Breast Milk and Alcohol

Busting Myths and Demystifying the Science


Research Findings Expert Views Alcohol Content Calculator
Alcohol & Breastfeeding

The Challenge

Advice from health authorities around drinking and breastfeeding tends to be vague and confusing. It is often acknowledged that an occasional drink is very unlikely to harm your baby, but it is also often discouraged as a precaution. Some authorities advise total abstinence or at least waiting several hours to feed after drinking.   

So, what should breastfeeding parents, who want to drink occasionally without feeling guilty or always having to pre-plan pump sessions and feed times, do?

Some may decide, alongside other factors, to give up breastfeeding early, contributing to the steep decline in breastfeeding rates seen in high-income countries across the first 6 months. But as the research findings and expert views suggest below, this could be overly cautious and perhaps even counterproductive when the benefits of breastfeeding are considered.

Alcohol & Breastfeeding

Key Considerations

Based on the research available, there is a lack of clear evidence to suggest that moderate and occasional drinking negatively impacts breastfed babies. This is because only a very low percentage of the alcohol a mother drinks gets into her milk.

Scientists have consequently suggested that highly conservative alcohol guidelines for breastfeeding parents have little justification1. Instead, it’s been proposed that adhering to general alcohol-consumption advice, e.g., drinking no more than 14 units a week across at least 3 days, would be enough to ensure breast milk alcohol content remains clinically irrelevant.

Note: co-sleeping should be avoided even with moderate drinking, as doing so after consuming more than two units has been linked to SIDS12.

Alcohol & Breastfeeding

Research Findings



How Alcohol Enters Breast Milk
    Alcohol content in breast milk roughly mirrors blood alcohol content (BAC)2. For example, drinking about two 175ml glasses of 12% ABV wine would give both your blood and breast milk an alcohol concentration of around 0.08% (a common limit for driving).

    Breastfeeding women may also absorb alcohol more slowly, as suggested by two studies which observed lower alcohol levels in lactating women's blood compared to non-lactating women3.


Alcohol Quantities Reaching Infants
  • Only a fraction of the alcohol a mother drinks can reach the infant. As an example, a 6kg infant drinking 150ml of milk after their 70kg mother had consumed about two 250ml glasses of 12% ABV wine would have a maximum blood alcohol content of 0.005%1.

    However, uncertainty remains around chronic heavy consumption of alcoholic drinks, as alcohol has been shown to be metabolised in newborns at roughly half the rate of adults4.


How Alcohol Leaves Breast Milk
  • Alcohol peaks in breast milk 30-60 minutes after consumption, decreasing at the same rate as blood alcohol content1.

    Because alcohol is metabolised by the mother and leaves breast milk naturally like it does blood, ‘pumping and dumping’ is only necessary for comfort.




Effect on Milk Yield
    One study of 22 women observed a 9.3% drop in expressed milk during the first two hours after drinking about 2.5 units of alcohol5. Two other studies found a reduction in milk-ejection (caused by oxytocin release being inhibited) when mothers drank the equivalent of about a bottle of strong 14% ABV wine6. The degree of reduction was seen to vary substantially based on the individual.

    Overall, these results have led researchers to suggest that the observed small and temporary impact of moderate and occasional drinking on milk production is unlikely to be of clinical relevance1.


Impacts on Infant Sleep
  • Three small studies by the same principal author have observed that moderate drinking can slightly alter infant sleep patterns, although the findings are not consistent.

    Two studies reported less infant sleep in the 3.5 hours after a mother drank about 3 units (equivalent to 250ml of 12% ABV wine), although one of these studies also observed infants sleeping more in the 20.5 hours that followed, so total sleep over 24 hours remained the same7. The third study reported no significant difference in total sleep time in the three-hour testing window, nor the rest of the day and night, although sleep was divided into a higher number of shorter sessions when alcohol was consumed8.


Long-Term Effects on Infants
  • One study of 400 women reported a decrease in psychomotor development in 12-month-olds9 where mothers drank more than two drinks daily. However, because other factors could have influenced the pattern and because no difference in mental development was seen, the study’s authors concluded that the clinical significance of their findings was unclear1. Additionally, a subsequent larger study of 915 children, led by the same principle author, did not reproduce this finding10.

