Tobacco or E-Cigarette Use During Lactation

Lactating parents who use tobacco (smoke/chew tobacco) or use e-cigarettes are still encouraged to breastfeed or provide their milk, but stopping tobacco or e-cigarettes with or without nicotine replacements is ideal for the health of both the parent and infant.

Effect on the Infant

• Infant exposure to 2nd hand smoke (in the air around a baby) and 3rd hand smoke (on a caregiver’s clothing) increases the risk of sudden infant death syndrome (SIDS), as well as bronchitis and pneumonia.
• Infants who sleep in the same bed with a cigarette smoker are at higher risk for SIDS.
• To keep babies safe, do not smoke near the baby such as in the car or home. Change clothes and wash hands after smoking, before handling the baby.

Effect on the Lactating Parent

• Cigarette smoking reduces the parent’s milk production. Little is known about the effect of e-cigarettes on milk production.
• Cigarette smoking decreases the fat and protein in the parent’s milk, which can have a negative impact on the baby’s growth and development. Little is known about the effect of e-cigarettes on the quality of breastmilk.
• Among women who quit smoking before or during pregnancy, breastfeeding for at least 6 months has been associated with a lower likelihood of relapse.

Nicotine Replacements and Other Medications to Stop Tobacco and E-Cigarette Use

• Breastfeeding parents are encouraged to quit tobacco or e-cigarettes. Using a nicotine replacement is a reasonable option.
• The lowest dose of a nicotine supplement is preferred, to limit the amount of nicotine in the milk.
• Bupropion is a medication for tobacco cessation and is generally safe during lactation.

References:

• Macchi M, Bambini L, Franceshini S et al. The Effect of Tobacco Smoking During Pregnancy and Breastfeeding on Human Milk Composition- A Systematic Review. European J of Clin Nutr 2021 May; 75(5): 736-747
• Míguez MC, Pereira B. Effects of active and/or passive smoking during pregnancy and the postpartum period. An Pediatr (Barc). 2021;95:222-32.
• Zhang K, Siziba LP, Suo NJ et al. Breastfeeding Duration is Positively Associated with Decreased Smoking Relapse in the Postpartum Period Midwifery 108 (2022)
• Tobacco in https://trashthepumpanddump.org/tobacco (accessed May 1, 2022)
• Nicotine Drugs and Lactation Database (LactMed) https://www.ncbi.nlm.nih.gov/books/NBK501586/ (Accessed 5/1/22)