Drinking Alcohol and Breastfeeding

Skip to: Overview
Skip to: Can Drinking an Alcoholic Beverage Help Me Relax and Stimulate Milk Production?
Skip to: What are the Risks To My Baby?
Skip to: What Other Effects Should I Consider When Deciding Whether and When To Drink?
Skip to: Can I Nurse My Baby and Still Drink Occasionally?
Skip to: How Is One Drink Defined?
Skip to: Important Considerations
Skip to: Do I Have To Pump And Dump After Drinking an Alcoholic Beverage?
Skip to: What if I Get Drunk?
Skip to: Can Alcohol Dependency/Self-medicating With Alcohol Affect A Breastfed Baby?
Skip to: Weighing The Risks And Benefits
Skip to: References
Skip to: Further resources

Overview

Breastfeeding mothers and lactating parents often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While warnings are often given not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding have not received as much research attention. A number of studies have focused on the effects of alcohol on lactation and the infant, but long-term outcomes are still unknown.

Especially when it is consumed in large amounts, alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant. There is also possibility of decreased milk-ejection reflex in the mother. No harmful effects to babies have been found when breastfeeding mothers drink no more than one drink a day.

Depending on how much alcohol you consume before you nurse your baby, may experience a number of effects from the alcohol in your milk. Even a small to moderate amount of alcohol may impair milk production and the milk ejection reflex. Some of the negative effects in the baby may be:

  • Sleep disturbances, 
  • Increased crying
  • Increased startling
  • Increased arousal
  • Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
  • Decreased milk intake by baby
  • Decreased weight gain

Potentially, depending on how much you drink and when you nurse your baby after drinking, there may be other, more severe effects on your baby as well. As a result, the guidance on drinking and nursing is changing. According to the CDC, “moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men”.[1]. We go into more detail below.

In brief, LactMed® [2], a database that contains information on drugs and other chemicals to which those who are breastfeeding may be exposed, offers the following information:

“Breastmilk alcohol levels closely parallel blood alcohol levels. The highest alcohol levels in milk occur 30 to 60 minutes after an alcoholic beverage, but food delays the time of peak milk alcohol levels. Nursing after 1 or 2 drinks (including beer) can decrease the infant’s milk intake by 20 to 23% and cause infant agitation and poor sleep patterns. Nursing or pumping within 1 hour before ingesting alcohol may slightly reduce the subsequent amounts of alcohol in breastmilk.”

Infants exposed to a significant amount of alcohol (0.3 g/kg parent’s body weight) through drinking human milk, spend significantly less time in both active and total sleep. REM sleep is also disrupted.  As infants are less able to process alcohol than adults due to their immature systems, some researchers believe that the dosage they receive through their mother’s/lactating parent’s milk may be stronger than it would be in an adult. In research conducted by Mennella and Garcia-Gomez, when an infant’s exposure occurred within 3.5 hours of a mother/lactating parent consuming a significant amount of alcohol, the effects were stronger. In the following 24-hour period, sleep patterns continued to be disrupted as the infant makes up for the earlier disruption. In addition, the research showed that during times when the infants were awake, they were less active [3].

Here are some common questions people ask with recommendations supported by the evidence available. Below, we will answer these questions and look at the possible impacts of drinking alcohol while breastfeeding in more detail. We will end with some tips for increasing safety if you want to drink alcohol while breastfeeding/chestfeeding/nursing (see How Can I Nurse My Baby and Still Drink Occasionally?). Pumping and dumping will not remove the alcohol from your bloodstream, so it will not affect the alcohol level in your milk.

CAN DRINKING AN ALCOHOLIC BEVERAGE HELP ME RELAX AND STIMULATE MILK PRODUCTION?

A long-standing “old wives’ tale” regarding consumption of alcohol, particularly beer, while breastfeeding, is that it can help boost milk production. While a barley component in beer–not the alcohol–does boost prolactin production [4], alcohol alone does so as well [5] However, in one study, milk production was actually decreased [6]. In addition, in their research on alcohol consumption in lactating women Menella et al found alcohol also inhibits the milk ejection reflex and thus reduces the baby’s milk intake [5].

The research shows that nursing infants actually consumed less milk in the three-to-four-hour period after mothers consumed a small to moderate amount of alcohol [7,8,9]. When a mother/lactating parent drinks alcohol and then breastfeeds their baby, their perception is that the baby nurses normally and for a normal time, so they do not realize that their baby is not getting as much milk [7]. According to Menella, who conducted this research on this over a period of years, “infants consumed approximately 20% less breast milk”. This was the case even though the infants nursed a “similar number of times during the first 4 hr after exposure to alcohol in mothers’ milk” (pp. 591-592) compared with nursing infants not exposed to alcohol in their mother’s milk [9]. Similarly, additional research conducted by Menella and Beauchamp showed that infants consumed about 23% less milk [7]. Menella also found that when pumping milk two hours after drinking alcohol, mothers obtained significantly less milk [8].

