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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Krebs NF, Belfort MB, Meier PP, Mennella JA, O'Connor DL, Taylor SN, Raiten DJ. Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3. Am J Clin Nutr 2023; 117 Suppl 1:S43-S60. [PMID: 37173060 PMCID: PMC10356564 DOI: 10.1016/j.ajcnut.2023.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/08/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | | | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Chanal C, Mazurier E, Doray B. Use of Psychoactive Substances during the Perinatal Period: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S17-S37. [PMID: 36480661 DOI: 10.1111/jmwh.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Based on their clinical practice and an extensive review of the literature, the authors propose a framework of procedures to be followed to provide services to all women of childbearing age who use psychoactive substances (alcohol, cannabis, cocaine, amphetamines, and opioids), especially during pregnancy or during the postpartum and breastfeeding periods, in view of their individual situations and environmental contexts.
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Affiliation(s)
- Corinne Chanal
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France.,Réseau de Périnatalité Occitanie Espace Henri BERTIN SANS, Bat A, 59 avenue de Fès-34080, Montpellier, France
| | - Evelyne Mazurier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France
| | - Bérénice Doray
- Service de génétique, CHU de La Réunion, allée des Topazes, cedex, 97405, SAINT-DENIS.,Centre Ressource Troubles du Spectre de l'Alcoolisation Fœtale (TSAF) - Fondation Père Favron - 43 rue du Four à Chaux, Saint-Pierre, 97410, Réunion
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Peixinho J, Toseeb U, Mountford HS, Bermudez I, Newbury DF. The effects of prenatal smoke exposure on language development ‐ a systematic review. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica Peixinho
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Umar Toseeb
- Department of Education University of York York UK
| | - Hayley S. Mountford
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Isabel Bermudez
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
| | - Dianne F. Newbury
- Faculty of Health and Life Sciences Oxford Brookes University Headington Campus Oxford UK
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Landa-Rivera JL, Pérez-Pérez J, González-Núñez MDP, Gil-Miralles RA, Jover-Escolano Y, Fernández-Pan Astacio V. Population-Based Survey Showing That Breastfed Babies Have a Lower Frequency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeed Med 2022; 17:182-188. [PMID: 34919408 PMCID: PMC8867097 DOI: 10.1089/bfm.2021.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Justification: Breastfeeding provides the best infant food, and closeness to the mother is crucial for successful breastfeeding. However, sharing parents' beds and sleeping on the stomach poses a high risk for sudden infant death syndrome (SIDS). There is little information on these practices regarding the Spanish population. Objective: To explore breastfeeding and bed-sharing practices in the study population Materials and Methods: A cross sectional observational study was conducted through an anonymous telephone survey with a representative random sample of babies born in the Health Area of La Marina Baixa, Alicante, between 2018 and 2019. A previous-day strategy was implemented to determine the feeding and bed-sharing variables. Results: The total breastfeeding and formula-feeding rates were 47.0% and 52.9%, respectively. The overall bed-sharing rate was 66.5%. The breastfeeding rate was 86.4% with bed-sharing and 13.6% without bed-sharing. The rate of prone sleeping position in children younger than 6 months of age was 9.3-3.5% with breastfeeding and 5.8% with formula feeding. Lower frequencies of tobacco, alcohol, and nonsupine sleeping positions were observed among mothers who practiced breastfeeding and bed-sharing. Conclusions: We found a close relationship between breastfeeding and bed-sharing and a lower frequency of SIDS risk factors associated with both practices. Families should be informed about the risk factors associated with SIDS to encourage safe bed-sharing while avoiding recommendations that discourage breastfeeding.
