Is there evidence that breastfeeding reduces the severity of Neonatal Abstinence Syndrome (NAS) and the duration of hospitalization for infants born with NAS? This is the topic of a recent study that reviewed research published in the last 10 years.
The authors found 10 studies that evaluated the effect of breastfeeding on NAS among babies born to mothers who were on methadone or buprenorphine during pregnancy. The studies reported on whether breastfeeding had an effect on the severity of NAS, the amount of pharmacologic treatment needed, and the duration of time the infants were in the hospital after birth.
This research study found that most published research on this topic involves small studies that were primarily chart reviews, limiting our knowledge on this topic. In addition, we have sufficient long term data on the effects of high maternal methadone doses during pregnancy and lactation on long term neonatal outcomes. So even though breastfeeding can help reduce Neonatal Abstinence Syndrome (NAS) severity and duration, what about the effect of long term exposure of opiates on the infant through breastfeeding?
At this point, it is good practice to encourage mothers on methadone and buprenorphine to breastfeed. The babies are expected to have less intense Neonatal Abstinence Syndrome (NAS), a shorter duration of NAS, and a greater likelihood of maternal-infant bonding. From personal experience I find that many of these mothers struggle with their milk supplies, especially if they smoke cigarettes. I suggest educating this group of mothers on the risks of combining methadone or buprenorphine with any other sedating medications, to reduce the risk of respiratory depression or death in the infant. In addition, they need to know that abrupt weaning can increase the risk of NAS in the infant, so if such a mother plans to wean, she should be given guidance on doing this slowly, watching for symptoms of NAS.
Mothers who are actively abusing substances, such as other opiates and/or other drugs of abuse, should refrain from breastfeeding.