Current evidence shows that, rather than producing more milk for your baby by drinking alcohol, the effects of alcohol on your body actually mean your baby will get less of your valuable milk. Why is this?

Mennella, Pepino, and Teff [5] found that alcohol significantly reduces oxytocin levels while also increasing prolactin levels. Both hormones influence the milk ejection reflex. The lower the level of oxytocin, the longer the delay in ejection of milk. The higher the level of prolactin, the longer the delay. The combination of alcohol’s effect on the two hormones leads to a significant delay in milk ejection.

WHAT ARE THE RISKS TO MY BABY?

Depending on the amount of alcohol consumed by the mother/lactating parent, and depending on when the baby is breastfed after alcohol consumption, various researchers have found the most common negative outcomes for the baby to be: [8,9,11,13,14,15,16]:

  • Sleep disturbances, including shorter sleep periods, more frequent wakefulness, and less total active and REM sleep in the three-hour-period after consuming alcohol
  • Increased crying
  • Increased startling
  • Increased arousal
  • Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
  • Decreased milk intake by the baby
  • Growth retardation
  • Impaired immune function
  • Delay of motor development
  • Potential impairment of cognitive development
  • Reduction in ability for abstract reasoning at school age (6-7 years)

The Academy of Breastfeeding Medicine state in Clinical Protocol #21 that consuming alcohol during lactation has several negative effects ranging from mild to severe. This is dependent on the amount of alcohol the mother/lactating parent has consumed and other factors related to how quickly their body processes alcohol [12].

As alcohol is completely water- and fat-soluble, it enters the bloodstream and human milk very easily [13]. The amount of alcohol in human milk after consumption of one standard drink is about 95% that of the amount of alcohol in the mother/lactating parent’s bloodstream.

Another review, conducted by Nonacs [14], showed that motor development of infants who were exposed to alcohol in human milk regularly was decreased or delayed. The more alcohol the infants consumed through breast milk, the lower the infants scored on indices of motor development. Infants cannot metabolize alcohol as quickly as adults can; newborns can only metabolize alcohol at 25% to 50% of the rate at which adults can [14].

Concerns about negative effects on the infant’s developing brain are based on animal research. Oei [15] notes that “robust animal data” indicate that “alcohol may be toxic to the developing brain, especially during periods of rapid brain development” such as occur in the first year after birth. Impairments to memory and inhibitory responses may also occur as a result of an infant’s consumption of alcohol.

Though research continues, Haastrup, Pottegård, and Damkier stated that “the possible long-term effects of alcohol in mother’s milk are unknown” (p. 171).

WHAT OTHER EFFECTS SHOULD I CONSIDER WHEN DECIDING WHETHER AND WHEN TO DRINK?

Depending on how much you drink, in addition to the effects on your milk production and ejection reflex, you can expect some degree of other effects on yourself.

Alcohol produces sedative effects as well as some stimulant effects. There is some evidence that suggests that people who are currently lactating may metabolize alcohol more quickly than non-lactating people. There is clear evidence that eating food while consuming alcohol also reduces blood alcohol levels after consumption. Drinking alcohol on an empty stomach increases the effects of alcohol on prolactin and oxytocin as well as on your body [17]. You should not sleep with your baby if you have been drinking alcohol, as your natural reflexes have been impaired.

Information about bed-sharing and alcohol here:https://www.llli.org/breastfeeding-info/sleep-bedshare/ https://www.basisonline.org.uk/parents-bed/

By interfering with your milk ejection reflex, alcohol may further reduce your milk production: without this reflex, your baby cannot nurse and empty the breast effectively. When milk stays in the breasts, it tells your body to reduce production. 

 CAN I NURSE MY BABY AND STILL DRINK OCCASIONALLY? 

Several sources offer safety suggestions to consider when breastfeeding and drinking alcohol.[19]

  • Be aware that newborns cannot metabolize alcohol well; if possible avoid drinking alcohol until your baby is at least 8 weeks old or older
  • Breastfeed your baby immediately before drinking any alcoholic beverage, if possible, or pump and save your milk.
  • Limit your alcohol intake to one (preferably) or two glasses of wine (8 ounces total) or one or two beers (see “How Is One Drink Defined” for more information on amounts of alcohol)
  • Wait at least 2 hours after drinking one standard drink before breastfeeding your baby.
  • Be aware that the more you drink, the longer it takes for the alcohol to clear your system.
  • If your baby needs to be nursed before two hours or more is up, use your previously expressed milk to feed your baby.
  • Drink juice when drinking alcohol
  • Eat food when drinking alcohol–it will slow the rate at which alcohol enters your bloodstream.
  • “Pump and dump” only if needed for comfort. As long as there is alcohol in your bloodstream, there will be alcohol in your milk.
HOW IS ONE DRINK DEFINED?

