Smoking and Breastfeeding

By Krista Gray, IBCLC. Last updated October 17, 2013.

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Is it safe to smoke while breastfeeding?

Everyone knows that smoking cigarettes is hazardous to their health.  And while the risks of smoking during pregnancy are well documented with increased incidences of preterm birth, low birth weight, and increased risk of abortion or stillbirth, much less is publicized about smoking and breastfeeding. Many mothers who smoked in the past want to make changes now that they have a baby, but change can be hard and take time.

They understand the importance of breast milk for their babies but wonder if the benefits are negated if they still use nicotine.  The bottom line is that even though nicotine does pass into breast milk, and mothers should seek to stop smoking or at least use a nicotine patch, breastfeeding is still a better option than formula feeding, for a variety of reasons.

The CDC states the following:

“Mothers who smoke are encouraged to quit, however, breast milk remains the ideal food for a baby even if the mother smokes.  Although nicotine may be present in breast milk, adverse effects on the infant during breastfeeding have not been reported.  AAP [AmericanAcademy of Pediatrics] recognizes pregnancy and lactation as two ideal times to promote smoking cessation, but does not indicate that mothers who smoke should not breastfeed.”1

What are the various forms of nicotine?

  • Cigarettes – Smoking 17/day is proportional to the 21 mg nicotine patch.  The 14 mg and 7 mg patches have significantly less nicotine than cigarette smoking.
  • Patch – This is considered a safer option than smoking.  Nicotine amounts don’t have a sharp rise and decrease as with cigarettes or gum so timing breastfeeding is less important.
  • Inhaler – Dispenses low levels of nicotine and even habitual users will typically incur less nicotine than smoking a pack of cigarettes each day.  There is minimal transfer of nicotine to breast milk.
  • Gum – Maternal serum levels fluctuate as with smoking cigarettes.  The faster the gum is chewed the greater the peak levels of nicotine.
  • E-cigarette – Considered safer than smoking a cigarette. Peak blood nicotine levels similar to the nicotine inhaler and minimal in breast milk.2

How can I reduce the levels of nicotine my baby is exposed to?

Smoking (or using gum, inhaler, etc.) immediately following breastfeeding and then waiting a couple of hours before nursing again allows the nicotine in breast milk to decrease before each breastfeeding.  The half-life of nicotine is 95 minutes – that means it reaches its peak in the maternal blood stream at this time.  It takes 5 half-lives to clear a drug completely.  (You can read more about this on how medications affect baby.)

Smoking and then breastfeeding right afterwards greatly increases the amount of nicotine in breast milk.  However, if your baby wants to nurse after smoking it is better to breastfeed than give formula.

It is important to smoke away from your baby.  Smoking in a separate, well ventilated room can greatly reduce the amount of second hand smoke your baby is exposed to.  Decreasing the number of cigarettes a mother smokes or switching to a nicotine patch is also beneficial.

What effect does smoking have on a mother’s breast milk?

Smoking cigarettes can have a detrimental effect on a mother’s milk supply, milk ejection reflex, and a baby’s weight gain.3  In a mother with an ample supply of milk this may not be as much of a concern, but with a mother with smaller breasts or less glandular tissue (breast size does not equal breast milk capacity) this could mean the difference of being able to provide enough milk for her baby versus having to supplement.  Slow weight gain in a baby could lead to failure to thrive, a very serious diagnosis.  Babies of mothers who smoke should have their weight watched diligently to ensure adequate growth.

The fat content of breast milk in mothers who use nicotine is also lower.4  Fat in breast milk is something that is affected by maternal diet and mothers who smoke not only have lower fat content but the fat has nicotine in it.  Fat is important for infant growth and brain development.  But, just because nicotine affects the fat content of breast milk does not mean the alternative – formula – is superior; it’s not.

What are the infant concerns when a mother smokes?

Mother’s who smoke are less likely to breastfeed.  Those that do breastfeed are more likely to breastfeed for a shorter duration than mothers who don’t smoke.5  Breastfeeding has tremendous health benefits for mothers and benefits for babies so anything that decreases the duration of a mother-baby breastfeeding relationship is significant.

Maternal smoking also exposes a baby to the dangers of second-hand smoke.  This can cause increased allergies and respiratory illness as well as unsafe carbon monoxide levels.6

These infant concerns continue to exist when a mother formula feeds her baby while smoking.  In fact, formula feeding while smoking is even more harmful than breastfeeding and smoking.  A baby receives the vast majority of smoking side effects from second-hand smoke rather than nicotine in breast milk.  In fact, the nicotine that does pass through breast milk is easily outweighed by the living, changing, and unique qualities of breast milk that impart antibodies and immunities to a baby to help him fight disease, infection, and illness, as well as equipping his immune system to maturity so it will be strong and prepared to work to its full potential over the course of a lifetime.

A baby who is regularly exposed to second-hand smoke especially needs the benefits of breast milk!

So, while it is important for a mother to try to decrease or cease smoking, it is far better for a mother to smoke and breastfeed than to stop breastfeeding in order to continue smoking.

Show 6 footnotes

  1. Centers for Disease Control and Prevention, “Breastfeeding.” Accessed October 16, 2013 via www.cdc.gov/breastfeeding/faq/.
  2. Hale, T.W. (2012) Medications and Mother’s Milk, 15th ed. Amarillo, TX: Hale Publishing, pp.832-4.
  3. Riordan, J. & Wambach, K. (2012) Breastfeeding and Human Lactation, 4th ed. Sudbury, MA: Jones and Bartlett Publishers, p. 347.
  4. Riordan, J. & Wambach, K. (2012) Breastfeeding and Human Lactation, 4th ed. Sudbury, MA: Jones and Bartlett Publishers, p.543.
  5. Riordan, J. & Wambach, K. (2012) Breastfeeding and Human Lactation, 4th ed. Sudbury, MA: Jones and Bartlett Publishers, p. 347.
  6. Riordan, J. & Wambach, K. (2012) Breastfeeding and Human Lactation, 4th ed. Sudbury, MA: Jones and Bartlett Publishers, p. 543.
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