Management of alcohol use during breastfeeding

Alcohol consumption during breastfeeding is often a continuation of consumption during pregnancy, making it difficult to separate adverse effects on the infant from each period. Confounders such as smoking also make interpretation difficult.

Alcohol use in breastfeeding has been associated with delayed let-down reflex for lactation and reduced breastmilk supply, probably related to inhibition of oxytocin releaseGiglia, 2010.

An infant’s liver maturation is not complete until approximately 3 months; reduced capacity to metabolise alcohol could lead to accumulation. Excessive drowsiness and irritability have been described in infants exposed to alcohol in breastmilk. Both animal and human studies suggest potential adverse long-term effects in offspring. Significantly poorer development of motor skills has been reported in infants breastfed by individuals who consumed one standard drink per day. It is not clear whether exposure to alcohol in breastmilk leads to an earlier start to drinking.

The level of alcohol consumption during breastfeeding that is safe for an infant has not been defined. Consider the relative harms and benefits of breastfeeding for patients who regularly consume alcohol. The safety of prescribing drugs to reduce alcohol cravings (eg naltrexone, acamprosate) has not been established in breastfeeding patients. There are no reports of disulfiram use while breastfeeding; the potential effects on the infant are unknown. Educational and behavioural interventions should be the mainstay of treatment; specialist advice and engagement is recommended.

Patient information on harm reduction measures while breastfeeding (such as timing of drinks and expressing milk) is available at the MotherSafe website. The FeedSafe app helps a patient plan safe timing for breastfeeding after drinking alcohol.