The sun is setting, baby is safe and sound with their grandparents, and it’s time for you to get your first night out in months. After more than nine months of abstaining, you can finally have that first post-pregnancy drink. But at the end of the night when it’s time to feed your child, what should you do if you’ve had a glass of wine? Or more?
The dangers of drinking alcohol during pregnancy are well known, but many new mothers find little direction on how to safely consume alcoholic drinks while breastfeeding. Many organizations recommend not drinking at all (it is the safest option). But if an occasional drink stands between you and continued breastfeeding, there are safe ways to compromise and still reap the benefits of breastfeeding for baby (and you!). A safe path to alcohol consumption while breastfeeding requires some planning. Alcohol direct impacts your ability to nurse by inhibiting oxytocin, a hormone responsible for milk let-down.1 When nursing mothers drink, they may find themselves unable to release milk until blood alcohol levels decrease. Once the alcohol is gone, they can express milk again. Because milk had extra time to build up, some moms may even feel as though their milk supply has increased. However, alcohol is also a diuretic that can cause dehydration…which can decrease milk volume. Ultimately, this may disrupt feeding schedules for infants. There are some claims that beer can increase milk supply, but so far there isn’t any evidence to support that claim.
How does alcohol get into milk?
Alcohol in the blood transfers into breast milk, so the concentration of alcohol present in human milk can be estimated by the Blood Alcohol Concentration (BAC—you may have heard of this from a breathalyzer). Once absorbed into the bloodstream, alcohol moves back and forth between the milk and the blood to find an equal balance.2 Alcohol is broken down by the liver, where it is metabolized to components naturally found in your body until no alcohol remains. At the same time, alcohol leaves the milk as well to keep that equal balance. This means there is no need to “pump and dump” after drinking if you wait for the alcohol to be out of your blood. In fact, pumping and dumping before you burn off the alcohol doesn’t work.3 New milk will still have alcohol in it until all the alcohol is gone from your blood.
So how long does it take to be safe?
It depends. Scientists have looked at this exact question (yay science!). Usually, the standard rule is 2 hours for every standard drink.4 But each person’s body works a little differently. The best predictors they found are your and you’ve had. Keep in mind, not all drinks are equal. In the US, a “standard drink” is defined as containing 14 grams of alcohol (see below for examples). Many common drinks contain much more alcohol than the standard. Be sure to use how many drinks you’ve had in the calculator…not the number of drinks. Need help with this? NIAAA can help you figure it out here.
At the InfantRisk Center, we recommend that after moderate drinking you can return to breastfeeding as soon as you feel neurologically normal. However, we know this makes many moms uncomfortable. To find out how long it will take body to eliminate drinks from breastmilk, use this calculator backed by real research to estimate how long it will take for there to be NO alcohol in your milk—your .
Calculate your “Time to Zero”
What if I can’t wait that long?
Unfortunately, even though you know you are off duty for the night your breasts don’t get that memo. Pumping right before you drink will give you the longest amount of time to wait comfortably. If you have more than 1 or 2 drinks, your breasts will probably get uncomfortably full while waiting for your alcohol levels to go down. Engorgement can lead to problems like mastitis, so we recommend pumping for comfort but not using the alcohol-contaminated milk for feedings. No one wants to throw out that precious liquid gold…but moms have found plenty of resourceful ways to repurpose it. You’ve probably heard claims that human milk can be used to treat many ailments. Most aren’t backed by science (yet), but it isn’t likely to be harmful either. Some online retailers can even turn milk into jewelry for a lifelong keepsake.
Don’t have a breast pump, or forgot to bring one with you? Manual expression might take a minute to get the hang of, but it’s very effective. All you need is your hands.
Some other tips:
Blood Alcohol Concentration (and therefore your milk) usually reaches its peak 30-60 minutes after drinking.5 Drinking alcohol with food may reduce overall alcohol absorption and drinking slowly over time with increased water intake reduces BAC. Many home remedies found online for “sobering up”, like exercising or taking cold showers, do not lower BAC and will not reduce alcohol levels in breast milk. Giving your body enough time to break down alcohol is the best way to lower BAC.
How does an occasional drink affect breastfeeding?
We know a lot about the harmful effects of maternal alcohol consumption on a developing child in the womb. However, less is known about low levels of alcohol exposure in breastfed infants. Feeding after drinking will likely cause mild agitation and disrupted sleep patterns6 at a minimum—it’s not a good idea. The calculator on this page can show you how long after drinking until the alcohol concentration in your milk returns to zero.