    To date, there is a lack of clear evidence to suggest moderate drinking effects breastfed infants negatively in the long-term.
Alcohol and Breastfeeding

Expert Views

"There is some evidence that drinking too much alcohol, too often, may affect your baby, making them sleepy, weak and slow to gain weight. In part because it can interfere with your milk ejection reflex or alter the taste of your milk. However, the research has shown that maternal blood levels need to reach 0.3% before this effect is seen, and at this point you would likely be pretty incoherent or even needing medical help."
Professor Amy Brown
Author of The Positive Breastfeeding Book
“Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.”
Dr Jack Newman
World renowned breastfeeding expert
"If you're one of those who have three or four drinks a day...I don't think you're harming your child. You could harm yourself, but not the baby. The breast is much better, even if the mother has three drinks a day, than the bottle.”
Carlos Gonzalez
Paediatrician and author of Breastfeeding Made Easy
"Those who suggest abstinence 'just in case' don't appreciate many women may end breastfeeding entirely in order to drink alcohol. These mums feel it's a valued part of their social life and complete abstinence feels like one more way breastfeeding separates you from 'normal'. It's another sacrifice we're asking mums to make just in case they can't be trusted to drink carefully and moderately.”
Emma Pickett
Lactation consultant (IBCLC), writer, and former Chair of the Association of Breastfeeding Mothers
Breast Milk Alcohol Content

Calculator

This tool is designed to show breastfeeding parents how much alcohol enters breast milk.
You will see that when moderate levels of alcohol are consumed (e.g. two standard drinks), breast milk alcohol content will peak at under 0.1%. In fact, it is physically impossible for blood and therefore breast milk to exceed an alcohol content of 0.55% - about the same as a non-alcoholic beer - and to reach this point, fatal amounts of alcohol would need to be consumed11.





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Emily Kucharski

About this Page

Hi, I'm Emily. I've worked in Communications for over a decade and I'm a new mum, so perhaps it's not surprising that I want to improve information and messaging quality when it comes to health advice for ourselves and our babies. In the journey to becoming a parent I've been struck by the amount of restrictive yet unsubstantiated advice we're given. Moderate drinking and breastfeeding is a key example. My aim in researching this topic and outlining the findings above is to help fellow parents make better-informed decisions for their own lives as well as their babies', and to hopefully alleviate some unnecessary worry and anxiety in the process.

Note: This website is an independent – and unfunded – project, motivated by a desire to help new parents have access to useful information. I don’t have any other motivations or links to the alcohol industry.
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References

1Haastrup et al. Alcohol and Breastfeeding, 2014.
2Kesaniemi et al. Ethanol and acetaldehyde in the milk and peripheral blood of lactating women after ethanol administration, 1974.
3Pepino et al. Lactational state modifies alcohol pharmacokinetics in women, 2007;
da-Silva VA et al. Ethanol pharmacokinetics in lactating women, 1993.
4Idanpaan-Heikkila et al. Elimination and metabolic effects of ethanol in mother, fetus, and newborn infant, 1972.
5Mennella. Short-term effects of maternal alcohol consumption on lactational performance, 1998.
6Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women, 1973;
Cobo E, Quintero CA. Milk-ejecting and antidiuretic activities under neurohypophyseal inhibition with alcohol and water overload, 1969.
7Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers' milk, 2001;
Mennella JA, Gerrish CJ. Effects of exposure to alcohol in mother's milk on infant sleep, 1998.
8Mennella JA, Beauchamp GK. The transfer of alcohol to human milk: Effects on flavor and the infant's behavior, 1991.
9Little RE et al. Maternal alcohol use during breast-feeding and infant mental and motor development at one year, 1989.
10Little RE et al. Alcohol, breastfeeding, and development at 18 months, 2002.
11https://www.sciencedirect.com/topics/nursing-and-health-professions/alcohol-blood-level
12Blair et al. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England, 2009.