Fast Facts about Cigarette Smoking and Breastfeeding
December 31, 2006 by Angela White, J.D., breastfeeding counselor
Filed under breast milk, breastfeeding basics, cancer, health of the baby, health of the mother, medication, scientific studies
Some women might be making new year’s resolutions to quit smoking. This article provides information (and not judgment!) about pregnancy, breastfeeding, smoking and quitting smoking.
First, some fast facts about breastfeeding and cigarette smoke:
~ It is far from ideal to smoke and breastfeed–but it is worse to smoke and not breastfeed. (1)
~ The half-life of nicotine is two hours, meaning that two hours after smoking a cigarette, half of the nicotine released into the body remains in the body. (2)
~ Nicotine decreases production of prolactin, the hormone that stimulates milk production. (3), (4)
~ Maternal smoking cuts breast milk production at two weeks postpartum from 514 milliliters per day to 406 milliliters per day. (5) (Breastfeeding counselors may wish to ask mothers with low supply whether they are smokers).
~ Mothers who smoked before, during, and after pregnancy were 2.18 times more likely not to breastfeed at 10 weeks. Women who smoked 10 or more cigarettes per day postpartum were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers. (6) (Remember, exclusive breastfeeding is recommended for 24 weeks and breastfeeding is recommended for at least 52 weeks total).
~ Women who quit smoking during pregnancy were more likely to breastfeed for six months or longer. (7)
~ The breast milk of mothers who smoked during pregnancy contained less of the healthy fats (total lipids and fatty acids) than milk produced by non-smokers. (8)
Second, if you want to see the voting results of the companion poll “Cigarette Smoking and Breastfeeding,” click here.
Third, in this article I’ll answer the questions: Should a smoker breastfeed? What are the effects of nicotine on the baby? How does secondhand smoke affect a baby? Can a nursing mother use smoking cessation medications and products? Where can I find resources on quitting smoking?
Should a smoker breastfeed?
The short answer is yes. The long answer is that a mother who smokes should continue to breastfeed and ideally should attempt to quit smoking. Some mothers may mistakenly believe that if they are smoking it’s better for their babies if they switch to formula. In reality, smoking and formula-feeding is the worst case scenario.
What are the effects of nicotine on the baby?
Breastfed babies of smokers are more likely to experience colic (excessive crying) compared to breastfed babies of nonsmokers. (4)
Also, the Australian Breastfeeding Association notes:
Nicotine is an appetite suppressant and can alter the taste of breastmilk. Babies may express their distaste for the milk by fussing and struggling at the breast or even refusing the breast. If the mother smokes more than 15 cigarettes a day, infants can exhibit symptoms of nicotine poisoning (Bisdom 1937). These symptoms may include vomiting after a feed, grey skin colour, loose stools, an increased heart rate and restlessness. Classically, the infant can be observed to wiggle and squirm, giving the appearance of trying to frantically ‘tread water’ and though they appear very tired they seem to find it hard to keep their eyes shut. Symptoms are slowly reversed when the mother decides to cut back or quit her previous smoking habit. However, infants may also suffer withdrawal symptoms such as sleep disturbances, headaches and irritability.
How does secondhand smoke affect a baby?
The Australian Breastfeeding Association says:
Babies who are “smoked over” are more likely to be hospitalised and to suffer from respiratory and gastrointestinal illnesses. Studies show that these infants are more likely to be colicky and irritable and to experience a wide range of problems from apnoea (short periods when the baby stops breathing), vomiting, poor growth, squint (strabismus, cast or lazy eye), hearing impairment and unexplained death. Smoking depresses the immune system, leaving both the mother and infant more vulnerable to infection, allergy and other immunodeficiency problems (Minchin 1991).
Can a nursing mother use smoking cessation medications and products?
Always consult with your doctor about the safety of any medication for you and your breastfed baby. The general answer is yes, the nicotine patch, nicotine gum and the nicotine inhaler are compatible with nursing. (These items are marketed under the trade names Habitrol, Nicoderm, Nicorette, Prostep, Nicabate, and Nicotinell TTS).
One of the foremost experts on medications and mothers’ milk states:
[T]he absolute infant dose of nicotine and its metabolite cotinine decreases by about 70% from when subjects were smoking or using the 21 mg patch to when they were using the 7 mg patch. In addition, use of the nicotine patch had no significant influence on the milk intake by the breastfed infant. Undertaking maternal smoking cessation with the nicotine patch is, therefore, a safer option than continued smoking.
(2), (9). Note that it’s dangerous to use the patch and continue to smoke–the combination of the two sources of nicotine results in extremely high levels of nicotine which can harm the baby.
While the patch provides a continual low-dose level of nicotine, the gum has a rapid effect on nicotine levels. Therefore, it’s best for women to breastfeed immediately before chewing the gum, then wait another two to three hours before breastfeeding again after chewing the gum.
Where can I find resources for quitting smoking?
There are several on-line resources for quitting smoking. I’ve also linked to one of many books on the subject (the American Lung Association’s book got a five star review from all its reviewers as of the writing of this article).
American Cancer Society’s Guide to Quitting Smoking
American Lung Association’s Resources on Quitting Smoking
Center for Disease Control’s Tobacco Information and Prevention Source
National Cancer Institute’s Quitting and Prevention Help and Information
Nicotine Anonymous (a 12-step fellowship program)
Smoking Cessation Leadership Center
Sources:
(1) Minchin M.K. “Smoking and breastfeeding: an overview.” J. Hum. Lact. 1991 Dec.;7(4):183-8.
