Alcohol and breastfeeding: What are the risks?

Mrs Helen Nwaogu had expressed concern that her baby was feeding every other minute and her breastmilk was not sufficient. Her friend had encouraged her to take a bowl of pap or dark stout beer to help boost breast milk production.

For decades, women have been told they should drink dark stout beer to boost their production of breast milk and nourish their newborns. As far back as 2000 B.C., records apparently show that the Sumerian people prescribed beer as an aid for breastfeeding.

Along with many other foods like oatmeal, beer developed a reputation as a “galactagogue,” a food thought to stimulate lactation.

Like many old wives’ tales, there is a grain of truth to these recommendations. The barley used to make beer contains a polysaccharide that increases prolactin production, which in turn stimulates breast milk production.

However, Dr Adejumoke Ayede, a consultant paediatrician, University College Hospital (UCH), Ibadan, Oyo State, stated that alcohol on its own if taken in excess, can actually decrease milk production.

Dr Ayede stated that the higher the alcohol intake, the greater the effect it will have on breast milk production. So, having an occasional drink does not carry the same risk as chronic, heavy drinking or binge drinking.

According to her, “Mild drinking can be allowed but binge drinking is one thing that we do not encourage in lactating women. It can affect breast milk production in terms of maternal behaviour and the content of the breastmilk.”

Dr Ayede stated that a drunken lactating mother may end up maltreating her newborn or not eat well and over time, thus impacting on the health of the baby who is expected to be exclusively breastfed in the first six months of life.

In addition, a mother’s alcohol ingestion before bedtime is linked to major infant safety concerns. In a recent study of co-sleeping environments and sudden infant death syndrome (SIDS), a combination of alcohol or drug use by the mother before co-sleeping led to a nine-fold increase of SIDS compared with those who did not use those substances.

According to the expert, alcohol is passed on to the babies of lactating mothers that are binge drinkers in their breast milk, causing drowsiness, excessive sleepiness and weakness in them.

She added, “over time, such a baby may also have a physical growth restriction if the mother drinks.”

Now, the impact of alcohol consumption is complicated by the fact that there are genetic, psychosocial, cultural, and economic factors that go along with and influence alcohol consumption. These factors also significantly impact the effect of alcohol on newborn babies.

Of course, most women do cut down or eliminate the amount and the frequency of alcohol consumed during pregnancy. But many women, particularly those who continue to drink during pregnancy, resume drinking again very soon after the baby is born and while they are breastfeeding.

Dr Ayede, however, added that when a lactating mother drinks occasionally and drinks responsibly, the volume of alcohol in her blood would not be so much and enough to be transported into her breast milk.

The paediatrician said , however, said that it is a myth that alcohol boosts breast milk yield.

Studies have found that babies nursing from mothers who have consumed an alcoholic drink will still feed as much over a 16-hour period as babies whose mothers haven’t imbibed at all.

A paediatric nurse and chief nursing officer at UCH, Ibadan, Mrs Bolaji Layemo said the teaching about alcohol and breast milk yield had been passed down from generation to generation, though scientifically it has not been proven to be true.

Mrs Layemo said many people in south-eastern Nigeria where this misconception was rife, believed that it could boost breast milk production since alcohol has a “feel good” effect.

Mrs Layemo, who spoke during a walk to mark the 2019 world breastfeeding week by the paediatric nurses at the UCH, Ibadan, stated that  parents and relevant others must be empowered to know how best to achieve exclusive breastfeeding effectively so that newborns can have adequate nutrition.

But in a meta-analysis of more than 40 papers, researchers had highlighted how alcohol impacted the way the body discharged milk. Breasts release milk through a reflex known as the “letdown,” which is triggered by a hormone called oxytocin. Oxytocin is extensively inhibited by alcohol.

In a nursing mother, however, the release of oxytocin associated with ingestion of alcohol stimulates milk ejection, which may also decrease the amount of milk available to the infant.

In 1998, a study in the journal, Alcohol Clinical Experimental Research, noted that drinking as little as 0.3 g of alcohol per kg (which is less than the amount considered acceptable by the American Academy of Paediatrics) reduced milk production by about 10 per cent.

But a subsequent study in 2001 reported that if mothers did not consume any more alcohol, babies breastfed more frequently and consumed larger amounts of milk in the eight  to 12 hours after maternal alcohol consumption.

Guidelines regarding the use of alcohol are varied. According to the recommendations on breastfeeding from the American Academy of Paediatrics, “ingestion of alcoholic beverages should be minimised and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately two oz liquor, eight oz wine, or two beers.”

Furthermore, they recommend that mothers avoid nursing their infants for two hours after their last drink to allow for the alcohol to be cleared from the breast milk.

At this time, there are no known benefits of exposing children on breast milk to alcohol. Although occasional drinking while nursing has not been associated with overt harm to them, the possibility of adverse effects has not been ruled out.

One study published in the New England Journal of Medicine suggested that exposure to alcohol above one drink per day through breast milk may be detrimental to infant motor development.

Another study published in Paediatrics found that infants who were given breast milk approximately one hour after their mothers consume alcohol may have impaired sleep-wake patterns.

Occasional drinking, however, does not warrant discontinuing breastfeeding, as the benefits of breastfeeding are extensive and well recognised.

Unfortunately, the myth of alcohol and breastfeeding had persisted due to the illusion that the baby is receiving more milk because of the perception of full breasts, combined with an observable increase in the infant’s suckling intensity and frequency.

The World Health Organisation (WHO) in 2001 also refuted all myths that alcohol had any positive effects on breast milk production.

So, until a safe level of alcohol in breast milk is established, no alcohol in breast milk is safest for nursing babies. It is, therefore, prudent for mothers to delay breastfeeding their babies until the alcohol is completely cleared from their breast milk.

Moreover, effective or increased breast milk yield is best promoted through a healthful, nutritious diet, including plenty of nonalcohol-containing fluids.