Drinking During Breastfeeding Linked to Later Cognitive Inhibitions in Children

Mother not drinking during breastfeeding

Dr. Mark Gold’s Research You Can Use

A recent study has noted a significant impact of drinking while breastfeeding upon children’s future cognition. Infants exposed to alcohol through breastmilk were found exposed to dose-dependent reductions in their cognitive abilities. The study, that appeared earlier this year in the journal Pediatrics, conclusively established that drinking alcohol while breastfeeding can impact the cognitive development of the child.

Even though the harmful effects of alcohol upon physiological development are well studied, cognitive risks of alcohol consumption during breastfeeding remain widely ambiguous. Similarly, it is clear that drug exposures in utero are not performance enhancing but compromise development.

Tobacco smoking during pregnancy, for example, is correlated with diminishing childhood cognition. But, cognitive consequences from smoking tobacco during breastfeeding have not been fully explored.

Since nicotine, cannabis, and alcohol continue to stay present in breastmilk after maternal consumption, understanding the full impact of smoking and drinking during lactation upon children’s cognition has become all the more imperative. While cannabis smoking has been identified as an emerging threat, alcohol and tobacco effects have been ongoing for decades, and their effects can be identified.

 The results of nicotine & drinking during breastfeeding

Breast milk is a live substance with unmatched immunological and anti-inflammatory characteristics that protect an infant against a variety of illnesses, infections, and diseases. It provides all the necessary nutrients a baby needs for its first six months.

Breastfeeding is deemed extremely beneficial and essential for both the mother and the child. However, it is essential to understand that nicotine and alcohol affect breastfeeding and harmful substances can be transferred to the baby through breast milk.

Baby in handDespite the recommendations issued by the World Health Organization (WHO) to avoid alcohol and drugs while breastfeeding, almost 12 percent to 83 percent of breastfeeding women reported the consumption of alcohol and 7 percent to 16 percent self-reported smoking tobacco.

These statistics may still be underestimated as alcohol drinking habits often go largely underreported.

Older maternal age, higher education, and extended breastfeeding duration are found to be linked with higher alcohol consumption during lactation. On the other hand, younger maternal age, lower education, and reduced income are correlated with tobacco smoking.

Rather than assume that drugs of abuse would be harmful until proven absolutely safe, many have taken the opposite approach. A lack of prospective or definitive harmful evidence regarding the influence of alcohol upon breastfed children supported the largely mistaken belief that alcohol is a galactagogue, that is, food or drug that increases the flow of a mother’s milk are considered two main factors behind alcohol consumption by breastfeeding women.

In reality, alcohol quickly transfers to breastmilk at similar concentrations as compared to maternal blood alcohol concentration and inhibits milk production. Drinking alcohol right after a feeding minimizes ethanol exposure, but not all women are aware of or use this technique.

Furthermore, unscheduled infant feedings can further flaw such reasoning. Even throwing away “contaminated” breastmilk does not help as ethanol concentration in breastmilk remains similar to maternal blood alcohol concentration. Alcohol content present in breastmilk peaks half an hour to an hour later and persists in the milk for at least two to three hours.

Mom And Daughter-Helping A Suicidal TeenSimilarly, nicotine also absorbs quickly into breastmilk, where concentrations may actually be higher than the maternal serum concentrations.

Nicotine’s inhibitive effect on milk production and modifying abilities upon breastmilk composition and taste have already been established. Despite the belief in the harmful effects of tobacco on infants, the addictive nature of nicotine makes it difficult for many breastfeeding women to quit.

Studies assessing the effects of alcohol and nicotine consumption during lactation still remain largely limited. Most of the relevant rat studies exposed the rat mothers, or dams, to much larger alcohol quantities than actually consumed by human mothers. Nevertheless, available data suggest that exposure to alcohol through breastmilk may lead to adverse cognitive effects for the offspring.

Human research has been mostly dependent on disordered infant sleeping and feeding patterns. A case study from 1978 discovered the development of pseudo-Cushing syndrome post high alcohol consumption during breastfeeding but not pregnancy.

Symptoms subsided after alcohol cessation. Little et al. found inhibited psychomotor scores at one year in infants that were exposed to alcohol during nursing. More recent studies were unable to find any such reductions in developmental scores.

Likewise, human studies exploring the associations between tobacco smoking during pregnancy and lactation and later childhood development, remain largely inadequate and limited.

The study

The present study sourced information from the Growing Up in Australia database, a longitudinal study of 5107 Australian children recruited as infants in 2004 and assessed every two years for cognitive development till they were 11 years of age.

The mothers of these children filled out a questionnaire constructed by WHO, enquiring about their alcohol consumption and cigarette smoking during their pregnancy and lactation periods. On each visit, the children were assessed for their nonverbal reasoning, vocabulary and cognitive abilities.

Baby not exposed to drinking during breastfeedingResults depicted that mothers with higher consumption of alcohol during pregnancy and lactation had children with lower nonverbal reasoning scores.

These children with low scores were mostly 6 to 7 years old who had been breastfed. Such low scores were not observed among children with mother who had consumed alcohol but had not breastfed.

Other influencing factors that could have potentially contributed to lower nonverbal reasoning scores included alcohol consumption during pregnancy, gender of the child, maternal age at pregnancy, birth weight and the duration of breastfeeding. These lower cognitive abilities evened out by the time these children reached the ages of 10 to 11.

Researchers believed that this could be due to several environmental factors in play that determine the cognitive abilities as the child progresses. As these children gained more education, the effects of alcohol exposure on during prenatal and lactation periods deteriorated. The researchers also noted that the clinical repercussions of alcohol exposure upon the children were not significant unless the mother consumed alcohol excessively.

Maternal smoking during breastfeeding and pregnancy, however, did not exert any significant influence on the children’s cognitive abilities. Researchers were quick to discourage this as a green light for smoking during pregnancy and lactation. Even though this may not affect a child’s cognitive abilities, smoking can cause significant harm to several other organs and organ systems.

Relevance to the future

This is the first study to explore the association between alcohol exposure during breastfeeding and cognition in children. The researchers concluded that even though the relationship was considerably small, it may easily be clinically significant when expecting and lactating mothers regularly or excessively consumed alcohol. Further detailed analysis involving the assessment of academic, developmental, physical and behavioral outcomes in children owing to alcohol and nicotine consumption is now more critical than ever.

1. http://pediatrics.aappublications.org/content/142/2/e20174266
2. https://www.ncbi.nlm.nih.gov/books/NBK52687/
3. https://www.healthyfamiliesbc.ca/home/articles/alcohol-and-smoking-after-pregnancy
4. https://link.springer.com/article/10.1007/s11062-008-9025-4
5. https://journals.sagepub.com/doi/abs/10.2466/pr0.1982.50.3.911

About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD

About the Transcript Editor:

Sana Ahmed photoA journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

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Published on November 19, 2018
Reviewed by Jacquelyn Ekern, MS, LPC on November 19, 2018
Published on AddictionHope.com

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