Tobacco or E-Cigarette Use During Lactation

Lactating parents who use tobacco (smoke/chew/vape tobacco) or use e-cigarettes are encouraged to breastfeed or provide their milk. While cessation of smoking while lactating is optimal and recommended for both the parent’s and infant’s health, a baby that is being fed breastmilk by a parent using tobacco will get benefits from breastmilk that a baby being fed formula does not. This is a great time to quit the habit, as you can benefit both yourself and your infant.

Effects of Tobacco Use and Smoking on Infant Health

• • Exposure to secondhand smoke (smoke in the air around a baby) and thirdhand smoke (smoke on a caregiver’s clothing) increases the risk of sudden infant death syndrome (SIDS) and increases the risk of respiratory illnesses, asthma, and pneumonia in a baby.
• • While bedsharing increases the risk of SIDS for all infants, infants who sleep in the same bed with a cigarette smoker are at significantly higher risk for SIDS than a baby sleeping in the same bed with a non-smoker.
• • To keep babies safe, do not smoke near a baby. If you do smoke, change your clothes and wash your hands after smoking and before handling a baby. You can also ask other smokers who visit your baby to change their clothes and wash their hands before holding your baby.
• • 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.
• • Evidence suggests that a baby exposed to nicotine during pregnancy and/or lactation has a higher risk of long-term developmental problems than a non-exposed baby.

Effect of Smoking on the Lactating Parent

• • Cigarette smoking and vaping nicotine reduce the parent’s milk production. Little is known about the effect of e-cigarettes on milk production.
• • Nicotine passes into breast milk while smoking. Therefore, if a lactating parent is going to smoke or vape, they should do so right after breastfeeding to minimize the amount of nicotine still present in breast milk by the time of the next feeding (much of the nicotine will be out of the breast milk after about 3 hours).
• • Among women who quit smoking before or during pregnancy, breastfeeding for at least 6 months has been associated with a lower likelihood of relapse.
• • Smoking/vaping is an addiction. If you are motivated to quit, you do not need to do it alone, and you are more likely to be successful if you get support. See the resources listed below for direct help with smoking cessation as well as support for your mental health during this challenging time.

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.
• • Studies show that behavioral therapy PLUS nicotine replacement works better than either alone.
• • The lowest dose of a nicotine supplement is preferred, to limit the amount of nicotine in the milk.
• • Bupropion is a non-nicotine medication for tobacco cessation and is generally safe during lactation.
• • Veranicline (Brand: Chantix) is not currently recommended for use in lactating people, especially during the newborn period or with premature babies. We do not have enough evidence to support its safety and recommend choosing a safer alternative for smoking cessation while lactating.

Resources

• • CDC Cessation Support Resources: https://www.cdc.gov/tobacco/hcp/patient-care/quitlines-and-other-resources.html
• • American Lung Association Resources: https://www.lung.org/quit-smoking
• • Smokefree.gov: https://smokefree.gov/
• • Mental Health Support (not smoking-specific): https://postpartum.net/

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)
• • Association of Women’s Health, Obstetric and Neonatal Nurses. Breastfeeding Recommendations for People Who Use Substances: AWHONN Practice Brief Number 16. J Obstet Gynecol Neonatal Nurs. 2023 Jan;52(1):e1-e4.
• • Nicotine Drugs and Lactation Database (LactMed) https://www.ncbi.nlm.nih.gov/books/NBK501586/ (Accessed 2/6/26)