Alcohol Usage

06.23.2010

It is well known that the use of alcohol during pregnancy can be quite hazardous for the fetus, and no one currently recommends the use of alcohol during pregnancy. However, many women may wish to consume alcohol after they have delivered their infant.

Following delivery, alcohol use is probably not as hazardous. If done judiciously, women may consume some alcohol without harming their infant. They simply need to wait a while before resuming breastfeeding. The use of alcohol in breastfeeding women should be governed by the rate of elimination in that mother. We basically suggest that mothers who consume alcohol wait for their body to metabolize and eliminate the alcohol before they return to breastfeeding.

In breastfeeding mothers, alcohol transfers readily into human milk. Alcohol is not stored in milk, but rather it enters and exits according to the mothers blood alcohol level. Milk levels of alcohol peak at 30 to 60 minutes following ingestion, and then fall rapidly if no more is ingested.

Remember that the levels in the mother’s milk are actually only a fraction of the amount the mother actually ingested. So in reality, the dose of alcohol in milk is rather low (<16% of mom’s dose), but this is a function of how much the mother consumed. (1)  Alcohol is rapidly metabolized in most humans. An average adult decreases blood alcohol levels by 15 to 20 mg/dL/hour.

To be safe, mothers need to drink only moderately and then wait for a specified amount of time prior to returning to breastfeeding. Mothers do not necessarily need to pump and discard their milk, only wait for their body to metabolize and eliminate it. Alcohol transfers into milk as the blood level rises, and then exits the milk compartment as the level in the blood goes down. Thus, if you just wait a few hours, the amount of alcohol in your milk is really quite reduced.

What does alcohol do to your milk supply? New data now clearly demonstrates that alcohol actually inhibits oxytocin release from the pituitary, thus it impedes the letdown process so that milk is not released from the breast as efficiently. Some studies show a 23% reduction in milk release while alcohol is present in the mother’s blood. (1)   In another study, alcohol completely blocked the release of oxytocin. (2)

The old suggestions that beer enhances milk production are simply wrong. It actually reduces the release of milk from the breast. If you have a robust milk supply, and your infant is gaining well, an occasional drink followed by a waiting period is unlikely to reduce your milk supply.

Older guidelines for determining the waiting period were rough estimates of the time required for elimination of alcohol. However, body weight is a better predictor of how fast or slow a mother metabolizes alcohol. Thus, a new more accurate method has been published and is quite suitable for estimating just how long a mother needs to wait before she returns to breastfeeding. (3)   

Whether or not to use alcohol is a choice that all breastfeeding mothers must make. The use of alcohol by breastfeeding mothers is widespread and is even considered “usually compatible” with breastfeeding by the American Academy of Pediatrics. (4)  However, data suggests that when used excessively, the infant may suffer various complications, including developmental delay. We suggest that you follow the nomogram below in deciding how much you drink, and when the infant can safely return to the breast

Facts:

1. Alcohol enters milk freely.
2. One drink includes: 12 oz of 5% beer, or 5 oz of 11% wine, or 1.5 oz of 40% liquor (80 proof).
3. The peak level in milk is likely to occur about 1 hour after consumption.
4. Alcohol leaves the milk compartment as the mother’s blood alcohol levels drop.
5. Alcohol present in pumped milk is permanent. Discard the milk.
6. Waiting “about” 2 hours per drink is required for complete metabolism of alcohol in a 180 pound female. 
7. Techniques such as drinking more water, taking caffeine, exercising, pumping and discarding of milk, etc. to enhance metabolism/clearance of alcohol do not work. Only time will eliminate alcohol.
8. Elixirs that contain ethanol can lead to blood alcohol levels similar to those seen by taking one alcoholic drink.
9. Storing milk before drinking is another way to make sure your infant is not exposed to alcohol.
10. Nothing can replace human breast milk as a source of nourishment for your child, therefore careful planning before drinking is advised over formula use.

References:

1. Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infant's behavior (see comments). N Engl J Med. 1991;325(14):981-985.
2. Coiro V, Alboni A, Gramellini D, et al. Inhibition by ethanol of the oxytocin response to breast stimulation in normal women and the role of endogenous opioids. Acta Endocrinol (Copenh). Mar 1992;126(3):213-216.
3. Ho E, Collantes A, Kapur BM, Moretti M, Koren G. Alcohol and breast feeding: calculation of time to zero level in milk. Biol Neonate. 2001;80(3):219-222.
4. American Academy of Pediatrics, Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93(1):137-150.