual report – noting in 2017 that 84% of infants started breastfeeding – decreasing to 58% at 6 months and 35% at 12 months.2 Many efforts, including the designation of baby-friendly hospitals that incorporate strategies to improve breastfeeding, have been implemented.

There is a dearth of information regarding the impact of medications, supplements and substances on breastfeeding.3 Incredibly, only 15% of products approved by the FDA for labeling between 2015 and 2017 included human lactation data.4 Because more than 3 million women breastfeed in the United States, data on common substances such as alcohol is essential in advising our patients.

From 2011 to 2018, the rate of alcohol consumption during pregnancy increased. Assuming 6,000,000 pregnancies in 2018, approximately 678,000 pregnant women consumed alcohol in the past 30 days.5 The COVID-19 pandemic has increased the need for this data. Alcohol consumption has increased dramatically, including among women of childbearing age.6 Among women, the frequency of alcohol consumption increased by 17% during the pandemic and by 19% among adults aged 30 to 59.

Interestingly, cultural practices are varied regarding alcohol consumption during pregnancy and breastfeeding.

Many years ago I was on National Public Radio’s The Diane Rehm Show with esteemed teacher David Barker. seven— the originator of fetal origins of adult disease — a pioneer in understanding the role of fetal development and programming in the impact of adult onset disease, known as of “Barker’s hypothesis”.8

The majority of the show was about the importance of optimizing fetal health, but one listener called with a question about alcohol consumption during pregnancy and breastfeeding. In the UK this is more acceptable.

Indeed, the National Health Service says “an occasional drink probably won’t harm your breastfed baby.”9 and encourages healthy rest and nutrition for milk supply. In the United States, the recommendation is not to consume alcohol while breastfeeding.ten fearing that drinking alcohol will affect milk production. I remember fondly the tiptoe I had to rein in trying to tactfully negotiate a disagreement with Barker’s advice and providing advice to our listeners.

Even with these recommendations, women often ask questions about alcohol consumption and breastfeeding: “Should I pump and dump if I have a glass of wine? and “Am I expecting it to go through my system?”

This month, experts Susan Crowe, MD, and Tricia Wright, MD, MS, provide the information needed with so much data available on this topic. They offer their expert advice on how best to counsel patients and provide you with clinical pearls and key takeaways.

Read the updated article,”Alcohol and breastfeeding: what are the risks?” now.

The references

1. Nonacs R. Alcohol and breastfeeding: what are the risks? Contemporary OB/GYN. Published online December 7, 2018. Accessed online July 21, 2021. https://www.contemporaryobgyn.net/view/alcohol-and-breastfeeding-what-are-risks

2. Breastfeeding newsletter. Centers for Control and Prevention of Disasters. Accessed July 21, 2021. https://www.cdc.gov/breastfeeding/data/reportcard.htm

3. Byrne JJ, Spong CY. “Is it safe?” – The many unanswered questions about medication and breastfeeding. N English J med. 2019; 380(14):1296-1297. doi: 10.1056/NEJMp1817420

4. National Institute of Child Health and Human Development. Working Group on Research Specific to Pregnant and Breastfeeding Women: Report to the Secretary, Health and Human Services, Congress. Washington DC. September 2018. Accessed July 21, 2021. https://www.nichd.nih.gov/sites/default/files/2018-09/PRGLAC_Report.pdf

5. Denny CH, Acero CS, Terplan M, Kim SY. Trends in alcohol consumption among pregnant women in the United States, 2011-2018. Am J Prev Med. 2020;59(5):768-769. Published online October 1, 2020. doi: 10.1016/j.amepre.2020.05.017

6. Lunnay B, Foley K, Meyer SB, et al. Alcohol consumption and perceptions of health risks during COVID-19: a qualitative study of middle-aged women in South Australia. Public Health Front. Published online April 26, 2021. Accessed July 21, 2021. https://www.frontiersin.org/articles/10.3389/fpubh.2021.616870/full

7. Fetal origins of adult disease. The Diane Rehm show. National Public Radio. July 15, 2003. Accessed July 21, 2021. https://dianerehm.org/shows/2003-07-15/fetal-origins-adult-disease

8. Olsen J. David Barker (1938-2013) – a giant of reproductive epidemiology. Acta Obstet Gynecol Scand. 2014 ; 93(11):1077-80. doi: 10.1111/aogs.12378. Published online April 8, 2014

9. Breastfeed and drink alcohol. National Health Service. Accessed 21 July 2021. https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/alcohol

10. Is it safe for mothers to breastfeed their child if they have consumed alcohol? Centers for Control and Prevention of Disasters. Accessed July 21, 2021. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/alcohol.html