What would chronic, heavy alcohol consumption do to my baby?
A Message from the InfantRisk Center:
Breastfeeding is hard. We know moms fight to continue their breastfeeding journey—against sleep, against pain, and against fear. At the InfantRisk Center, we want to encourage and empower moms to keep you breastfeeding while keeping baby safe. Our resources include our app, MommyMeds to lookup prescription and Over-the-Counter drugs for breastfeeding safety, and a nurse-staffed call line for your support. Don’t forget: breastfeeding isn’t just good for your baby’s health, it’s great for you too.
Kori Adair, 4th year Pharmacy Student
Kaytlin Krutsch, PharmD, MBA, BCPS
- Cobo E, Quintero CA. Milk-ejecting and antidiuretic activities under neurohypophyseal inhibition with alcohol and water overload. Am J Obstet Gynecol. Nov 15 1969;105(6):877-87. doi:10.1016/0002-9378(69)90094-5
- Pepino MY, Steinmeyer AL, Mennella JA. Lactational State Modifies Alcohol Pharmacokinetics in Women. Alcoholism: Clinical and Experimental Research. 2007;31(6):909-918. doi:10.1111/j.1530-0277.2007.00387.x
- Centers for Disease Control and Prevention. Breastfeeding: alcohol. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/v…. Accessed October 27, 2021.
- Ho E, Collantes A, Kapur BM, Moretti M, Koren G. Alcohol and breast feeding: calculation of time to zero level in milk. Biol Neonate. 2001;80(3):219-22. doi:10.1159/000047146
- Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Alcohol. [Updated 2021 May 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501469/.
- Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infant’s behavior. N Engl J Med. Oct 3 1991;325(14):981-5. doi:10.1056/nejm199110033251401
- Binkiewicz A, Robinson MJ, Senior B. Pseudo-Cushing syndrome caused by alcohol in breast milk. J Pediatr. Dec 1978;93(6):965-7. doi:10.1016/s0022-3476(78)81220-7
- Hoh TK. Severe hypoprothrombinaemic bleeding in the breast fed young infants. Singapore Med J. Mar 1969;10(1):43-9.
- Gibson L, Porter M. Alcohol and Tobacco use While Breastfeeding and Risk of Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder. Journal of Autism and Developmental Disorders. 2021;doi:10.1007/s10803-021-05027-3
— Update: 14-04-2023 — cohaitungchi.com found an additional article Alcohol and breastfeeding: What are the risks? from the website www.contemporaryobgyn.net for the keyword alcohol while breastfeeding chart.
The harmful effects of alcohol use during pregnancy are well-established.1 We know much less, however, about the consequences of alcohol intake in breastfeeding women and their infants. In the clinic when we review a patient’s medical history, we regularly query women about their use of tobacco, alcohol, and other substances, and we advise women regarding the deleterious effects of these substances when taken during pregnancy.
There seems, however, to be considerable variation in what is recommended for breastfeeding women. With regard to the consumption of alcohol by breastfeeding women, some health care providers urge abstinence, while others state that alcohol consumption by breastfeeding women carries little risk.2
In a recent review, Haastrup and colleagues reported that the prevalence of alcohol consumption in breastfeeding women is high, ranging from
36% to 83% in developed countries.3 Epidemiological studies have shown that while breastfeeding women were less likely to report binge drinking, patterns of drinking at 1 and 3 months after giving birth did not differ significantly between women who chose to breastfeed and women who never breastfed.4
Although information regarding the effects of alcohol consumption on breastfeeding women and their infants is limited, it is essential that women receive accurate information regarding the potential risks of exposure to alcohol transferred to the infant as a result of breastfeeding.
PK and metabolism of alcohol in mother and infant
Alcohol consumed by a mother passes freely into her breast milk; alcohol levels in breast milk are similar to those measured in maternal blood and peak 30 to 60 minutes after an alcoholic beverage is consumed.3 The amount of alcohol taken in by a nursing infant through breast milk is estimated to be 5% to 6% of the weight-adjusted maternal dose.3
Read more Alcohol and breastfeeding: What are the risks?
