Lifestyle and Breast Milk
The following information is written for women who are breastfeeding, or are pregnant and considering breastfeeding their baby.
A woman's lifestyle, including diet and other behaviors, can have an affect on her breast milk, and therefore on her baby. It's important for all nursing mothers to take care of themselves so they can provide the best care to their babies. This includes getting enough rest and proper nutrition so you have enough energy to take care of your baby and avoid illness. Some women think that when they are sick, they should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can't be passed through breast milk. In fact, her breast milk will have antibodies in it. These antibodies will help protect her baby by helping the baby fight off the illness. Here are some other lifestyle issues that affect breast milk:
VirusesA few viruses can pass through breast milk. HIV, the virus that causes AIDS, is one of them. Women who are HIV positive should not breastfeed. Also, women with Hepatitis C may be able to transmit the virus through breast milk, but it is not certain. However, bleeding or cracked nipples on the breast of a woman with Hepatitis C puts a breastfeeding infant at higher risk for getting the virus.
DietNutrition Breastfeeding mothers who have generally good diets produce healthy breast milk for their babies, even when they don't eat well at times. But, chronically undernourished women who have had diets very low in vitamins and minerals, and low stores in their bodies may produce milk that is lower than normal in some vitamins, especially vitamins A, D, B6, or B12. These breastfeeding mothers can help the vitamin levels in their milk return to normal by improving their diets or by taking vitamin supplements. It is recommended that nursing mothers take in about 2700 calories every day (about 500 calories more than a non-pregnant, non-nursing woman).
Fluids Many women think they have to drink a lot of fluids to have a good milk supply. This is actually untrue. A nursing woman does, however, need to drink enough fluids to stay well hydrated for her own health and strength to give her baby the best care she can. Always drink when you are thirsty, which is your body's signal that you need fluid. You can make it easy to remember to get enough fluid, if you drink a glass of water or a nutritious beverage (milk or juice) every time you feed your baby.
Caffeine Many breastfeeding women wonder about how caffeine will affect their baby. Results from studies show that, while excessive caffeine intake (more than five 5 ounce cups of coffee per day) can cause the baby to be fussy and not able to sleep well, moderate caffeine intake (fewer than five 5 ounce cups) usually doesn't cause a problem for most breastfeeding babies.
Allergies Sometimes a baby may have a reaction to something the mother eats (like spicy foods, foods that can cause gas, or dairy products). Symptoms of an allergy to something in the mother's diet include diarrhea, rash, fussiness, gas, dry skin, green stools with mucus, or the baby pulling up his/her knees and screaming. This doesn't mean the baby is allergic to the mother's milk. If the mother stops eating whatever is bothering her baby, the problem usually goes away on its own.
Here's how to tell if something you are eating is upsetting your baby:Remember: It takes about two to six hours for your body to digest and absorb the food you eat and pass it into your breast milk.
- So, if you eat dinner at 5:00 P.M., and your baby shows the symptoms listed above around 9:00 P.M., think about what you ate for dinner. To be sure if those foods are causing the problem, you will have to eat them again and see if he/she has the same reaction.
- If your baby seems very fussy, try keeping a record of what you eat and drink.
- Bring the record to your health care provider to talk about a possible link between certain foods and your baby's symptoms.
- If you think a particular food is causing a problem, stop eating it for a while and see if your baby reacts better. You can always try later to introduce that food again into your diet in small amounts. If your baby doesn't seem to react to it anymore, you could add more the next time.
Sometimes a baby can be born with a condition called primary lactase deficiency or with galactosemia, in which they can't tolerate breast milk. This is because their bodies can't break down lactose, a sugar found in the milk of humans and animals. Symptoms include diarrhea and vomiting. Babies with severe galactosemia may have liver problems, malnutrition, or mental retardation. Babies with these conditions must be fed formula that comes from plants, such as soy milk or a special galactose-free formula.
