Background/Aims The benefits of breastfeeding for the mother-infant dyad are recognised. Every effort should be made to encourage and facilitate women to breastfeed successfully. The use of alcohol in the context of breastfeeding is the subject of debate. Guidance can be conflicting and a potential source of confusion. The HSE Alcohol Programme requested public health expertise to undertake a review of the evidence to provide clarity for women. Low-risk alcohol consumption was the context (<11 standard drinks per week; standard drink = 10 g alcohol - half-pint beer, 100 ml 12.5% wine).
Key literature was assessed around a number of themes:
Alcohol concentration in breast milk and time to elimination
Level of potential alcohol exposure in the breastfeeding infant
Effects on infant feeding, sleep and neurodevelopment
Methods A research request was made through the HSE Library Service to source relevant literature. Keywords in the search strategy included ‘breastfeeding’, ‘breast milk’, ‘alcohol’, ‘ethanol’, ‘infant’, ‘paediatric’. Multiple databases were searched: Scopus, Pubmed, Embase, Web of Science, Cochrane, Cinahl, PsycINFO, Science Direct, and Clinical Key.
Titles and abstracts were assessed against pre-specified inclusion criteria. Full-text articles for studies meeting the inclusion criteria were retrieved for in-depth review. CASP checklists were used to assess study quality.
Results 3 systematic reviews and 27 observational studies were identified.
Alcohol level peaks in breast milk about 30–60 minutes post-ingestion.
2 hours required, on average, to metabolise 1 standard drink. Breast milk will contain alcohol until this time has elapsed.
If an infant were fed at peak alcohol concentration it will receive only about 3% of the maternal ‘dose’.
No significant effect on the amount the infant drinks at the breast. It may result in more interrupted infant sleep. No effect on neurodevelopment.
Key messages Avoid alcohol in the first month postpartum as feeding is very frequent and it takes time to establish a routine.
For women breastfeeding beyond 1 month:
- Continue to adhere to guidance on low-risk alcohol consumption.
- Feed your baby before having a drink.
- Express milk before drinking alcohol. This will allow you to feed your baby if they need feeding before you are ready.
Conclusion This review provides an important update to HSE advice on alcohol use and breastfeeding. Our findings have since been incorporated into new user-friendly guidance, available at askaboutalcohol.ie, breastfeeding.ie and the recently launched mychild.ie. The information presented is consistent throughout to ensure robust, clear and transparent advice.
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