Alcohol use

Can I drink alcohol while breastfeeding?

The World Health Organization recommends that breastfeeding mothers avoid alcohol. If they choose to drink, they are urged to do it only occasionally and to wait until the alcohol is detoxified before breastfeeding. The reason is that alcohol enters breast milk. After one drink, it can be detected in breast milk for about two to three hours, and that time as well as the amount of alcohol increases with each additional drink. It is unclear how alcohol drunk by a breastfeeding mother affects a baby’s brain, but there is some evidence that it interferes with sleep patterns, co-ordination, and thinking ability. Babies cannot detoxify alcohol nearly as well as adults. 

A) Alcohol in breast milk

If a mother drinks while breastfeeding, the alcohol will enter her breast milk. The more she consumes, the more alcohol there will be in the breast milk. Alcohol levels in breast milk are similar to those in the mother’s blood and peak 30 to 60 minutes after the drink is consumed (Haastrup 2014).

Babies cannot detoxify alcohol nearly as well as adults, making them more vulnerable to its effects. Newborns detoxify it at one-quarter to one-half of the adult rate (Haastrup 2014; Pikkarainen 1967).

B) Effects of alcohol use by the mother on their baby

1) Alcohol use in pregnancy

Any alcohol consumed during pregnancy poses risks to the developing baby, including (Popova 2021):

  • Fetal alcohol syndrome
  • Birth defects
  • Premature delivery
  • Having breathing problems
  • Having difficulty breastfeeding and feeding in general
  • A delay in their mother's milk coming in

2) Alcohol use while breastfeeding

It is a myth that alcohol increases milk production. Actually, it interferes with the let-down reflex and can reduce the amount of milk a baby takes in (Mennella 2005). Several studies (Fleming 2008; Giglia 2008; Howard 1998; Jagodzinski 2007) showed that mothers who drank excessively tended to breastfeed for shorter periods.

The effect on the development of the baby’s brain of a breastfeeding mother drinking alcohol is unknown (Haastrup 2014; NIH). There is some evidence that a baby’s sleep patterns, coordination, and thinking ability may be affected (Gibson 2018; Little 1989; May 2016; Mennella 2001; Mennella 1998b). When infants take in breast milk with alcohol, they appear to startle more easily and cry more (Schuetze 2002). Alcohol can affect the genes that control the baby’s neurodevelopment (Fransquet 2016).

Alcohol changes the smell of breast milk (Mennella 1991). Infants can learn to like the smell of alcohol (Mennella 1998a). This may result in a more positive attitude to alcohol later in life.

C) Recommendations for alcohol use while breastfeeding

1) Avoiding alcohol while breastfeeding

The World Health Organization recommends avoiding alcohol while breastfeeding (WHO 2014). Mothers who use alcohol regularly for a long time should not breastfeed (Reece-Stremtan 2015).

2) Limiting alcohol consumption

If mothers wish to use alcohol, most authorities recommend that they limit the amount to occasional drinks.

A standard drink of alcohol is considered to be:

  • 350 millilitres (12 U.S. fluid ounces) of 5% beer
  • 225 ml (8 oz) of 7% malt liquor
  • 150 ml (5 oz) of 12% wine
  • 45ml (1.5 oz) of 40% hard liquor

Mothers are advised to wait 2 to 2 1/2 hours before breastfeeding after drinking one standard drink. Lighter mothers require more time than heavier mothers to detoxify the same amount of alcohol. For a 54-kg (119-lb) mother, it takes about 2 1/2 hours to eliminate the alcohol from a standard drink and about 2 hours for an 82-kg (181-lb) mother (Anderson 2018).

Each additional drink increases the time by the same amount, so two drinks for a 54-kg mother will take 5 hours to clear and three drinks will take 7 1/2 hours.

3) Express if breastfeeding is delayed

If a mother has to delay breastfeeding because of her alcohol intake, she needs to express to prevent becoming overfull and throw out the expressed milk. The baby would need to be given a replacement feed with appropriate milk.