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Affiliation(s)
- José Leonardo Landa-Rivera
- Marina Baixa Hospital, Association for the Promotion of and Scientific and Cultural Research into Breastfeeding (APILAM), Alicante, Spain
| | - Juan Pérez-Pérez
- Pediatric Service, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
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Han AA, Buerger AN, Allen H, Vincent M, Thornton SA, Unice K, Maier A, Quiñones-Rivera A. Assessment of Ethanol Exposure from Hand Sanitizer Use and Potential for Developmental Toxicity in Nursing Infants. J Appl Toxicol 2022; 42:1424-1442. [PMID: 34991177 PMCID: PMC9543418 DOI: 10.1002/jat.4284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022]
Abstract
Ingestion of ethanol during pregnancy is known to have detrimental effects on the fetus. Although the potential developmental effects of maternal ethanol intake during lactation are less well characterized, public health guidelines recommend avoidance of alcohol or, if alcohol is consumed, to allow for 1–2 h to pass before nursing. A proposal to classify ethanol as potentially harmful to breast‐fed children warrants an investigation of the potential adverse neurodevelopmental effects of low‐dose ethanol exposure during lactation. There currently are no studies that have examined neurodevelopmental outcomes from lactational exposure to ethanol from the use of topical products that contain ethanol, such as alcohol‐based hand sanitizers (ABHS). Furthermore, the epidemiological literature of lactational ethanol exposures from maternal alcohol consumption is limited in design, provides equivocal evidence of neurological effects in infants, and is insufficient to characterize a dose–response relationship for developmental effects. Toxicological studies that observed neurodevelopmental effects in pups from ethanol via lactation did so at exceedingly high doses that also caused maternal toxicity. In this investigation, blood ethanol concentrations (BECs) of breastfeeding women following typical‐to‐intense ABHS use were computationally predicted and compared to health benchmarks to quantify the risk for developmental outcomes. Margins of 2.2 to 1000 exist between BECs associated with ABHS use compared to BECs associated with neurotoxicity adverse effect levels in the toxicology literature or oral ethanol intake per public health guidelines. Neurodevelopmental effects are not likely to occur in infants due to ABHS use by breastfeeding women, even when ABHSs are used at intense frequencies. Adverse neurodevelopmental effects of ethanol exposure are supported by toxicological studies; ethanol as a potential “lactation hazard” needs evaluation. A lactation hazard may not be applicable for all ethanol‐containing products, such as hand sanitizers. Furthermore, internal dose assessments of hand sanitizer use are lacking. Computationally modeled blood ethanol concentrations following hand sanitizer use are lower than concentrations associated with toxicological and guideline benchmarks. Therefore, there is low potential for the use of ethanol‐containing hand sanitizers to be a lactation hazard.
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Szukalska M, Merritt TA, Lorenc W, Sroczyńska K, Miechowicz I, Komorowicz I, Mazela J, Barałkiewicz D, Florek E. Toxic metals in human milk in relation to tobacco smoke exposure. ENVIRONMENTAL RESEARCH 2021; 197:111090. [PMID: 33798522 DOI: 10.1016/j.envres.2021.111090] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
Several reports confirm the deleterious effects of tobacco smoking and exposure to second-hand smoke (SHS) resulting in changes in the composition of breast milk. The aim of our study was to compare the levels of selected essential, as well as, toxic metals found in colostrum (collected at day 1 ± 2 post-birth) and mature milk (1 month ± 7 days post-birth) of nonsmoking women (n = 52) compared to those found in women who smoke tobacco (n = 51) and women exposed to second-hand smoke during pregnancy and lactation (n = 47). Women's non-smoking or smoking status was determined by their responses to a questionnaire, including questions about others who may smoke in the home environment, and confirmed by measurement of cotinine in the blood serum by high performance liquid chromatography with diode array detector (HPLC-DAD). Inductively coupled plasma mass spectrometry (ICP-MS) and flame atomic absorption spectroscopy (F-AAS) techniques were used to determine the metal concentrations in colostrum and mature milk previously digested by a microwave mineralizer. We confirmed that exposure to tobacco smoke increases concentrations of heavy metals (cadmium and lead) in colostrum and mature milk. These increased concentrations of heavy metals may disturb the action of bioactive substances necessary for the optimal growth and development of newborns and infants. These findings support the need for increased concern and information to lactating women about preventing their exposure to cigarette smoking and SHS due to the adverse effects of tobacco smoke on breast milk with added risks to their infants.
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Affiliation(s)
- Marta Szukalska
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd Street, 60-631, Poznan, Poland
| | - Thurman Allen Merritt
- Children's Hospital, School of Medicine, Loma Linda University, Loma Linda, CA92354, USA
| | - Wiktor Lorenc
- Department of Trace Analysis, Faculty of Chemistry, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Katarzyna Sroczyńska
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, 33 Polna Street, 60-535, Poznan, Poland
| | - Izabela Miechowicz
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 79 Dabrowskiego Street, 60-529, Poznan, Poland
| | - Izabela Komorowicz
- Department of Trace Analysis, Faculty of Chemistry, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Jan Mazela
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, 33 Polna Street, 60-535, Poznan, Poland
| | - Danuta Barałkiewicz
- Department of Trace Analysis, Faculty of Chemistry, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd Street, 60-631, Poznan, Poland.
