by Merran Laver
While it is well established that alcohol ingestion
by pregnant women can adversely affect the developing foetus, the effects
on lactating infants are uncertain. How are babies affected by the alcohol
they absorb from the milk of a mother who has had a glass of wine, or
a vodka and lime? It seems that no one really knows.
Alcohol, or ethanol, is a simple molecule requiring no digestion. It
alters the storage and metabolism of nutrients and is directly toxic
to many body tissues. From the small intestine most alcohol is immediately
dispersed into the blood and other body fluids, including breast milk.
Soon after drinking, the alcohol concentration of breast milk closely
parallels that of blood. General and scientific literature on breastfeeding
shows conflicting advice regarding alcohol intake. However, generally
excessive indulgence is not recommended while moderate intake is seen
as ‘probably OK’.
Traditional folklore suggests alcohol is beneficial to both mother and
child by increasing milk supply, aiding relaxation and preventing colic
in the baby. Sheila Kitzinger, in her book, The Experience of Breastfeeding,
recommends an alcoholic drink with a meal to provide extra fluid and
to act as a mild tranquilliser.
Other authors view alcohol as a potent, dangerous drug which is harmful
to babies. In one text alcohol is first on a list of common drugs that
cause diarrhoea or irritability in babies. Inhibition of the milk-ejection
reflex is referred to in many books, as is the finding that babies drink
less milk from mothers who have been drinking alcohol. Both these assertions
have been supported by scientific research.
All researchers of the relatively few studies carried out in this area
emphasise the lack of evidence available to draw sound conclusions.
Some advise that low levels are probably harmless, while others advocate
complete avoidance. As one pointed out, the infant brain continues to
develop postpartum, and exposure to ethanol at this critical period
is of concern.
The studies investigating alcohol in breast milk, and how babies are
affected, have revealed various findings. One found that alcohol ingested
regularly through breast milk has a slight but significant damaging
effect on motor (physical) development in babies. Others have shown
that high alcohol consumption inhibits the release of oxytocin, a hormone
responsible for the milk-ejection reflex. It has also been found that
alcohol alters the smell and flavour of breast milk, and one study assessed
whether this was the reason babies drink less milk after their mother
has been drinking. Results, however, showed that the milk’s different
flavour was not the cause, and the authors concluded that some other
factor (e.g. change in milk composition) is responsible for reduced
intake.
A 1995 study looked at how alcohol exposure to the breastfeeding infant
could be minimised. It shows that many factors influence a woman’s
blood alcohol level including her weight and proportion of fat tissue,
stomach contents and menstrual cycle. This study emphasised that a younger
infant (less than 3 months) will be affected more by alcohol than an
older infant or adult, due to differences in detoxification rates. A
young baby’s liver is immature, and all babies’ livers have
low levels of ADH enzyme - important in the detoxification of alcohol.
The mother’s liver takes 2-3 hours to process one drink, and the
more she drinks the longer it will take to clear her system (ie - 3-4
drinks may take 6-12 hours). Contrary to common belief that some activities
may hasten the process - such as drinking water - nothing can speed
detoxification.
Most health professionals, such as community dietitians, recognise that
many breastfeeding women will choose to drink alcohol. Generally abstinence
is encouraged, but this is not always realistic. Recommended methods
for minimising exposure to babies include expressing milk before drinking,
eating food with alcohol, drinking slowly and not consuming more than
a standard drink daily (10grams alcohol; equivalent to a beer or a nip
of spirits). One lactation consultant advises women, if they drink alcohol,
to breastfeed while drinking or immediately after. This will delay the
baby’s next feed for as long as possible, during which time peak
alcohol levels in the mother’s milk should have subsided. A drug
resource centre suggests using formula feeding after drinking as a relatively
safe alternative.
We all know that alcohol is powerful, and poisonous if taken in large
quantities. We also know it’s used for pleasure rather than to
benefit physically. The only useful nutritional value of alcohol is
energy, which is something many of us try to cut down on. Alcohol is
a popular and widely accepted substance in society. Every breastfeeding
mother must make up her own mind about whether or not to drink alcohol,
and if so - how much. There are no solid answers to how each baby will
be affected by any quantity of alcohol, but consensus seems to be moderation
and minimal exposure.
References:
Infants’ Suckling Responses to the Flavour of Alcohol in Mother’s
Milk (1997) Vol.21 No(4) Alcoholism - Clinical and Experimental Research
Maternal Alcohol Use during Breastfeeding and Infant Mental and Motor
Development at One Year (1989) 321 (6-10)New England Journal of Medicine
Alcohol and Breastfeeding (1995) 11(4) Journal of Human Lactation
Minimising Alcohol Exposure of the Breastfeeding Infant (1995) I.B.C.
Lactation Consultants 11(4) Journal of Human Lactation Alcohol in Breastmilk
(1985) 25:71 Aust. New Zealand Journal Obstet. Gynaec.
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