Smoking When Breastfeeding: Possible Risks To The Baby

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Many women who smoke quit the habit during pregnancy but return to it after delivery. About 25% of American women of reproductive age smoke (1). Mothers who smoke while breastfeeding expose their babies to nicotine and other potentially harmful compounds through breast milk.

Smoking during breastfeeding is unhealthy for the mother and may affect the baby. So should you stop breastfeeding if you find the habit too difficult to quit? Learn the effects of smoking during breastfeeding on the baby and ways to minimize the risk to your baby if you smoke.

How Does Smoking Affect Breastfeeding Mothers?

Nicotine in tobacco and other additional compounds found in cigarettes affect different parts and processes of the body, including the production of breast milk. Smoking could affect your body in the following ways (2).

  • You may notice a decrease in breast milk supply since nicotine reduces serum prolactin levels. Prolactin is a hormone responsible for the stimulation of breast milk production.
  • Smoking several cigarettes in a day may alter the composition of breast milk, such as a decrease in the iodine content of the milk. It could increase the risk of inadequate nourishment for the baby.
  • The increase in nicotine and carbon monoxide levels in the blood may alter the flavor of breast milk.
  • Mothers who smoke may feel less inclined to breastfeed, leading to early weaning and making them miss out on the various advantages of breastfeeding, including lower risk of certain types of cancers in the long run.

How Does Maternal Smoking Affect The Baby?

The various compounds, including nicotine, found in cigarettes and other tobacco products are quickly absorbed into the blood by the blood vessels in the lungs (3). The compounds eventually reach the breasts, where they find their way into breast milk.

Exposure to nicotine and other harmful chemicals through breast milk and the home environment could increase the risk of following conditions in the breastfeeding baby (4) (5) (6).

  • Sudden infant death syndrome (SIDS)
  • Increased risk of infections
  • Frequent vomiting and diarrhea
  • Chronic irritability and fussiness
  • Reduced sleep and erratic sleep-wake patterns
  • Nutritional deficiencies due to change in breast milk composition
  • Long-term liver problems since nicotine is metabolized by the liver
  • Type-1 diabetes due to damaged pancreatic beta cells due to nicotine exposure
  • Thyroid gland dysfunction and obesity in the long run
  • Behavioral problems in the long run due to chronic exposure to nicotine

If you smoke near your baby, they could inhale secondhand smoke. Nicotine and other compounds from the cigarette smoke could settle on your clothes, causing the baby to be exposed to the residue. This is known as thirdhand smoke. Exposure to secondhand smoke and thirdhand smoke could increase the risk of the following problems in the baby (7) (8).

  • Chronic breathing problems, such as asthma
  • Upper respiratory infections, such as pneumonia
  • Ear infections, including inner ear infections
  • Meningococcal disease, such as meningitis
  • Frequent colic, irritability, and behavioral problems
  • Poor sleep and appetite
  • Increased risk of cancers, including childhood cancers, such as leukemia

Besides these problems, the baby who frequently inhales secondhand smoke is at an increased risk of all the problems that a smoker may experience in the long run, such as long-term addiction, circulatory system problems, and poor immunity.

How Much Nicotine Is Transmitted Through Breast Milk?

The amount of nicotine transmitted through breast milk could vary as per several factors, such as the cigarette’s nicotine content, the number of cigarettes smoked in 24 hours, the quantity of nicotine absorbed in a smoking session, and the body’s speed of nicotine metabolism. Nevertheless, a substantial amount of nicotine passes into breast milk. Experts state that the nicotine transferred to breast milk is twice the quantity transferred to the placenta when smoking during pregnancy (1).

Research indicates that the maternal blood continues to contain nicotine even if the mother’s last smoke was 24 hours ago (9). It indicates that your breast milk will continue to contain a small amount of nicotine unless you quit smoking completely.

How To Minimize The Risk To Your Baby If You Smoke?

The best way to eliminate any smoking-related risk to your baby is by quitting smoking. You may speak to a doctor or seek help from a local help group who may guide you with ways and resources to quit smoking.

If you cannot quit smoking for now or are doing so by reducing the number of cigarettes you smoke gradually, remember not to stop breastfeeding. Experts recommend that you do not stop breastfeeding if you are smoking since breastfeeding could offer several significant benefits to the baby (10). Breast milk is also the best and only natural source of nourishment for babies younger than six months.