Alcohol can typically be detected in breast milk for about 2 to 3 hours after a single drink is consumed. However, it must be noted that the length of time alcohol can be detected in breast milk increases according to the amount of alcohol a mother consumes. Alcohol from 1 drink can be detected in breast milk for about 2 to 3 hours but the time period extends to about 4 to 5 hours if a mother consumes 2 drinks and to about 6 to 8 hours if she consumes 3 drinks, and so forth. Other factors influencing the amount of alcohol in breast milk include how fast it is consumed, whether it is consumed with food, the mother’s body weight, and individual variations in alcohol absorption and metabolism.3,5
Blood alcohol levels in a nursing infant depend on the amount of alcohol in breast milk, but also on the infant’s capacity to metabolize alcohol. In a newborn, alcohol is metabolized at 25% to 50% of the rate observed in adults.3,6
Alcohol and milk production
Breastfeeding women are sometimes told they should drink alcohol to boost breast milk production and that the nutrients contained in dark stout beers, like Guinness, help to nourish the baby. In the early 1900s, beer companies marketed low-alcohol beers or “tonics” specifically for nursing women as a means of increasing their strength and enhancing breast milk production.7,8
Like many old wives’ tales, there is a grain of truth to these recommendations. The barley used to make beer contains a polysaccharide that increases prolactin production, which in turn stimulates breast milk production.7 However, alcohol on its own actually decreases milk production.
Alcohol also is a potent inhibitor of oxytocin. Because of this effect, it was used clinically in the 1970s to stop contractions and prevent preterm birth. In a nursing mother, however, release of oxytocin associated with ingestion of alcohol stimulates milk ejection, which may also decrease the amount of milk available to the nursing infant.9 The higher the alcohol intake, the greater the effect; however, one study noted that drinking as little as 0.3 g of alcohol per kg (which is less than the amount considered acceptable by the American Academy of Pediatrics) reduced milk production by about 10%.10
Short-term effects of alcohol on a nursing infant
Studies have shown that infants breastfed by women who had consumed alcohol prior to nursing consumed approximately 20% less milk in the first 4 hours after maternal alcohol consumption than women who did not drink.7 However, a subsequent study reported that, if mothers did not consume any more alcohol, babies breastfed more frequently and consumed larger amounts of milk in the 8 to 12 hours after maternal alcohol consumption.11
Although some have speculated that this reduction in infant milk consumption may be caused by changes in the taste of the milk, it is probably more related to decreased supply. In fact, Mennella observed that infants actually consumed larger amounts of alcohol-enriched milk than plain breast milk, when provided to them in a bottle.12
Changes in infants’ sleep patterns have also been observed.7,13,14 While 2 studies reported that the total amount of sleep was unchanged after consuming alcohol-containing milk, these studies noted that the sleep was more fragmented.7,13 In contrast, another study demonstrated that total duration of sleep decreased on average by about 25% after infants consumed alcohol-containing milk.14
Long-term effects of alcohol on a nursing infant
Possible long-term effects on infants of alcohol delivered in mother’s milk are less studied, with only a handful of the studies looking at neurodevelopmental outcomes in exposed infants. However, this may be a particularly difficult area of research. Not only must we consider the direct effects related to alcohol exposure via breast milk, it is possible that alcohol consumed by the mother may have an effect on a developing child by altering the mother’s behavior or her capacity to parent.
In a study of 400 infants, Little and colleagues investigated infant development at age 1 year in relation to maternal use of alcohol while breastfeeding.15 Cognitive development, as measured using the Bayley Mental Development Index (MDI), was not affected by maternal use of alcohol. However, indices of motor development, as measured using the Psychomotor Development Index (PDI), were significantly lower in infants exposed regularly to alcohol in breast milk (even after controlling for prenatal alcohol exposure). The researchers observed an inverse dose-response relationship between the frequency of maternal alcohol consumption and scores on the PDI. Infants of breastfeeding mothers who had 1 or more drinks daily had a mean PDI score of 98, compared to a mean score of 103 in infants exposed to less alcohol in breast milk (95% confidence interval of the mean difference, 1.2 to 9.8). This association persisted after controlling for more than 100 potential confounding variables, including smoking and use of other drugs. In addition, the effect was more pronounced when mothers who supplemented breastfeeding with formula were excluded from the analysis.
However, in a similar study from the same group, there was no association between scores on the Griffiths Developmental Scales and alcohol exposure in a group of 18-month-old children.16 The researchers note that, while the Bayley and Griffith Scales are comparable in terms of their ability to detect neurodevelopmental deficits, these tests, when used in infants and toddlers, are limited in their ability to detect small effects. They suggest that studies of older children may be of greater utility in assessing the effects of drinking while nursing.
