Breastfeeding Alcohol By Roslyn Giglia 15 September 2008 Overview Physiological effect of alcohol on lactation Effect of alcohol on the breastfed infant Some our my research results Focus groups Alcohol breastfeeding duration Who is drinking? Recommendations Diminished let-down reflex through the inhibition of oxytocin. Results in decreased breastmilk volume a hungry, cranky baby. Exposure to small amounts of alcohol in breastmilk can disrupt the infant s sleep wakening patterns. Results in a cranky baby. 1
May result in less than optimal breastfeeding outcomes. Mothers may introduce complementary formula feeds in an effort to settle placate the infant. In the long term can result in a deficit in motor development. Focus Group Results Theme: Foods that promote breastmilk production It certainly made me feel better I felt it did help my breastmilk. It definitely made me feel better. Theme: Opinion of alcohol breastfeeding More conscientious when I was pregnant because of the developing foetus. You have to give it a chance. Once they re out you can breastfeed them. 2
Theme: Advice on consuming alcohol during lactation I don t think I was actively discouraged even from my obstetrician. I wasn t encouraged but I wasn t discouraged put it that way. He never said I shouldn t have any. Theme: Effect of alcohol on the baby If I didn t know then I had to feed her I would just feed her. If she slept longer than she was supposed to then I would feel guilty probably jump on the internet find out all the crazy stuff about it but I wouldn t be doing it all the time. Alcohol breastfeeding duration Current Australian Alcohol Guidelines Guideline 11 Women who are pregnant or might soon become pregnant Women who are breastfeeding are advised not to exceed the levels of drinking recommended during pregnancy, may not consider drinking at all. 11.3 if they choose to drink, over a week, should have less than 7 stard drinks, AND, on any one day, no more than 2 stard drinks (spread over at least two hours); Drinking breastfeeding duration Women who consumed alcohol at more than two stard drinks per day were almost twice as likely to discontinue breastfeeding earlier (HR 1.9, 95% CI 1.1, 3.0) than women who drink at low risk levels, even after adjustment for potential confounders. Why is this so? Disrupt infant sleeping patterns causes the baby to cry this in turn may prompt the mother to commence formula feeding discontinue breastfeeding at this critical time in an effort to placate the infant. Decreased milk ejection reflex resulting diminished milk yield in lactating mothers decreased in the volume of milk received by the infant, may further exacerbate their unsettled behaviour once again prompting mothers to commence formula feeding. 3
Why is this so? Mothers may be wary of the health risks associated with drinking alcohol breastfeeding. In an effort to reduce these risks continue to consume alcohol they may voluntarily stop breastfeeding. Finally is the possibility that mothers who drink at high levels are generally more likely to make poorer health lifestyle choices. Maternal drinker profile Women who consumed alcohol during pregnancy were significantly more likely to consume alcohol during lactation. Alcohol consumption was also associated with attendance at antenatal classes. A greater proportion of women who drank alcohol breastfed were from a higher income family. Women least likely to consume alcohol in the postpartum period were of Asian origin, more likely to be self employed, unemployed, receiving a pension, studying or carrying out home duties. Many Australian women are unaware of the Guidelines. May not be aware of the health risks to their infant or the longterm consequence of shortened breastfeeding duration associated with drinking above this level. Considerable public health gains can be achieved by developing alcohol intake guidelines specific to lactating women, which support safe alcohol intake that in turn promote extended breastfeeding. HOWEVER New guidelines Guideline 3 For women who are pregnant, are planning a pregnancy or are breastfeeding 3.1 Not drinking is the safest option 4
Suggested Advice for Alcohol Intake of Breastfeeding Mothers No alcohol in the first month. After that limit alcohol intake. Preferable 1 2 stard drinks per day Drinking just after breastfeeding If wanting to drink more than (2) then expressing milk in advance skipping one feed may be an option to consider. Guideline 3B Breastfeeding Advice for breastfeeding mothers Not drinking is the safest option Women should avoid alcohol in the first month After that, limit alcohol intake to: - no more than two stard drinks a day - drinking immediately after a breast feed Expressing milk in advance of consuming alcohol skipping one feed may be considered. Thank you If you are interested to be involved in Roslyn s future research regardless of where you live, please let Roslyn know. R.Giglia@exchange.curtin.edu.au 5