Smoking

By Diane Wiessinger, MS, IBCLC and Kathleen Bruce, RN, IBCLC

Smoking is one of the most difficult addictions to break. Smoking and breastfeeding is better for both you and your baby than smoking and formula feeding. If you smoke, your baby will still benefit from breastfeeding.

Here are some points to consider for mothers who smoke: Do your best to cut back or to stop. You can find good ideas through your doctor or at the American Cancer Society’s website.

Quitting smoking, or cutting back, not only improves your own health and that of your baby, but can also make breastfeeding more of a pleasure. Studies indicate that smoking may lower your milk supply and increase the risk of early weaning. Breastfeed often, and when your baby wants to, not according to a schedule. Frequent, freely offered breastfeeding helps ensure that your milk supply matches your baby’s needs. Maintaining a good milk supply helps ensure that you will be able to breastfeed as long as you choose.  Smoke after breastfeeding, in a room away from the baby, never in the car, and preferably outside. Smoking after you breastfeed means your blood levels – and thus your milk levels – of tobacco chemicals are at their lowest while you’re actually breastfeeding. Smoking outside helps keep your baby from inhaling second-hand smoke – a risk factor for SIDS and life-long respiratory problems. It also keeps you from re-inhaling your own smoke.

If your baby doesn’t breastfeed well in the early days or weeks, get help from an IBCLC lactation professional (look at www.ilca.org for a local listing of IBCLC professionals), and use a good electric pump - such as a Medela Lactina, Symphony, or Pump in Style - to keep your supply up (visit Breastfeeding National Network (BNN) to find a source of Medela pumps in your area). Establishing a good supply within the first few weeks makes it far easier to maintain that supply as your baby grows.

Some mothers find that nicotine patches, used according to instructions, can be a substitute for smoking and can reduce your blood (and milk) levels of nicotine and other tobacco-related chemicals. They also eliminate the risks of second-hand smoke. It is important not to smoke in addition to using the patch, as then you would simply be adding more chemicals to what you already use, and this could be dangerous for you and your baby.

Remove the patch at night when you wouldn’t be smoking anyway. Check  with your doctor for appropriate dose and frequency if you wish to try nicotine gum.   Some vegetables contain nicotine. Consider limiting your intake of eggplant, green and pureed tomatoes, and cauliflower if you smoke.

If you smoke, others may be able to smell smoke in your expressed milk. Your baby’s urine may have levels of cotinine (a product of nicotine) that are several times higher than the levels in formula-fed babies of mothers who smoke. How can milk like that be better for your baby than formula? Your milk still contains living cells and other germ-killing substances that help protect your baby from disease, plus nutrients that are known to promote brain development and hormones that help your baby’s digestive and immune systems develop normally. Formula has none of these substances. It is best to cut back or quit smoking for your health and for the health of your child. However, even if you find you can’t quit or cut back, remember that breastfeeding your baby is still the most important investment you can make in your own and your baby’s health.

Editors: Mary V. Bibb BA IBCLC


References: Amir L. Maternal smoking and reduced duration of breastfeeding: a review of possible mechanisms. Early Human Dev 2001; 64(1): 45-67. Labrecque M, Marcoux S, Weber J-P, et al. Feeding and urine cotinine values in babies whose mothers smoke. Pediatrics 1989; 83(1):93-7. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical profession, 5th edition. Mosby, St. Louis. J Hopkinson, R Schanler, K Fraley, C Garza: Milk Production by Mothers of Premature Infants: Influence of Cigarette Smoking. Pediatrics 1992; 90(6): 934-938.

New References: 2007

“Our findings suggest an association with maternal smoking during pregnancy and lowered cognitive development in children at age 4 years.”


Int. J Epidemio. 2007 June 5; Maternal smoking habits and cognitive development of children at age 4 years in a population-based birth cohort.
Julvez J, Ribas-Fitó N, Torrent M, Forns M, Garcia-Esteban R, Sunyer J.


“CONCLUSION: In conclusion, exposure to environmental tobacco smoke worsens the symptoms and the prognosis of bronchiolitis, while breastfeeding seems to have a protective effect even in children exposed to environmental tobacco smoke.”

Minerva Pediatr. 2007 June;59(3):199-206. The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants

Chatzimichael A, Tsalkidis A, Cassimos D, Gardikis S, Tripsianis G, Deftereos S, Ktenidou-Kartali S, Tsanakas I.

 Matern Child Health J. 2007 May;11(3):287-91. Epub 2007 Jan 17.
“Maternal smoking and infant feeding: breastfeeding is better and safer.”
Dorea JG.

“This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.”

 

PEDIATRICS Vol. 108 No. 3 September 2001, pp. 776-789
AMERICAN ACADEMY OF PEDIATRICS: The Transfer of Drugs and Other Chemicals Into Human Milk
Committee on Drugs
 

“In the previous edition of this statement, the Committee on Drugs placed nicotine (smoking) in Table 2, "Drugs of Abuse-Contraindicated During Breastfeeding." The reasons for placing nicotine and, thus, smoking in Table 2 were documented decrease in milk production and weight gain in the infant of the smoking mother and exposure of the infant to environmental tobacco smoke as demonstrated by the presence of nicotine and its primary metabolite, cotinine, in human milk.4-12 There is controversy regarding the effects of nicotine on infant size at 1 year of age.13,14 There are hundreds of compounds in tobacco smoke; however, nicotine and its metabolite acotinine are most often used as markers of tobacco exposure. Nicotine is not necessarily the only component that might cause an increase in respiratory illnesses (including otitis media) in the nursing infant attributable to both transmammary secretion of compounds and environmental exposure. Nicotine is present in milk in concentrations between 1.5 and 3.0 times the simultaneous maternal plasma concentration,15 and elimination half-life is similar 60 to 90 minutes in milk and plasma.7 There is no evidence to document whether this amount of nicotine presents a health risk to the nursing infant. The Committee on Drugs wishes to support the emphasis of the American Academy of Pediatrics on increasing breastfeeding in the United States. Pregnancy and lactation are ideal occasions for physicians to urge cessation of smoking. It is recognized that there are women who are unable to stop smoking cigarettes. One study reported that, among women who continue to smoke throughout breastfeeding, the incidence of acute respiratory illness is decreased among their infants, compared with infants of smoking mothers who are bottle fed.16 It may be that breastfeeding and smoking is less detrimental to the child than bottle feeding and smoking. The Committee on Drugs awaits more data on this issue. The Committee on Drugs therefore has not placed nicotine (and thus smoking) in any of the Tables but hopes that the interest  in breastfeeding by a smoking woman will serve as a point of discussion about smoking cessation between the pediatrician and the prospective lactating woman or nursing mother. Alternate (oral, transcutaneous) sources of nicotine to assist with smoking cessation, however, have not been studied sufficiently for the Committee on Drugs to make a recommendation for or against them in breastfeeding women. “