Maternal Alcohol Use and Breastfeeding

CQ #29 - February 7, 2017

by Anne Eglash MD, IBCLC, FABM

How does maternal alcohol use during breastfeeding affect infant growth and development? For children who are diagnosed with Fetal Alcohol Syndrome (FAS), or milder versions, collectively considered Fetal Alcohol Spectrum Disorder (FASD), we often assume that the most impactful alcohol exposure is during pregnancy. Certainly some women have moderate to heavy alcohol consumption during pregnancy, but for mothers who largely abstain during pregnancy, many go back to pre-pregnancy levels of alcohol intake postpartum, even while breastfeeding. Various studies have shown that 36% of breastfeeding mothers in the USA consume alcohol, 47% of breastfeeding mothers in Australia drink alcohol, and 20% of Canadian breastfeeding mothers drink alcohol.

In the 2016 study cited for this Clinical Question, the authors evaluated a group of 6-8 year-olds with FASD in South Africa to determine how much of their developmental delay may be due to postpartum alcohol exposure via breastfeeding, as opposed to their prenatal exposure to alcohol.

What do you think the authors found regarding the impact of alcohol exposure during breastfeeding on a child’s development and degree of FASD? (choose 1 or more)

Drinking alcohol postpartum is more likely if the mother drank alcohol during pregnancy
The amount of alcohol transmitted through breastmilk is low enough to not see an impact on infant development if the baby was not exposed to alcohol prenatally.
Among children with FASD who were exposed to alcohol prenatally, those exposed to alcohol during breastfeeding had more developmental anomalies than those who were not exposed to alcohol during breastfeeding
Binge drinking during breastfeeding can have a negative impact on the verbal IQ of the child.

Click here to view the answer to this question.

Correct Answers: The answer is 1, 3 & 4 Read the ABSTRACT

Reprod Toxicol. 2016 Aug; 63:13-21. doi: 10.1016/j.reprotox.2016.05.002. Epub 2016 May 10.

Breastfeeding and maternal alcohol use:
Prevalence and effects on child outcomes and fetal alcohol spectrum disorders.
May PA1, Hasken JM2, Blankenship J3, Marais AS4, Joubert B4, Cloete M4, de Vries MM4, Barnard R4, Botha I4, Roux S4, Doms C4, Gossage JP3, Kalberg WO3, Buckley D3, Robinson LK5, Adnams CM6, Manning MA7, Parry CD8, Hoyme HE9, Tabachnick B10, Seedat S4.

OBJECTIVE:
Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes.

METHODS:
Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes.

RESULTS:
Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding.

CONCLUSIONS:
Alcohol use during the period of breastfeeding was found to significantly compromise a child's development.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

Fetal Alcohol Spectrum Disorder is considered a disease stemming from prenatal exposure to alcohol. This study increases our awareness that alcohol exposure during breastfeeding contributes to fetal alcohol spectrum disorder. These authors found that children who were not exposed to alcohol during pregnancy but were exposed to at least moderate alcohol during breastfeeding demonstrated developmental delays such as lower body weight and lower verbal IQ. These developmental findings are subtle, and may not lead to questioning a breastfeeding mother about her alcohol use, unless perhaps the infant has failure-to-thrive.

Various prominent websites regarding FASD do not mention alcohol during breastfeeding, including the Center for Disease Control, American Academy of Pediatrics and the National Organization for Fetal Alcohol Syndrome.

The Bright Future list of recommendations for routine well child care does not recommend drug and alcohol screening for children until adolescence.

In searching through the American Academy of Family Physicians and the American College of OB/Gyn guidelines for care during the 6-week postpartum visit, I was unable to find recommendations on screening breastfeeding mothers for alcohol or drug intake.

So essentially, the screening of breastfeeding mothers for alcohol intake does not have a standardized ‘home’ during any well-child or postpartum maternal care visits.

Based on the work of these researchers and others, we ought to consider adding this screening to the postpartum depression screening done at 6 weeks postpartum, and during well-child visits, at least during the first 6-12 months of age. This would be an opportunity to share information on safe alcohol use during breastfeeding, the risks of moderate and heavy alcohol intake for both mother and infant, and resources for alcohol rehabilitation for mothers who drink excessively. For more information on the facts of alcohol during breastfeeding, check out Lactmed/Toxnet through the National Library of Medicine

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Maternal Alcohol Use and Breastfeeding

What do you think the authors found regarding the impact of alcohol exposure during breastfeeding on a child’s development and degree of FASD? (choose 1 or more)

Correct Answers: The answer is 1, 3 & 4 Read the ABSTRACT

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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