Tobacco
IABLE
Index Tobacco

Tobacco

People can breastfeed or provide their milk if they are tobacco users. Lactating individuals who smoke are less likely to breastfeed or provide their milk after 2 months postpartum, often due to a decrease in milk production. In addition, there is evidence that tobacco smoking can cause a decrease in milk fat and iodine concentration, as well as a decrease in protein and total calories. Breastfed or human milk fed infants of a lactating parent who smokes should have their growth closely tracked. It is important to not expose infants to second-hand smoke, due to an increased risk for Sudden Infant Death Syndrome.

Lactating individuals who smoke should be encouraged to use quit.  Bupropion is helpful for tobacco cessation and is generally safe during lactation.

Nicotine replacement products can also be used, although it is recommended to use the lowest dose of nicotine that is short acting, such as the nicotine gum or inhaler, as opposed to the patch which is longer acting, in order to limit the amount of nicotine in milk.

Varenicline (Chantix in the USA) can be quite effective for smoking cessation, but little is known about its safety during lactation, so at this time it is not recommended.

References

  1. Míguez MC, Pereira B. Effects of active and/or passive smoking during pregnancy and the postpartum period. An Pediatr (Barc). 2021;95:222-32.
  2. Macchi M, Bambini L, Franceschini S et al The effect of tobacco smoking during pregnancy and breastfeeding on human milk composition- a systematic review Eur J Clin Nutr 2021 May; 75(5) 736-47
  3. Nicotine Drugs and Lactation Database (LactMed) https://www.ncbi.nlm.nih.gov/books/NBK501586/ (Accessed 12/24/21)
  4. Varenicline Drugs and Lactation Database (Lactmed) https://www.ncbi.nlm.nih.gov/books/NBK501688/(Accessed 12/24/21)