More recently, data were analyzed from Growing Up in Australia: The Longitudinal Study of Australian Children, which included 5107 Australian infants and their caregivers recruited in 2004.17 Information on breastfeeding, alcohol use, and other demographic variables were collected at baseline, and the children were assessed every 2 years. Heavier maternal alcohol consumption at the initial assessment was associated with dose-dependent reductions in abstract reasoning at ages 6 to 7 years in children who had been breastfed. This association was not observed in infants who had never breastfed, suggesting that exposure to alcohol via breastmilk, rather than psychosocial or environmental factors associated with that exposure, was responsible for the reductions in cognitive functioning observed in breastfed infants. This finding was independent of prenatal alcohol use, sex of child, maternal age, income, birth weight, and breastfeeding duration. Smoking while breastfeeding did not impact any of the outcomes studied.
While these studies raise concerns about the impact of alcohol on a nursing infant, there are many different patterns of alcohol consumption, and it would be erroneous to assume that having an occasional drink carries the same risk as chronic, heavy drinking or binge drinking. Our understanding of the impact of alcohol consumption is made even more complicated by the fact that there are genetic, psychosocial, cultural, and economic factors that go along with and influence alcohol consumption; these factors may also significantly impact children’s outcomes.
All pregnant and postpartum women should be queried regarding their past and present use of alcohol. National surveys indicate that about 1 in 2 women aged 18 to 44 drink alcohol, and 18% of women who drink alcohol in this age group binge drink. While many women with alcohol use disorders are able to abstain from drinking during pregnancy, relapse rates are high after delivery.18 In addressing maternal use of alcohol, screening for problematic patterns of use and offering treatment when appropriate may help to reduce behaviors that put an infant at risk.
Proximate to delivery, all women should be provided information regarding use of alcohol while breastfeeding. Although the information is incomplete, our current data indicate that maternal alcohol consumption may affect milk production and infant sleep patterns. In addition, the most current studies indicate that alcohol passed through breast milk may have adverse neurodevelopmental effects.
Guidelines regarding use of alcohol are varied. According to the most recent recommendations on breastfeeding from the AAP,2 “ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, or 2 beers.” Furthermore, they recommend that mothers avoid nursing their infants for 2 hours after their last drink to allow for the alcohol to be cleared from the breast milk.
The Motherisk program in Toronto, Canada, has issued more conservative recommendations,18 stating, “At this time, there are no known benefits of exposing nursing infants to alcohol. Although occasional drinking while nursing has not been associated with overt harm to infants, the possibility of adverse effects has not been ruled out. Occasional drinking, however, does not warrant discontinuing breastfeeding, as the benefits of breastfeeding are extensive and well recognized. Until a safe level of alcohol in breast milk is established, no alcohol in breast milk is safest for nursing babies. It is, therefore, prudent for mothers to delay breastfeeding their babies until alcohol is completely cleared from their breast milk.”
To minimize exposure, Motherisk has developed a nomogram that can be used to help mothers who choose to drink alcohol while breastfeeding estimate how long it takes to clear alcohol from breast milk, taking into consideration body weight and number of drinks (Table 1).
Read more Celebrating a Birthday when you are socially distancing
Information about the long-term effects of exposure to alcohol during breastfeeding remains lacking. Therefore, to minimize the risk of adverse events in nursing children, it is best to counsel mothers on adhering to recommendations from healthcare authorities on alcohol intake in breastfeeding women
The author reports no potential conflicts of interest with regard to this article.
- Georgieff MK, Tran PV, Carlson ES. Atypical fetal development: Fetal alcohol syndrome, nutritional deprivation, teratogens, and risk for neurodevelopmental disorders and psychopathology. Dev Psychopathol. 2018;30(3):1063-1086.
- Breastfeeding SO. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.
- Haastrup MB, PottegÃ¥rd A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol. 2014;114(2):168-173.
- Little RE, Lambert MD, Worthington-Roberts B. Drinking and smoking at 3 months postpartum by lactation history. Paediatr Perinat Epidemiol. 1990;4(3):290-302.
- Koren G. Drinking alcohol while breastfeeding. Will it harm my baby? Can Fam Physician Med Fam Can. 2002;48:39-41.
- Pikkarainen PH, RÃ¤ihÃ¤ NC. Development of alcohol dehydrogenase activity in the human liver. Pediatr Res. 1967;1(3):165-168.
- Mennella JA, Beauchamp GK. Beer, breast feeding, and folklore. Dev Psychobiol. 1993;26(8):459-466.
- Bryce E. Should breast-feeding women really drink Guinness? LiveScience. https://www.livescience.com/63122-breastfeeding-moms-guinness-beer.html. Accessed September 8, 2018.
