by Anne Eglash MD, IBCLC, FABM
The question this week is the effect of tobacco smoking and breastfeeding. According to the United States Centers for Disease Control, 10.7% of pregnant women smoke tobacco, with 50-80% of these mothers relapsing to smoking within 6 months postpartum.
The article for this week’s Clinical Question of the Week is a literature review of the impact of cigarette smoking on lactation, including breastmilk composition and infant development.
Which statement below do you think is false about the effect of maternal cigarette smoking on lactation?
- Mothers who smoke and breastfeed have a higher risk of mastitis when they wean.
- Mothers who smoke and breastfeed make less milk.
- Tobacco smoking decreases the mother’s prolactin level.
- Tobacco smoking adversely affects the taste of breastmilk.
- Total fat in breastmilk is lower among mothers who smoke by 19-26%.
- Maternal smoking decreases iodine and vitamin C levels in the breastmilk.
- Heavy smoking during pregnancy and breastfeeding is associated with a higher rate of early age leukemia.
- Breastfeeding infants of smoking mothers have a 50% higher risk of colic, and spend less time sleeping.
- 9. A baby of a cigarette smoking mother has a lower risk of SIDS if the mother breastfeeds.
See the Answer
Abstract
Environ Res. 2016 Aug 11;151:321-338. doi: 10.1016/j.envres.2016.08.002. [Epub ahead of print]
Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review.
Napierala M1, Mazela J2, Merritt TA3, Florek E4
Author information
Abstract
Approximately 10% of women report smoking during pregnancy. The number of breastfeeding women who relapse back to smoking is even greater. Smoking may cause adverse changes to the milk’s composition by not only reducing its protective properties, but also by affecting the infant’s health. The pathophysiological mechanisms underlying these adverse effects are not entirely known. This article is a review of previous reports about the effects of smoking on the lactation process, breast milk composition and infant development. A systematic search for English language articles published until 2015 was made, using a MEDLINE data. The key search terms were “smoking and breastfeeding”, “smoking and lactation”, “smoking and milk composition”, “nicotine and breast milk”. Studies have shown that nicotine levels in breast milk of women who smoke are three times higher than those in the plasma levels. Breast milk volume is reduced and the duration of lactation period is shorter. Smoking causes adverse changes to the milk’s composition by not only reducing its protective properties, but also affecting infants’ response to breastfeeding and to breast milk.
Copyright © 2016 Elsevier Inc. All rights reserved.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Sheesh! – What a smoking gun! There has been a great deal of research on tobacco smoking and lactation- hence the large # of options in the question this week!
We know that exposure to cigarette smoke is bad for infants, and in reality for anyone. The question is whether a breastfeeding infant is partially protected from those bad effects of cigarette smoke exposure. There are no clear cut answers. The authors of this article point out that smoking alters the biochemical composition of breastmilk, causing more infant health problems such as increased colic, worsened sleep, and higher risk of cardiac rhythm disorders.
The authors close with their recommendations on how a tobacco smoking mother can reduce her infant’s exposure to tobacco-containing substances. They suggest smoking as few cigarettes per day as possible, prevent infant exposure to second-hand and third-hand smoke, and try to leave as much time as possible between the last cigarette and time of breastfeeding.
There is no evidence that breastfeeding is contraindicated for tobacco smoking mothers, but we need to work hard to minimize infant exposure to tobacco through education during preconception, prenatal care, and postpartum follow ups.