Is Nicotine safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Nicotine. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
Maternal smoking is a major risk factor for sudden infant death syndrome (SIDS). Nicotine is thought to be the causative factor by reducing the dopamine content of the carotid bodies and reducing the infant's ability to autoresuscitate during hypoxic episodes.[ 4 ] Nicotine in the breastmilk of smokers also appears to reduce the heart rate variability in male breastfed infants.[ 8 ] In a study of the infants of 5 mothers who were using 21 mg nicotine patches for smoking cessation, the infants' average Denver Developmental age was equivalent to their chronological age.[ 1 ] An infant was born to a mother who was vaping nicotine throughout pregnancy and postpartum partially provided breastmilk to her infant because of a limited breastmilk supply. Her infant was initially admitted to the newborn nursery and transferred to the NICU after 4 hours due to signs and symptoms of respiratory distress, grunting and tachypnea, and required high-flow nasal canula oxygen therapy at 2 L/minute with FiO2 of 25%. Laboratory values and imaging were consistent with transient tachypnea of the newborn. On the second day of life, the newborn s examination was notable for irritability, tremors, hypertonia, weak suck, high-pitched cry, and sneezing. The neonate s Finnegan scores remained persistently elevated over the first 24 hours with the highest score of 18. Morphine was administered throughout most of the newborn s NICU stay, with the highest dose of 0.1 mg/kg/dose every 3 h. Morphine was gradually weaned beginning on day 8 of life; however, by day 17, the infant s Finnegan scores had begun to trend upward and the infant s clinical assessment was notable for a high-pitched cry, irritability, difficulty sleeping after feeds, and excessive sucking. Consequently, the morphine dose was increased. It was noted that symptoms were more pronounced when breastmilk intake was minimal, leading to speculation of postnatal exposure through breastmilk. The mother admitted to using e-cigarettes, tak
Effects on milk supply
Cigarette smoking reduces milk yield.[ 9 , 10 ] This effect may be caused by nicotine, although other factors associated with smoking may also play a role.[ 11 - 13 ] In a study of 15 nursing mothers who were using nicotine patches in decreasing doses from 21 mg to 14 mg to 7 mg over several weeks, their average milk production was 17% lower than average literature values as judged by infant milk intake. The study did not directly compare the milk production of smokers to nonsmokers, however. In this study, infant milk intake during maternal use of the nicotine patch was similar to that during smoking.[ 1 ] A woman had a history of mild galactorrhea and breast engorgement from risperidone that had improved with the discontinuation of risperidone 1 year prior. She had serum prolactin levels measured. She had quit smoking 2 to 3 weeks prior to having her prolactin levels checked and had started using 10 to 12 nicotine pouches daily (6 mg each) to help with nicotine cravings. Initial laboratory values showed a prolactin level of 312 mcg/L (reference 5.2 to 26.5 mcg/L). Because she was trying to get pregnant, she discontinued nicotine pouches immediately after learning of high prolactin levels. Prolactin levels normalized 2 and 3 days later (13.4 mcg/L and 8.8 mcg/L, respectively).[ 14 ]
Levels in milk
Maternal Levels. Fifteen lactating women who smoked an average of 17 (range 14 to 20) cigarettes daily were studied during smoking and after smoking cessation while using nicotine transdermal patches in decreasing doses of 21, 14 and 7 mg daily. One woman who smoked 6 cigarettes daily was started on the 14 mg daily patch. The women supplied milk samples from before and after each nursing on the day before attending their clinic appointments which were 2 to 3 weeks apart. Milk was analyzed for nicotine and its metabolite cotinine. During smoking, the milk nicotine concentration was about 200 mcg/L. Steady-state milk nicotine concentrations during the 21 mg patch was about 175 mcg/L, which was not statistically different from smoking levels. Likewise, milk cotinine levels were not different between smoking and the 21 mg patch. Milk nicotine concentrations were lower than smoking levels with the 14 and 7 mg patches at about 140 and 70 mcg/L, respectively. Cotinine milk levels were also lower with these doses than with smoking. Calculated daily infant nicotine equivalent dosages (nicotine plus cotinine) were as follows: 25.2 mcg/kg with smoking, 23 mcg/kg with the 21 mg patch, 15.8 mcg/kg with the 14 mg patch, and 7.5 mcg/kg with the 7 mg patch. On average, infants ingest 1.9% of the maternal weight-adjusted dosage of nicotine and about 7.8% of the maternal weight-adjusted dosage when cotinine was also considered.[ 1 ] A paper reporting a new method of analyzing nicotine found that nonsmokers (n = 2) had milk nicotine concentrations averaging 0.049 mcg/L of nicotine, passive smokers (n = 5) had an average concentration of 0.18 mcg/L and smokers (n = 5) had an average concentration of 1.59 mcg/L.[ 7 ] Infant Levels. Nine breastfed infants with an average age of 4.8 months (range 2.5 to 21 months) whose mothers were using nicotine patches for smoking cessation had plasma concentrations of cotinine measured during maternal use of a 21 mg nicotine patch. Infant plasma cotin
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.