- Mennella JA, Pepino MY, Teff KL. Acute alcohol consumption disrupts the hormonal milieu of lactating women. J Clin Endocrinol Metab. 2005;90(4):1979-1985.
- Mennella JA. Short-term effects of maternal alcohol consumption on lactational performance. Alcohol Clin Exp Res. 1998;22(7):1389-1392.
- Mennella JA. Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcohol Clin Exp Res. 2001;25(4):590-593.
- Mennella JA. Infants’ suckling responses to the flavor of alcohol in mothers’ milk. Alcohol Clin Exp Res. 1997;21(4):581-585.
- Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol Fayettev N. 2001;25(3):153-158.
- Mennella JA, Gerrish CJ. Effects of exposure to alcohol in mother’s milk on infant sleep. Pediatrics. 1998;101(5):E2.
- Little RE, Anderson KW, Ervin CH, Worthington-Roberts B, Clarren SK. Maternal alcohol use during breast-feeding and infant mental and motor development at one year. N Engl J Med. 1989;321(7):425-430.
- Little RE, Northstone K, Golding J, ALSPAC Study Team. Alcohol, breastfeeding, and development at 18 months. Pediatrics. 2002;109(5):E72-72.
- Gibson L, Porter M. Drinking or smoking while breastfeeding and later cognition in children. Pediatrics. 2018;142(2).
- Forray A, Merry B, Lin H, Ruger JP, Yonkers KA. Perinatal substance use: a prospective evaluation of abstinence and relapse. Drug Alcohol Depend. 2015;150:147-155.
— Update: 01-05-2023 — cohaitungchi.com found an additional article Alcohol and breastfeeding: What are the risks? from the website www.contemporaryobgyn.net for the keyword alcohol while breastfeeding chart.
Although the harmful effects of alcohol use during pregnancy are well documented and recommendations to avoid alcohol during pregnancy are clear, the risks of alcohol use during lactation are less understood.
When patients ask medical professionals for guidance about the safety of consuming alcoholic beverages during lactation, they often are met with conflicting advice. Providers and patients are tasked with navigating the limited information available on this very relevant topic.
Because of the lack of definitive data around lactation and alcohol consumption, recommendations from professional organizations vary (Table 1).
The World Health Organization recommends avoiding alcohol during lactation,1 whereas the American Academy of Pediatrics (AAP) states that occasional alcohol use equivalent to 8 oz of wine or 2 cans of beer per day may be acceptable and that waiting 2 hours after the last drink before breastfeeding is sufficient.2,3 The Academy of Breastfeeding Medicine offers similar advice, also acknowledging that the long-term effects of alcohol in human milk remain unknown.4 The American College of Obstetricians and Gynecologists (ACOG) has guidance directed toward parents in which it recommends waiting at least 2 hours after a single drink before breastfeeding; however, an ACOG Committee Opinion recommends that “a mother should be encouraged by her health care provider to wait 3 to 4 hours after a single drink before breastfeeding her infant.”5,6
Alcohol is ubiquitous in our society, and many females wish to resume alcohol use during lactation after abstaining during pregnancy. In 2019, more than half of the US adult population drank alcohol in the past 30 days. About 26% of the adult population reported binge drinking (for women, 4 or more drinks on 1 occasion) and 6.3% reported heavy drinking (for women, 8 or more drinks per week) in the past month.7
Although about 50% of lactating females reported using alcohol at least occasionally, only 13% reported being counseled by their health care provider about the risks of alcohol use during lactation.8,9
Because of the high prevalence of alcohol consumption and the fact that 58% of infants in the US are breastfeeding for at least 6 months, health care providers will encounter questions from patients about the safety of alcohol use during lactation.10 Any advice to restrict lactation because of maternal alcohol intake must be balanced carefully with the known maternal and infant health benefits of lactation. Although data are limited on this topic, much is known and should be communicated to patients during pregnancy and postpartum care.
Is alcohol present in human milk subsequently absorbed by an infant?
Alcohol is a small (46 Da) and very water-soluble molecule, so it passes freely into human milk.11 Therefore, levels of alcohol in milk closely parallel maternal blood alcohol concentrations. The milk alcohol levels peak about 30 to 60 minutes after consumption of an alcoholic beverage, but the peak can be delayed by an additional hour if alcohol is consumed with food.