Smoking, Drugs and AlcoholSmoking Nursing mothers should not smoke or take drugs. Tobacco from cigarettes contains a drug called nicotine, which transfers to breast milk and may even affect the amount of milk you produce. The risk for sudden infant death syndrome (SIDS) becomes greater when a mother smokes or when the baby is around second-hand (or passive) smoke. Smoking and passive smoke may also increase respiratory and ear infections in babies. If you smoke and are breastfeeding, talk to your health care provider about what you can do to quit smoking. If you can't quit, breastfeeding still is best because the benefits of breast milk still outweigh the risks from nicotine.
Illegal Drugs Some drugs, such as cocaine and PCP, can make the baby high. Other drugs, such as heroin and marijuana can cause irritability, poor sleeping patterns, tremors, and vomiting. Babies can become addicted to these drugs.
Alcohol Alcohol does get to your baby through breast milk, and has been found to peak in its concentration about 30 to 60 minutes after drinking, or 60 to 90 minutes if it is taken with food. The effects of alcohol on the breastfeeding baby are directly related to the amount of alcohol a mother consumes. Moderate to heavy drinking (2 or more alcoholic drinks per day) can interfere with the let-down reflex and the milk-ejection reflex. It also can harm the baby's motor development and cause slow weight gain. For this reason, and for the general health of the mother, if alcohol is used, intake should be limited. If you know that you are going to have alcohol, such as some wine with dinner, you can pump your milk beforehand to give to your baby after you have had the alcohol. Then pump and discard the milk that is most affected by the drink(s).
Medications Most medications have not been tested in nursing women. No one knows exactly how a given drug will affect a breastfed child. Most over-the-counter and prescription drugs, taken in moderation and only when needed, are thought to be safe. You should always check first with a health care provider before taking medicine. To reduce the baby's exposure, you can take the drug just after nursing or before the baby sleeps. Even mothers who must take daily medication for conditions such as epilepsy, diabetes, or high blood pressure may be able to breastfeed.
In general, when breastfeeding it is safe to take:
- acetaminophen (like Tylenol)
- epilepsy medications (although one, Primidone, should be taken with caution - talk with your health care provider about this drug)
- most antihistamines
- aspirin (should be used with caution)
- moderate amounts of caffeine; remember there is caffeine in soda and candy bars
- ibuprofen (like Advil)
- thyroid medicines
- progestin-only birth control pills (the "mini-pill")
You can go to the American Academy of Pediatrics web site, http://www.aap.org, for a more detailed list of drugs and their effect on breast milk.
Medications that are not safe to take when breastfeeding:
Some drugs can be taken by a nursing mother if she stops breastfeeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply. During this time, the baby can drink her previously frozen breast milk or formula. These drugs include radioactive drugs used for some diagnostic tests like Gallium-67, Copper 64, Indium 111, Iodine 123, Iodine125, Iodine-131, radioactive sodium, or Technetium-99m, antimetabolites, and a few cancer chemotherapy agents.
There are drugs that if new mothers have to take them, they need to choose between taking them or breastfeeding. Some of these drugs that should never be taken while breastfeeding include:
- Bromocriptine (Parlodel) - a drug for Parkinson's disease, it also decreases a woman's milk supply.
- Cyclophosphamide, Doxorubicin, and most chemotherapy drugs for cancer - these drugs kill cells in the mother's body and may harm the baby.
- Ergotamine (for migraine headaches); Methotrexate (for arthritis); and Cyclosporine (for severe arthritis and psoriasis, aplastic anemia, Crohn's disease, kidney disease, and for after organ transplant surgery).
Drugs whose effects on nursing infants is not known but may be cause for concern include:
- Antianxiety drugs - Alprazolam, Diazepam, Lorazepam, Midazolam, Perphenazine, Prazepam, Quazepam, Temazepam. Antidepressant drugs - Amitriptyline, Amoxapine, Bupropion, Clomipramine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Nortriptyline, Paroxetine, Sertraline, Trazodone.
- Antipsychotic drugs - Chlorpromazine Galactorrhea, Chlorprothixene, Clozapine, Haloperidol, Mesoridazine, Trifluoperazine.
- Other drugs - Amiodarone, Chloramphenicol, Clofazimine, Lamotrigine, Metoclopramide, Metronidazole, Tinidazole.
The above information is in part, information provided by the National National Women's Health Center (www.4women.gov)
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Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care June 21, 2017