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Gibson L, Porter M. Alcohol and Tobacco use While Breastfeeding and Risk of Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder. J Autism Dev Disord 2021; 52:1223-1234. [PMID: 33893938 PMCID: PMC8067780 DOI: 10.1007/s10803-021-05027-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/08/2022]
Abstract
Research has linked prenatal alcohol and tobacco use with Attention Deficit Hyperactivity Disorder (ADHD), and variably with Autism Spectrum Disorder (ASD). Lactational use has been scantly considered. This study examined whether it may alter ADHD or ASD risk. Participants were 5107 infants recruited in 2004 and assessed longitudinally for the Growing Up in Australia Study. Logistic regression did not find any associations between maternal alcohol and tobacco use while breastfeeding and ADHD or ASD diagnosis at ages 6–7 or 10–11 years. Alcohol and tobacco use during lactation may not increase ADHD or ASD risk. Abstaining from alcohol and tobacco, however, may still be the safest option. Analyses were limited by lack of alcohol timing and retrospective variables that future research should address.
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Affiliation(s)
- Louisa Gibson
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Melanie Porter
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
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Gibson L, Porter M. Maternal drinking and smoking. Can it explain the exceptional academic performance of LBOTE children? A preliminary analysis. BMC Res Notes 2021; 14:141. [PMID: 33863380 PMCID: PMC8052672 DOI: 10.1186/s13104-021-05544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Although children from language backgrounds other than English (LBOTE) may be disadvantaged in English-reliant exams, they outperform children from an English language background (ELB) on many Australian National Assessment Program–Literacy and Numeracy (NAPLAN) assessments. Maternal alcohol and tobacco use during pregnancy and/or breastfeeding have been associated with poorer cognitive and academic performance. Using data from the Growing Up in Australia Study, this paper aimed to identify demographic, lifestyle, and prenatal and perinatal risk differences related to maternal tobacco and alcohol use between LBOTE and ELB groups, as a first step in trying to understand the academic performance differences. Results Only data from breastfed babies was included in the current analyses. Although LBOTE children were disadvantaged in several demographic areas, their NAPLAN performance was the same or superior to ELB children across all Grade 3 and 5 NAPLAN assessments. The LBOTE group were, however, breastfed for longer, and their mothers smoked fewer cigarettes and drank less alcohol on fewer occasions throughout their pregnancy. The LBOTE mothers also had lower or less risky patterns of alcohol consumption while breastfeeding. The longer breastfeeding duration of LBOTE children combined with lower maternal use of alcohol and cigarettes during pregnancy and/or breastfeeding may partially contribute to their exceptional NAPLAN performance.
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Affiliation(s)
- Louisa Gibson
- Faculty of Medicine, Health and Human Sciences, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Melanie Porter
- Faculty of Medicine, Health and Human Sciences, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia
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Gibson L, Porter M. Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes 2020; 13:232. [PMID: 32336274 PMCID: PMC7184702 DOI: 10.1186/s13104-020-05072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives Prenatal intake of alcohol and tobacco have been associated with negative outcomes in children. Consumption of alcohol while breastfeeding has also been associated with dose-dependent decreases in abstract reasoning ability and academic scores in children at later ages. Using longitudinal data from The Growing Up in Australia Study, the current study aimed to investigate whether intake of alcohol or tobacco while breastfeeding was related to later developmental health outcomes in children. Results Multivariable linear regression analyses were performed on a sample of 2008 babies who were actively breastfeeding at study entry and 4679 babies who had been breastfed at any time (actively breastfed babies combined with babies who had been previously breastfed). Only a diagnosis of Autism spectrum disorder and Attention deficit disorder were associated with lower developmental health outcomes. Neither maternal alcohol consumption nor tobacco smoking while breastfeeding were associated with developmental health outcomes at 6–7 years old or 10–11 years old for either sample group. A relationship between maternal consumption of alcohol or tobacco smoking while breastfeeding and later developmental health outcomes in children was not identified.
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Affiliation(s)
- Louisa Gibson
- Faculty of Medicine, Health and Human Sciences, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Melanie Porter
- Faculty of Medicine, Health and Human Sciences, Department of Psychology, Macquarie University, Sydney, Australia
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