The overall bioavailability of alcohol in lactating females is about 25% lower when compared with nonlactating females, resulting in lower peak alcohol blood levels, but the time to the peak blood alcohol levels is the same.11 Feeding or expressing milk prior to alcohol consumption may contribute further to decreased bioavailability.12 If an infant consumes milk during the time of maximum alcohol concentration, the amount of alcohol the infant consumes is estimated to be about 5% to 6% of the weight-adjusted maternal intake.9
Alcohol elimination from breast milk depends largely upon maternal weight and the amount of alcohol consumed. The more alcohol is consumed, the longer it will be present in the milk.
After drinking a standard single drink (Figure 1), alcohol is typically detected in milk for approximately 2.5 hours for a 132.3-lb person (60 kg). If a second beverage is consumed, the time to eliminate alcohol doubles and alcohol will be detectable in milk for closer to 5 hours. If a binge-drinking episode occurs, alcohol may be detected for more than 9 hours.11
Although alcohol test strips have been used to determine the presence of alcohol in milk, it is more reliable to use nomograms to determine when milk is free of alcohol (Table 2).
Once alcohol-containing milk is consumed, it is absorbed by the infant. Calculations estimate that infant blood alcohol levels would reach about 0.005% after consuming human milk following maternal consumption of 4 standard drinks.9 The rate at which an infant can metabolize alcohol is about half that of adults because of immature metabolic pathways that detoxify alcohol.13
Little and colleagues hypothesized that the infant brain may be exquisitely sensitive to alcohol even in these small quantities because of the infant’s rapid brain growth and immature metabolism.14
Is “pump and dump” a way to eliminate alcohol?
It is not necessary to pump and dump milk after consuming alcohol. This will not speed the elimination of alcohol from milk. However, if alcohol use results in delayed or skipped feeding, expressing milk can maintain supply and avoid complications of engorgement.15
Is alcohol a galactagogue?
Contrary to folklore advocating the use of alcohol to stimulate milk production, alcohol has been shown to decrease milk production, at least temporarily.16 It interacts with the neuroendocrine axis, disrupting the hormones that influence lactation. Alcohol inhibits the release of oxytocin, the hormone responsible for the milk ejection reflex.
Alcohol in doses of 0.5 g/kg (which is about 8 oz of wine or 2 beers for a 132.3-lb individual [60 kg]) has been shown to reduce oxytocin response to suckling by 18%; doses of 1.5 g/kg have been shown to reduce oxytocin response by 80%. Consequently, lactating females who consume alcohol may experience delays in milk letdown ranging from about 30 seconds for lower doses and as high as 330 seconds with higher doses of alcohol exposure.17
In contrast, prolactin levels increase in response to alcohol consumption. Although prolactin is a hormone important for milk production, the observed increases in prolactin levels after alcohol intake have not been associated with increased milk production.18
Beer has a reputation for increasing milk supply. The polysaccharide found in barley and malt has been shown to increase serum prolactin levels in nonpregnant, nonlactating females. However, infants consumed 23% less milk in the hours following maternal alcoholic beer consumption (versus nonalcoholic beer), and beer is not recommended for use as a galactagogue.19
Overall, infants consume about 20% less milk during the immediate hours after maternal alcohol consumption, likely because of diminished milk production. The decrease in milk intake by the infant is not related to a decreased time spent suckling, or to an infant rejecting the flavor of the milk.
In fact, Mennella observed that infants consumed larger amounts of milk flavored with alcohol compared with unaltered milk when offered both options through the bottle.20 Infants appear to compensate for decreased feeding volumes by breastfeeding more frequently in the 8 to 16 hours after maternal alcohol consumption.21
Read more Driving While Pregnant: Common Questions Answered
Alcohol use, infant sleep
Even small amounts of alcohol in human milk have been shown to disrupt and shorten total duration of infant sleep. Mennella and Garcia-Gomez observed infants after consumption of milk 1 hour after maternal intake of 0.3 g/kg of alcohol (slightly more than 1 standard drink for a 132.3-lb. person [60 kg]), and sleep was noted to be more fragmented and was overall diminished during the 3.5 to 4 hours that followed.
When infants were observed for 24 hours, they appeared to compensate by spending more time in active sleep from 3.5 to 24 hours following consumption of alcohol-containing milk.22 Infants exposed to even low doses of alcohol in milk may experience more arousal than sedation.
Schuetz and colleagues observed infants to be fussier, with more frequent crying and startling, in the hour following the consumption of alcohol-containing milk. Although some of this behavior may have been explained by maternal behavior after alcohol consumption, these findings are consistent with the diminished sleep and increased infant arousal noted in other studies.23
The long-term impacts of an infant’s exposure to alcohol through human milk are not definitively understood. It is a challenging topic to study because the impact of dyad interactions after maternal alcohol consumption may play a role in neurodevelopmental outcomes.
