Is nicotine expressed in breast milk?

Nicotine Expression in Breast Milk

Yes, nicotine is definitely expressed in breast milk, with concentrations in breast milk approximately 2.9 times higher than in maternal plasma. 1 Breastfeeding mothers who smoke or use nicotine products should be informed about the transfer of nicotine to their infants through breast milk and the potential health implications.

Nicotine Transfer to Breast Milk

• Nicotine has a half-life of 60-90 minutes and concentrates in breast milk at levels 2.9 times higher than in maternal plasma 1
• After smoking a single cigarette, nicotine peaks in breast milk at approximately 30 minutes post-smoking and can be completely eliminated from milk within 3 hours 2
• Cotinine (nicotine's major metabolite) also transfers into breast milk and has a much longer elimination time, requiring up to 72 hours to be completely cleared from breast milk 2
• The relative infant dose of nicotine and cotinine through breast milk has been calculated at 12.8% and 77.6% respectively, which is significant exposure 2

Effects on Lactation and Infant Health

• Cigarette smoking or use of nicotine products is associated with reduced milk production and shorter lactation duration 3
• Smoking causes adverse changes to breast milk composition, reducing its protective properties 4
• Nicotine exposure through breast milk may lead to several negative effects on infants:
  • Changes in sleep and wakefulness patterns 5
  • Reduction of iodine supply 5
  • Histopathological damage to liver and lung 5
  • Intracellular oxidative damage 5
  • Reduction of pancreatic β cells and decreased glucose tolerance 5
• Exposure to secondhand smoke is associated with increased risk of SIDS, asthma, and other respiratory illnesses 3

Recommendations for Breastfeeding Mothers Who Use Nicotine

• Breastfeeding mothers should be strongly encouraged to stop smoking and minimize secondhand exposure 3
• If a mother continues to smoke after counseling:
  • She should minimize her smoking 3
  • Never smoke while breastfeeding 3
  • Never smoke inside the home or car 3
  • Smoke immediately after breastfeeding to maximize the time between smoking and the next feeding (ideally at least 3 hours) 3, 2

Nicotine Replacement Therapy During Breastfeeding

• Nicotine cessation products may be used while breastfeeding 3
• For breastfeeding mothers trying to quit, nicotine replacement therapy is a safer option than continued smoking 6
• When using nicotine replacement therapy, products with shorter half-lives (such as gums or 2mg tablets) are preferred and should be taken after feeding 1
• Research shows that the absolute infant dose of nicotine and cotinine decreases by about 70% when mothers use the 7mg nicotine patch compared to when they are smoking 6
• The FDA notes that nicotine replacement products should only be used during breastfeeding on the advice of a healthcare provider, as the risks to the child are not fully known 7

Clinical Approach for Healthcare Providers

• Assess smoking status of all breastfeeding mothers
• Provide strong encouragement and support for smoking cessation
• If the mother cannot quit smoking:
  • Advise to smoke only after breastfeeding
  • Recommend waiting at least 3 hours between smoking and the next feeding
  • Consider nicotine replacement therapy as a safer alternative
  • Emphasize the importance of smoke-free environments for the infant
• Monitor infant growth and development closely