(2) Hale, Thomas W. Ph.D., Medications and Mothers’ Milk, 12th edition, Texas: Hale Publishing (2006), p. 645.
(3) Benowitz N.L. “Nicotine replacement therapy during pregnancy.” JAMA 1991;266(22):3174-3177.
(4) Matheson I., Rivrud G.N. “The effect of smoking on lactation and infantile colic.” JAMA 1989; 261(1):42-43.
(5) Hopkinson J.M. et al. “Milk production by mothers of premature infants: influence of cigarette smoking.” Pediatrics 1992; 90(6):934-938.
(6) Liu J., Rosenberg J.D., Sandoval A.P. “Breastfeeding duration and perinatal cigarette smoking in a population-based cohort.” Am. J. Public Health. 2006 Feb. 96(2):309-14.
(7) Giglia R.C., Binns C.W., Alfonso H.S. “Which women stop smoking during pregnancy and the effect on breastfeeding duration.” BMC Public Health. 2006 Jul. 26;6:195.
(8) Agostoni C. et al. “Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation.” Eur. J. Clin. Nutr. 2003 Nov. (57)11:1466-72.
(9) Ilett K.F. et al. “Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk.” Clin. Pharmacol Ther 2003; 74(6)516-524.
I am breastfeeding my newborn, and I smoke 1 ultralight cigarette a day. Can this harm my baby at all? I know I shouldn’t smoke, period, but with 3 kids, a full time job, and going through a divorce, my stress levels are high, and I can’t seem to be without this small daily dose of nicotine. Before I got pregnant I smoked a pack a day of full strength cigarettes, so I feel this is a vast improvement for me, but I also don’t want to harm my baby. Should I stop breastfeeding? Replace a feeding after my cigarette with formula? Or is this ok? Someone please let me know! Thanks very much!
Jess, congrats on cutting back from a pack a day! That is wonderful.
It is better to breastfeed than to stop breastfeeding or replace a feeding with formula. Ideally you’d want to cut out that last cigarette too, but it is still the best thing for your newborn to continue breastfeeding.
Comparing smoking to formula-feeding? I am absolutely appauled. There is a HUGE difference between the two, because formula-feeding doesn’t cause cancer or kill the baby. There are those of us who tried to breastfeed and weren’t successful for whatever reason, and the baby has to eat somehow! My siblings and I were formula-fed as well as my son, and we have been just fine. My son is almost three and hasn’t been sick a day in his life even when he’s been around sick people while all the other babies I know have been sick multiple times. Don’t give me that crap! I’d much rather formula-feed my child than for him to start smoking when he is older. Breast milk may be better, but I haven’t had issues with formula-feeding and I don’t regret choosing it. Breastfeeding doesn’t work for everyone. GET OVER IT! And once again, there is no way you can compare smoking to formula-feeding. Formula hasn’t put any of my family or my son in a coffin!!!!!!!
I hate judgmental people who think they are holier than thou. Come on!
Kristina…breastfeeding is better than formula. But formula exists for those times when breastfeeding is not possible. You are taking things out of context. I wonder why you didn’t breastfeed? It takes a lot of effort to breasfeed, I worked very hard at it, I spent six weeks pumping until my son finally got the hang of it. You are being judgmental by your comments. I was formula fed, and yes I’m fine. But many babies do have serious problems from formula. The thing is that people do the best they can. and if you dont like judgmental people you shouldnt be so judgmental. Oh by the way formula has killed babies do your research before you leave rude comments
I think keeping your cigarette smoking to a minimum(max 4/day), good hand-washing (after each one), brushing teeth and changing clothes as well as trying to leave atleast 1 hour before feed due is the best of a bad situation. if we choose to smoke were entitled to a life too-there is a lot worse yu could do and a lot less effort you could put in. personally I hate formlula-its like giving someone elses milk to my child!
This website definately made me feel better about my smoking and breastfeeding.
I probably smoke 1-2 a day and I feel like such a bad parent but this has been
A hard habit that I’ve been stuggling with for a long time
Thanks to Amber for sticking up for us breastfeeding mothers. I realize that there are certain situations that keep women from breastfeeding but the majority of women give up because it’s to hard. I can’t tell you how many times I wanted to throw the towel in and say bring on the formula but I held it together and I’m glad. Society makes it such a big deal to breastfeed that mothers who don’t feel the need to come up with excuses rather than simply saying they can’t take it (which is okay, it’s not easy) So us breastfeeding mothers constantly have to defend ourselves for hanging in there and doing what is best, and not what is easiest. So all you formula moms can attack if you want but you know the truth and more of you (than are willing to admit)just didn’t want to put in the effort. Which again I feel is okay, we are not cows and there are alternatives but society has made it a big deal, not the breastfeeding mothers, so give us a break.
My question is can I reproduce my milk supply if I choose to start pumping again. I started smoking again, an my newborn is 3mths old; I smoke 5-6 cigarettes a day. An due to the high cost of formula i was just wondering if I could start pumping again an if my milk supply would just naturally increase.
try fenugreek and blessed thistle to help u get more milk. they are available in most health food stores. i found the blessed thistle drops to be more effective than the pills