Also, it is difficult to quantify the amount of alcohol to which an infant is exposed, and information about quantity of maternal alcohol intake and timing of subsequent feeds is not usually available. In contrast, there is clear evidence that fetal exposure to alcohol during pregnancy can have adverse physical and long-term neurodevelopmental outcomes.24 Little and colleagues evaluated infants who were exposed to alcohol through human milk for both cognitive and psychomotor development.
Although cognitive outcomes at 1 year were not shown to be affected by maternal alcohol use, a measurable decrease in motor function development was noted. However, when the infants were evaluated as 18-month-olds, this deficit was no longer demonstrated.14,25 Data regarding alcohol consumption during lactation and academic outcomes are limited.
May and colleagues analyzed outcomes of first-grade students who had been exposed to alcohol during lactation, and they were noted to have poorer grammatical comprehension than nonexposed children.26
Gibson and Porter found no relationship between lactational alcohol exposure and either vocabulary or early literacy scores. They did, however, observe a dose-dependent reduction in abstract reasoning and cognitive abilities at age 6 to 7 years.27 Subsequent analysis of these outcomes revealed that increased or riskier maternal alcohol consumption during lactation was associated with dose-dependent reductions in grade 3 (aged 7-10 years) writing, spelling, grammar, and punctuation scores, as well as grade 5 (aged 9-11 years) spelling scores.28 These findings suggest that alcohol exposure during lactation may later affect a child’s academic performance.
Lactating females should be instructed to minimize their infants’ exposure to alcohol when they choose to consume alcoholic beverages. An individual can be advised to feed or express milk just prior to alcohol consumption.
The number of alcoholic beverages should ideally be limited to 1 drink per day or less during lactation, and binge drinking should be avoided.15 Lactating females should be advised that the AAP guidance regarding safe infant sleep recommends avoiding alcohol use because of infant safety concerns.29 Parental alcohol consumption is associated with an increased risk of sudden infant death syndrome. This risk is particularly high when a parent who has consumed alcohol shares a bed with an infant.30
Breastfeeding while under the influence of alcohol may exacerbate this risk. Although the absolute dose of alcohol transferred to an infant through milk is quite small and may be considered negligible when compared with relative adult doses, parents should be provided with information about the short-term impacts on an infant exposed to alcohol via human milk.22,23
They also should be informed that limited data reveal a possible link between an infant’s alcohol exposure and later academic performance.28
Lactating females should be routinely screened for past and current use of alcohol using a validated screening tool. Effective screening tools are available online through the National Institute on Drug Abuse (NIDA). The NIDA Quick Screen evaluates alcohol and other substances (Figure 2).30
The Alcohol Use Disorders Identification Test is a screening tool for alcohol use.31,32 The results can guide conversations with patients about alcohol use during lactation. When making recommendations about the duration of time to avoid feeding after alcohol intake, it is important to consider the total number of alcoholic beverages consumed.
A conservative approach would recommend accurate monitoring of alcohol consumption along with the use of a nomogram to calculate the time needed to completely clear alcohol from milk after maternal consumption of an alcoholic beverage before resuming lactation (Table 2).
Alternatively, a lactating female should wait at least 2 to 3 hours before directly feeding her baby milk after a single drink.5 If the baby becomes hungry before that time, previously expressed milk may be offered to the baby. Although there is no known safe amount of alcohol exposure to an infant, occasional moderate (1 drink or less) maternal alcohol use during lactation has not demonstrated harmful effects on infants and therefore should not prompt weaning.
Further research on the long-term developmental impacts of alcohol exposure on infants through human milk will help to inform patients and providers in the future.
1. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. World Health Organization. November 19, 2014. Accessed June 11, 2021. https://www.who.int/publications/i/item/9789241548731
2. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841. doi:10.1542/peds.2011-3552
3. Sachs HC; Committee on Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-e809.
4. Reece-Stremtan S, Marinelli KA. ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeed Med. 2015;10(3):135-141. doi:10.1089/bfm.2015.9992
5.Breastfeeding your baby. American College of Obstetricians and Gynecologists. Breastfeeding Your Baby. Updated May 2021. Accessed June 11, 2021. https://www.acog.org/womens-health/faqs/breastfeeding-your-baby
6. Committee opinion no. 496: at-risk drinking and alcohol dependence: obstetric and gynecologic implications. Obstet Gynecol. 2011;118(2 Pt 1):383-388. doi:10.1097/AOG.0b013e31822c9906
7. Alcohol facts and statistics. National Institute on Alcohol Abuse and Alcoholism. Updated June 2021. Accessed June 11, 2021. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
8. Haastrup MB, Pottegård A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol. 2014;114(2):168-173. doi:10.1111/bcpt.12149
9. Pepino MY, Mennella JA. Advice given to women in Argentina about breast-feeding and the use of alcohol. Rev Panam Salud Publica. 2004;16(6):408-414.
