Breastfeeding During Pregnancy is Safe and Should Be Supported
Healthy pregnant women can safely continue breastfeeding an older child, as there is no evidence that breastfeeding during pregnancy increases the risk of miscarriage, preterm delivery, or intrauterine growth restriction in developed countries. 1, 2
Evidence Supporting Safety
The available evidence consistently demonstrates that breastfeeding during pregnancy poses minimal risk:
- No increased risk of miscarriage or preterm delivery has been documented in healthy women who breastfeed while pregnant 1, 2
- No evidence of intrauterine growth restriction in the developing fetus, particularly in women from developed countries 1
- The Italian Society of Perinatal Medicine supports breastfeeding during pregnancy in the first two trimesters and considers it sustainable in the third trimester 1
When to Exercise Caution
While generally safe, certain clinical scenarios warrant more careful consideration:
- Women at risk for preterm delivery should be counseled about the theoretical (though unproven) risk that breastfeeding-induced oxytocin release could trigger uterine contractions 1, 2
- High-risk pregnancies may benefit from individualized assessment, though no evidence definitively supports routine discontinuation 2
Important Clinical Considerations
Nutritional Requirements
- Lactating pregnant women have exceptionally high nutritional demands that must be addressed to support both the nursing child and developing fetus 2
- Adequate maternal nutrition is essential for safe continuation of breastfeeding during pregnancy 2
Milk Composition Changes
- Limited data exists on breast milk composition during pregnancy, though postpartum milk composition may be affected in subsequent pregnancies, particularly in developing countries 1
- No data is available on growth patterns of infants nursed by pregnant women 1
Clinical Approach
Healthcare providers should support the mother's desire to continue breastfeeding during pregnancy unless specific contraindications exist. 1, 3 The decision should prioritize:
- The mother's wishes and ability to meet increased nutritional demands 2
- Assessment of pregnancy risk factors (history of preterm delivery, current pregnancy complications) 1, 2
- Recognition that few absolute contraindications to breastfeeding exist 3
Common Pitfalls to Avoid
- Do not routinely advise discontinuation of breastfeeding upon discovering pregnancy, as currently available data do not support this practice 1
- Avoid excessive caution that leads to unnecessary interruption of breastfeeding without assessing the risk-benefit ratio 3
- Do not ignore maternal nutritional status, as this is critical for supporting both lactation and pregnancy simultaneously 2
The benefits of continued breastfeeding for the older child—including ongoing immune protection, nutritional support, and psychological bonding—should be weighed against theoretical risks that lack strong evidence 4, 1