A ‘standard drink’ is measured differently in different countries. It is important to understand what a ‘standard drink’ is if you choose to drink alcohol and breastfeed.
Please check with your Ministry of Health or other pertinent government resource for appropriate information in your country.
Some examples:
To determine standard drink measures in Europe, please refer to Standard Drink Measures in Europe[20].

In the UK, the NHS suggest using this unit calculator: https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator

In the United States, it is defined by the National Institutes of Health (NIH) this way [21]:

In the United States, one “standard” drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:

  • 12 ounces of regular beer, which is usually about 5% alcohol
  • 5 ounces of wine, which is typically about 12% alcohol
  • 1.5 ounces of distilled spirits, which is about 40% alcohol

Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers’ Milk (17th ed., 2019):

“Alcohol transfers into human milk readily, with an average plasma/milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight. Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2 – 3 hours after drinking alcohol. Heavy drinkers should wait longer.

In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less. Compensatory increases in intake were then observed during the 8 – 16 hours after exposure when mothers refrained from drinking.

Adult metabolism of alcohol  is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”

IMPORTANT CONSIDERATIONS
    • Your baby’s age
      • A newborn has an immature liver, and will be more affected by alcohol
      • Up until around three months of age, infants metabolize alcohol at about half the rate of adults
      • An older baby can metabolize alcohol more quickly than a young infant but still not as well as an adult
    • Your weight
      • A person’s size has an impact on how quickly they metabolize alcohol
      • A heavier person can metabolize alcohol more quickly than a lighter person
    • Amount of alcohol
  • Know what constitutes a “standard drink”
    • The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed
    • The more alcohol consumed, the longer it takes to clear the body. The CDC state “Alcohol from 1 drink can be detected in breast milk for about 2-3 hours, alcohol from 2 drinks can be detected for about 4-5 hours, and alcohol from 3 drinks can be detected for about 6-8 hours, and so on.”
  • Whether you will be eating
    • An alcoholic drink consumed with food slows the rate of absorption of the alcohol into the bloodstream.
DO I HAVE TO PUMP AND DUMP AFTER DRINKING AN ALCOHOLIC BEVERAGE?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as your blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.

WHAT IF I GET DRUNK?

If you are intoxicated, you should not breastfeed until you are completely sober, at which time most of the alcohol will have left your body. Drinking to the point of intoxication, or binge drinking, has been shown to impact the way infants sleep. The negative impact on sleep occurs when the infants are exposed to alcohol through milk containing alcohol at the level it would be found in human milk one hour after a mother consumed a significant amount of alcohol (0.3 grams per kilogram of their body weight).

CAN ALCOHOL DEPENDENCY/SELF-MEDICATING WITH ALCOHOL AFFECT A BREASTFED BABY?

Yes. Alcohol dependence or self-medicating with alcohol by the mother/lactating parent can result in slow weight gain or failure to thrive in their baby. As noted earlier, even a small to moderate amount of alcohol negatively affects the milk ejection reflex (let-down) and reduces the baby’s milk intake. The baby can suffer significant disruption to their sleep [21] or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is self-medicating with alcohol excessively, contact your healthcare professional or a reputable organisation supporting people who are struggling with alcohol use.

WEIGHING THE RISKS AND BENEFITS

Often, situations in which alcohol is being offered arise. Maybe you are going out with family, or on a date, or you have had an incredibly stressful week and someone suggests a beer. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