4) No need to express milk to remove alcohol from the breast before breastfeeding

Alcohol moves freely between blood and breast milk. If alcohol is in the blood, it is in the breast milk. Similarly, if the alcohol is out of a mother’s blood, there will not be any in her milk.

This means mothers do not have to express breast milk and throw it away before resuming breastfeeding. There is no need to “pump out the alcohol”. They can simply resume breastfeeding once the recommended amount of time has passed since the last drink.

References

Anderson PO. Alcohol Use During Breastfeeding. Breastfeed Med. 2018 May 4
 
Gibson L, Porter M. Drinking or Smoking While Breastfeeding and Later Cognition in Children. Pediatrics. 2018 Aug;142(2)
 
Fleming MF, Lund MR, Wilton G, et al. The Healthy Moms Study: the efficacy of brief alcohol intervention in postpartum women. Alcohol Clin Exp Res. 2008 Sep;32(9):1600-6
 
Fransquet PD, Hutchinson D, Olsson CA, et al. Perinatal maternal alcohol consumption and methylation of the dopamine receptor DRD4 in the offspring: the Triple B study. Environ Epigenet. 2016 Dec 7;2(4):dvw023
 
Giglia RC, Binns CW, Alfonso HS, et al. The effect of alcohol intake on breastfeeding duration in Australian women. Acta Paediatr. 2008 May;97(5):624-9
 
Howard CR, Lawrence RA. Breast-feeding and drug exposure. Obstet Gynecol Clin North Am. 1998 Mar;25(1):195-217
 
Haastrup MB, Pottegård A, Damkier P. Alcohol and breastfeeding. Basic Linc Pharmacol Toxicol. 2014;114(2):168–173
 
Jagodzinski TD, Fleming MF. Correlates of postpartum alcohol use. WMJ. 2007 Sep;106(6):319-25
 
Little RE, Anderson KW, Ervin CH, et al. Maternal alcohol use during breast-feeding and infant mental and motor development at one year. N Engl J Med. 1989;321(7):425–430pmid:2761576
 
May PA, Hasken JM, Blankenship J, et al. Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol. 2016 Aug;63:13-21
 
Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infant’s behaviour. N Engl J Med. 1991 Oct 3;325(14):981-5
 
Mennella JA, Beauchamp GK. (Mennella 1998a). Infants’ exploration of scented toys: Effects of prior experiences. Chem Senses. 1998 Feb;23(1):11-7
 
Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers' milk. Alcohol (Fayetteville, NY). 2001;25(3):153-158
 
Mennella JA, Gerrish CJ. (Mennella 1998b). Effects of exposure to alcohol in mother's milk on infant sleep. Pediatrics. 1998 May;101(5):E2
 
Mennella JA, Pepino MY, Teff KL. Acute alcohol consumption disrupts the hormonal milieu of lactating women. J Clin Endocrinol Metab. 2005;90(4):1979–1985
 
Pikkarainen PH, Räihä NC. Development of alcohol dehydrogenase activity in the human liver. Pediatr Res. 1967 May;1(3):165-8

Popova S, Dozet D, O'Hanlon G, et al. Maternal alcohol use, adverse neonatal outcomes and pregnancy complications in British Columbia, Canada: a population-based study. BMC Pregnancy Childbirth. 2021 Jan 22;21(1):74

Reece-Stremtan S, Marinelli KA. ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeed Med. 2015 Apr;10(3):135-41
 
Schuetze P, Das Eiden R, Chan AWK. The Effects of Alcohol in Breast Milk on Infant Behavioral State and Mother‐Infant Feeding Interactions. Infancy 2002;3(3):349-363
 
United States National Institute of Health (NIH). National Library of Medicine, Toxnet, Drugs and Lactation Database (LactMed) [Internet]. Bethesda: U.S. National Library of Medicine; [date unknown] [cited 2018 Oct 10]
 
World Health Organization. Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. Geneva, Switzerland: World Health Organization; 2014