If you smoke and wish to breastfeed, you could reduce the risk of harmful effects to your baby through the following ways (11) (12).

  • Smoke after you breastfeed and never before it. The nicotine level in your breast milk is reduced by half in about two hours after smoking. The longer the
  • gap between your smoking and breastfeeding sessions, the lesser the quantity of nicotine ingested by the baby.
    Always smoke away from the baby to prevent exposure to secondhand smoke. Preferably change all your clothes after a smoking session to prevent exposing your baby to thirdhand smoke.
  • Wash your hands after you smoke to prevent the baby from coming in contact with thirdhand smoke
  • If possible and legally permitted, smoke outdoors in a dedicated area.
  • Choose a specific room in your home to smoke and never take the baby to that room. It can help prevent exposure to thirdhand smoke and other cigarette residues.
  • Do not smoke at any place where you may take the baby. For instance, do not smoke in the car if you travel in that car with your baby.

You may also reduce your baby’s exposure to nicotine by choosing alternative methods of nicotine administration, such as nicotine gums and nicotine patches. Remember to use them after a breastfeeding session to reduce the risks for the baby further. Speak to a licensed nicotine replacement therapy practitioner who may guide you to use alternatives, such as specialized nicotine patches and e-cigarettes. The therapist can use them to reduce your nicotine dosage gradually, eliminating your nicotine dependence eventually.

Smoking while breastfeeding might affect the baby adversely by increasing the risks of SIDS, liver problems, and nutritional deficiencies due to exposure to nicotine and other harmful substances. To reduce your child’s exposure to cigarettes, it is advised to reduce the number of cigarettes you smoke per day and quit it eventually. The presence of nicotine in the body affects breastmilk production, which hampers the baby’s nourishment. Also, do not stop breastfeeding under any circumstances as it is your baby’s major source of nutrition. Consider the benefits of breastfeeding and the dangers of smoking for both you and your baby before you decide.

Key Pointers

  • Smoking when breastfeeding may increase the risk of infection in babies, chronic irritability, nutritional deficiencies, and frequent vomiting.
  • Nicotine and other chemicals through breast milk or the home environment may get instantly absorbed by blood vessels in the lungs of the baby.
  • If you still want to smoke when breastfeeding, ensure to smoke only after breastfeeding and outdoors away from the baby.

1. Smoking While Breastfeeding;MGH Center for Women’s Mental Health
2. Tobacco and E-Cigarettes; CDC
3. Neal L. Benowitz, Janne Hukkanen, and Peyton Jacob,Nicotine Chemistry, Metabolism, Kinetics and BiomarkersU.S. National Library of Medicine
4.Candida Canicali Primo et al., Effects of maternal nicotine on breastfeeding infants;U.S. National Library of Medicine
5. Breastfeeding and smoking;NHS UK
6. P.C. Lisboa et al., Effects of maternal nicotine exposure on thyroid hormone metabolism and function in adult rat progeny; Journal of Endocrinology
7. Breastfeeding & cigarette smoke;The Royal Women’s Hospital
8. Second-hand smoke and third-hand smoke: effects on children; Raising Children Network
9. Julie A. Mennella, Lauren M. Yourshaw, and Lindsay K. Morgan,Breastfeeding and Smoking: Short-term Effects on Infant Feeding and Sleep; U.S. National Library of Medicine
10. Smoking & Breastfeeding;La Leche League GB
11. Smoking & Your Baby;National Institutes of Health
12. Breastfeeding and smoking;Australian Breastfeeding Association
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Regina Kincaid

(RM, IBCLC)
Regina qualified as a midwife in 2005 in Germany and has since worked in maternity care in England and Ireland. She achieved stage 1 of the UNICEF Baby Friendly accreditation as infant feeding lead midwife at Ealing Hospital in London and worked in the lactation team of the National Maternity Hospital in Dublin, Ireland. She did her Neonatal Examination Course... more

Dr. Meenakshi Maruwada

Dr. Meenakshi is a dentist and a passionate writer with over eight years of experience in dentistry and four years in writing. She started her career as a dentist with a dental chain in Mumbai and soon rose to lead the clinic as a Head Dentist. She then switched to working for two start-ups in healthcare, before beginning her own... more