Breastfeeding and alcohol: Do they mix?

Because August is National Breastfeeding Month, we are providing you with a cover story on it. At Contemporary OB/GYN®, our editorial meetings include an analysis of what articles are performing best in online metrics. One that consistently is at the top is the 2018 article titled, “Alcohol and Breastfeeding: What Are the Risks?”¹

We wanted to take a deeper dive and provide an update.

Breastfeeding is associated with numerous health benefits for both mother and child and has been identified as a strategy for the improvement of public health. For women, this includes a reduction in postpartum bleeding, anemia, urinary tract infections, and promotion of 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 biannual report —noting in 2017 that 84% of infants started breastfeeding —declining to 58% at 6 months and 35% at 12 months.² Many efforts, including the designation of baby-friendly hospitals that incorporate strategies to enhance 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 data on human lactation.⁴ Given that more than 3 million women breastfeed in the US, data on common substances such as alcohol are essential for counseling our patients.

From 2011 to 2018, the rate of alcohol consumption in pregnancy increased. Assuming 6,000,000 pregnancies in 2018, around 678,000 pregnant women drank alcohol in the past 30 days.⁵ The COVID-19 pandemic has heightened the need for this data. Alcohol consumption has substantially increased, including in women of reproductive age.⁶ For women, the frequency of alcohol consumption increased 17% during the pandemic and rose 19% in adults aged 30 to 59 years.

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

Many years ago I was on National Public Radio’s The Diane Rehm Show with esteemed professor David Barker ⁷— the originator of the fetal origins of adult disease—a pioneer in understanding the role of fetal development and programming on the impact of adult disease onset, known as the “Barker hypothesis”.⁸

The majority of the program focused on the importance of optimizing fetal health, but a listener called in with a question about the consumption of alcohol both during pregnancy and breastfeeding. In the UK this is more acceptable.

Indeed, the National Health Service states “an occasional drink it unlikely to harm your breastfed baby”⁹ and encourages healthy rest and nutrition for milk supply. In the US, the recommendation is not to consume alcohol while breastfeeding¹⁰ with concerns that alcohol consumption may impair milk supply. I fondly recall the tiptoeing I needed to master trying to negotiate a tactful disagreement with the advice of Barker and providing guidance for our listeners.

Even with these recommendations, women commonly ask questions about alcohol consumption and breastfeeding: “Should I pump and dump if I have a glass of wine?” and “Do I just wait until it has passed through my system?”

This month, experts Susan Crowe, MD, and Tricia Wright, MD, MS, provide the needed insight with as much data as are available on this topic. They offer their expert guidance on how best to advise patients and provide you with clinical pearls and key takeaways.

Read the updated article, "Alcohol and breastfeeding: What are the risks?" now.

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 Report Card. Centers for Disease Control and Prevention. 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 medications and breast-feeding. N Engl J Med. 2019; 380(14):1296-1297. doi: 10.1056/NEJMp1817420

4. National Institute of Child Health and Human Development. Task force on research specific to pregnant women and lactating women: report to 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 use among pregnant women in the U.S., 2011-2018. Am J Prev Med. 2020;59(5):768-769. Epub 2020 Oct 1. 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. Front Public Health. 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 in reproductive epidemiology. Acta Obstet Gynecol Scand. 2014; 93(11):1077-80. doi: 10.1111/aogs.12378. Epub 2014 Apr 8

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

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