From the Guidelines
Nicotine use while breastfeeding is not recommended due to its potential harm to the infant, and mothers who smoke or use nicotine products should be strongly encouraged to quit for their health and their baby's health. According to the study published in Pediatrics 1, cigarette smoking, or the use of nicotine products, is associated with reduced production of milk and shorter lactation. If a mother cannot quit nicotine completely:
- Minimize use as much as possible
- Avoid smoking or using nicotine products for at least 2-3 hours before breastfeeding
- Never smoke in the same room as the baby Nicotine passes through breast milk and can affect the baby's sleep patterns, heart rate, and may reduce milk supply. It also increases the risk of Sudden Infant Death Syndrome (SIDS) 1. For mothers trying to quit:
- Consider nicotine replacement therapy (NRT) under medical supervision
- Use the lowest effective dose of NRT
- Time NRT use immediately after breastfeeding to minimize nicotine in milk, as suggested by the study 1. Breastfeeding is still recommended even if the mother uses nicotine, as the benefits of breast milk generally outweigh the risks of nicotine exposure 1. However, a completely nicotine-free environment is ideal for infant health and development.
From the FDA Drug Label
If you are pregnant or breast-feeding, only use this medicine on the advice of your health care provider. Smoking can seriously harm your child. Try to stop smoking without using any nicotine replacement medicine. This medicine is believed to be safer than smoking. However, the risks to your child from this medicine are not fully known.
The use of nicotine during breastfeeding (lactation) is not fully known in terms of risks to the child.
- The drug label advises to only use nicotine on the advice of a health care provider if breastfeeding.
- It is believed to be safer than smoking, but the risks are not fully known 2. The FDA drug label does not provide enough information to confirm nicotine is safe during breastfeeding.
From the Research
Nicotine Safety During Breastfeeding
- The use of nicotine during breastfeeding has been studied, and the evidence suggests that nicotine can pass into breast milk and affect the infant 3, 4, 5, 6.
- A study published in 2020 found that the conservation of the benefit of breastfeeding in smokers with regard to the prevention of respiratory infections, infantile colic, cognitive deficits, obesity, sudden infant death, is not known to date 3.
- However, the same study recommended promoting breastfeeding in non-weaned women to limit smoking, and the use of nicotine replacement therapy is possible during breastfeeding 3.
- Another study published in 2003 found that the absolute infant dose of nicotine and its metabolite cotinine decreases by about 70% from when subjects were smoking or using the 21-mg patch to when they were using the 7-mg patch 5.
- A 2013 review of scientific evidence found that maternal nicotine can have several negative effects on breastfeeding infants, including changes in sleep and wakefulness patterns, reduction of iodine supply, and intracellular oxidative damage 6.
- A 2021 study found that prenatal exposure to electronic nicotine delivery systems (ENDS) is negatively associated with breastfeeding duration, independent of potential confounders 7.
- It is recommended that breastfeeding mothers restrict their intake of nicotine and other recreational drugs to minimize the risk of adverse effects on the infant 4, 6.
- A free interval between smoking and breastfeeding can reduce the concentration of nicotine in milk, and it is recommended that non-weaned women who are breastfeeding do not smoke just before breastfeeding 3.