  • Plan Ahead
    • If you choose to drink alcohol, plan as well as you can to reduce your baby’s exposure to alcohol; If possible, store some expressed breastmilk in advance. 
    • Breastfeeding immediately before consuming any alcoholic beverage, then waiting to nurse again for about three hours, will help ensure that your baby gets very little alcohol from you.
    • If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express. 
  • Alternatives
    • If you plan to drink more than a moderate amount of alcohol, ensure that your baby has a responsible alternative caregiver.
    • If you don’t really want to go to a family or work event talk to a trusted friend or with your local La Leche League Leader about the pros and cons of going. 
    • You might prefer to stick to non-alcoholic drinks.
    • Have a trusted friend or an online La Leche League group on hand to message when at an event where everyone else is drinking.
    • Whenever possible, ask for and take up offers of help that allow you to have a short break from mothering and parenting to focus on something you enjoy doing.
References:
    1. Centers for Disease Control (CDC). https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol
    2. LactMed. Retrieved 11 May 2020 from https://www.ncbi.nlm.nih.gov/books/NBK501469/
    3. Mennella, J. A., & Garcia-Gomez, P. L. (2001). Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol 25(3) pp. 153-158. DOI: 10.1016/s0741-8329(01)00175-6
    4. Koletzko, B., & Lehner, F. (2000). Beer and breastfeeding. Advances in Experimental Medicine and Biology 478 pp. 23-8. doi: 10.1007/0-306-46830-1_2. PMID: 11065057    
    5. Mennella, J. A., Pepino, M. Y., & Teff, K. L. (2005). Acute alcohol consumption disrupts the hormonal milieu of lactating women. The Journal of Clinical Endocrinology & Metabolism 90(4) pp. 1979-1985. doi: 10.1210/jc.2004-1593.
    6. Mennella, J. A., & Pepino, M. Y. (2008). Biphasic effects of moderate drinking on prolactin during lactation. Alcoholism: Clinical and Experimental Research 32(11) pp. 1899-1908. Doi: 10.1111/j.1530-0277.2008.00774.x.
    7. Mennella, J. A., & Beauchamp, G. K. (1993). Beer, breast feeding, and folklore. Developmental Psychobiology, 26(8) pp. 459-466. doi: 10.1002/dev.420260804
    8. Haastrup, M. B., Pottegård, A., & Damkier, P. (2013). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology 114 pp. 168-173. doi: 10.1111/bcpt.12149 
    9. Mennella, J. A. (2001). Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcoholism: Clinical and Experimental Research 25(4) pp. 590-593.
    10. Mennella, J. A. (1998). Short-term effects of maternal alcohol consumption on lactational performance. Alcoholism: Clinical and Experimental Research 22(7) pp 1389-1392. doi: 10.1111/j.1530-0277.1998.tb03924.x
    11. Brown, R. A., Dakkak, H., & Seabrook, J. A. (2018). Is breast best? Examining the effects of alcohol and cannabis use during lactation. Journal of Neonatal-Perinatal Medicine, 11(4) pp. 345-356. Doi: 10.3233/NPM-17125.
    12. Reece-Stremtan, S., Marinelli, K. A., & The Academy of Breastfeeding Medicine. (2015). ABM Clinical Protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, Revised 2015. Breastfeeding Medicine 10(3) pp. 135-141. doi: 10.1089/bfm.2015.9992 
    13. Anderson, P. O. (2018). Alcohol Use During Breastfeeding. Breastfeeding Medicine 13(5) pp. 315-317. DOI: 10.1089/bfm2018.0053.
    14. Nonacs, R. (2018). Alcohol and breastfeeding: What are the risks? Contemporary OBGYN Net December 2018 24-28.
    15. Oei, J-L. (2019). Risky maternal alcohol consumption during lactation decreases childhood abstract reasoning at school age. Evidence-based Nursing 22(10 p. 25. doi: 10.1136/ebnurs-2018-102999.
    16. Gibson, L., & Porter, M. (2018). Drinking or smoking while breastfeeding and later cognition in children. Pediatrics 142(2). doi: https://doi.org/10.1542/peds.2017-4266.
    17. Gibson, L., & Porter, M. (2020). Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes 13:232. doi.org/10.1186/s13104-020-05072-8.
    18. Pepino, M. Y., Steinmeyer, A. L., & Mennella, J. A. (2007). Lactational state modifies alcohol pharmacokinetics in women. Alcoholism: Clinical and Experimental Research 31(6) pp. 909-918. doi: 10.1111/j.1530-0277.2007.00387.x. 
    19. Tay, R. Y., Wilson, J. McCormack, C., et al. (2017) Alcohol consumption by breastfeeding mothers: Frequence, correlates and infant outcomes. Drug and Alcohol Review 36 pp. 667-676. doi: 10.1111/dar.12473.
    20. Standard Drink Measures in Europe (2015). Published by RARHA (Reducing Alcohol Related Harm). Accessed 4 Dec 2020 from http://www.rarha.eu/Resources/Deliverables/Lists/Deliverables/Attachments/14/WP5%20Background%20paper%20Standard%20drink%20measures%20HRB.pdf 
    21. National Institutes of Health. What Is a Standard Drink? Accessed 4 Dec 2020 from https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink
    22. Drugs and Lactation Database (LactMed), Alcohol, May 11 2020 https://www.ncbi.nlm.nih.gov/books/NBK501469/
      Accessed 27 October 2020
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LLL France Article
LLL Greece Article

Reviewed and revised December 2020, with minor language changes March 2021.

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