10. Breastfeeding report card—United States, 2020. CDC. Updated September 17, 2020. Accessed June 11, 2021. https://www.cdc.gov/breastfeeding/data/reportcard.htm
11. Anderson PO. Alcohol use during breastfeeding. Breastfeed Med. 2018;13(5):315-317.doi:10.1089/bfm.2018.0053
12. Mennella JA, Pepino MY. Breast pumping and lactational state exert differential effects on ethanol pharmacokinetics. Alcohol. 2010;44(2):141-148. doi:10.1016/j.alcohol.2009.10.011
13. Horst PG, Madjunkov M, Chaudry S. Alcohol: a pharmaceutical and pharmacological point of view during lactation. J Popul Ther Clin Pharmacol. 2016;23(2):e145-e150.
14.Little RE, Anderson KW, Ervin CH, Worthington-Roberts B, Clarren SK. Maternal alcohol use during breast-feeding and infant mental and motor development at one year. N Engl J Med. 1989;321(7):425-430. doi:10.1056/NEJM198908173210703
15. Alcohol. CDC. Updated February 9, 2021. Accessed June 11, 2021. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/alcohol.html
16. Mennella JA. Short-term effects of maternal alcohol consumption on lactational performance. Alcohol Clin Exp Res. 1998;22(7):1389-1392.
17. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol. 1973;115(6):817-821. doi:10.1016/0002-9378(73)90526-7
18.Mennella JA, Pepino MY, Teff KL. Acute alcohol consumption disrupts the hormonal milieu of lactating women. J Clin Endocrinol Metab. 2005;90(4):1979-1985. doi:10.1210/jc.2004-1593
19. Mennella JA, Beauchamp GK. Beer, breast feeding, and folklore. Dev Psychobiol. 1993;26(8):459-466. doi:10.1002/dev.420260804
20. Mennella JA. Infants’suckling responses to the flavor of alcohol in mothers’ milk. Alcohol Clin Exp Res. 1997;21(4):581-585.
21. Mennella JA. Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcohol Clin Exp Res. 2001;25(4):590-593.
22. Mennella JA, Garcia-Gomez PL. Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol. 2001;25(3):153-158. doi:10.1016/s0741-8329(01)00175-6
23. Schuetze P, Eiden RD, Chan AWK. The effects of alcohol in breast milk on infant behavioral state and mother-infant feeding interactions. Infancy. 2002;3(3):349-363.
24. Dejong K, Olyaei A, Lo JO. Alcohol use in pregnancy. Clin Obstet Gynecol. 2019;62(1):142-155. doi:10.1097/GRF.0000000000000414
25. Little RE, Northstone K, Golding J; ALSPAC Study Team. Alcohol, breastfeeding, and development at 18 months. Pediatrics. 2002;109(5):E72-E72. doi:10.1542/peds.109.5.e72.
26. May PA, Hasken JM, Blankenship J, et al. Breastfeeding and maternal alcohol use: prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol. 2016;63:13-21. doi:10.1016/j.reprotox.2016.05.002
27. Gibson L, Porter M. Drinking or smoking while breastfeeding and later cognition in children. Pediatrics. 2018;142(2):e20174266. doi:10.1542/peds.2017-4266
28. Gibson L, Porter M. Drinking or smoking while breastfeeding and later academic outcomes in children. Nutrients. 2020;12(3):829. doi:10.3390/nu12030829
29. Moon RY; Task Force On Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940. doi:10.1542/peds.2016-2940
30. The NIDA quick screen. National Institute on Drug Abuse. Accessed June 11, 2021.https://archives.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen
31. Instrument: AUDIT-C questionnaire. NIDA CTN Common Data Elements. Accessed June 11, 2021. https://cde.drugabuse.gov/instrument/f229c68a-67ce-9a58-e040-bb89ad432be4
32. Wright TE, Terplan M, Ondersma SJ, et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. Am J Obstet Gynecol. 2016;215(5):539-547. doi:10.1016/j.ajog.2016.06.038