Alcohol

The effects of maternal alcohol (ethanol) ingestion during lactation are complex and depend on the pattern of maternal drinking. With casual alcohol use (such as 1 glass of wine or beer) it is best to wait 2 to 2.5 hours per drink before nursing. Alcohol can decrease milk production, with 5 drinks or more decreasing milk letdown and disrupting nursing until maternal alcohol levels decrease. Casual drinking does not appear to affect breastfeeding duration, but daily heavy use of alcohol (more than 2 drinks daily) might decrease the length of time that mothers breastfeed their infants. Women with a family history of alcoholism have a blunted prolactin response following breast stimulation and may breastfeed more frequently to compensate. Beer may increase serum prolactin levels during nursing because of polysaccharides from barley and hops. In a US survey of 102 mothers who used beer as a galactogogue, 42% thought it increased milk supply.[1] Although they may contain small amounts of alcohol, nonalcoholic cocktails and beer have minimal risks of infant alcohol exposure via breastmilk when consumed in moderation.[2] The use of alcohol-based hand sanitizers do not result in clinically relevant alcohol levels in breastmilk.[3] Breastmilk alcohol levels closely parallel blood alcohol levels. The highest alcohol levels in milk occur 30 to 60 minutes after an alcoholic beverage, but food delays the time of peak milk alcohol levels. Nursing after 1 or 2 drinks (including beer) can decrease the infant’s milk intake by 20 to 23% and cause infant agitation and poor sleep patterns. Nursing or pumping within 1 hour before ingesting alcohol may slightly reduce the subsequent amounts of alcohol in breastmilk. The long-term effects of daily use of alcohol on infant development are unclear.[4] In infants who were subjected to high alcohol exposure during pregnancy, breastfeeding for 4 or more months markedly improved their scores on the Bayley scales of mental and psychomotor development compared to infants who were breastfed 3 months or less.[5] Heavy maternal use may cause excessive sedation, fluid retention, and hormone imbalances in breastfed infants. Greater or riskier alcohol consumption by nursing mothers may affect their children’s academic performance negatively in school. Preliminary data failed to find an increased risk of autism spectrum disorder or attention deficit hyperactivity disorder among the infants whose mothers used alcohol during breastfeeding.[6]