Breastfeeding And Alcohol

By Wells Shoemaker, M.D.

After nine months of puffy ankles, low back pain, heartburn, and dreary abstention, a mother can finally see her baby smile. She can also return to the civilized pleasures of wine with supper... or can she?

Lactation counselors, helpful grandmothers, and board certified obstetricians have all traditionally endorsed the use of beer or wine with meals for nursing mothers.

While professionals have debated the risks of moderate alcohol consumption for the fetus, no one questioned the safety of occasional alcohol use by breastfeeding mothers...until recently.

Two studies, both published in the New England Journal of Medicine, have attacked this once-safe harbor:

(1) Ruth Little, Sc.D., and coworkers reported in 1989 that breastfed infants whose mothers used alcohol performed equally in mental tests at one year of age, but lagged behind in motor development when compared to the babies of non-drinkers.

(2) Julie Mennela, Ph.D., from the Monel Chemical Senses Center in Philadelphia, reported in 1991 that the milk of alcohol-consuming mothers had a different odor and was less appealing to infants.

As a pediatrician and founder of a hospital-based lactation program, I find serious flaws in both studies.

The Little group did not quantify nor verify the reported alcohol consumption among their mothers, nor did they define different types of beverages, the timing of drinking with meals, nor time of day.

They used standard developmental tests, but acknowledge that the tests "are not precise measures." Indeed, the scoring system does not measure a quantitative feature, such as weight or blood pressure. These scores are helpful to guide decisions for an individual, but are not legitimately designed to be added, divided, squared, and averaged by a statistician.

Accepting these limitations, what were the differences? The alcohol-exposed babies scored 98 and the others 103 on a motor test. This corresponds to approximately a one-week difference in the age at walking, when the norm extends from 9 to 15 months.

As the author states in her conclusion, "What is the clinical importance of these findings? For the individual child, probably none."

The Monel Chemical group, which has also published their data on garlic odors in breast milk, studied a dozen women and reported their odor assessments after mothers drank a measured amount of alcohol.

The New England Journal of Medicine subsequently published a sound repudiation of this study in the correspondence section, stressing the biological implausibility of the minute amounts of alcohol having any effect and the lack of any objective measurement of aromatic differences, even with highly sensitive instrumentation. Furthermore, there are no population studies that remotely suggest any difference in growth of babies based upon mothers' alcohol consumption habits while nursing.

Let's Calculate

Let's do some arithmetic, deliberately skewed to maximize the amounts of alcohol that could reach a breastfeeding baby.

Let's say a mother drinks to the point of intoxication with a blood alcohol content (BAC) of 0.10. Let's say the alcohol passes from the blood into the mother's milk immediately and with equal concentration (both assumptions are exaggerations). The mother's milk will have 0.1 grams of alcohol in 100 ml (about 3 1/2) ounces of milk.

Let's say her typical 11 pound (5 kg) two-month-old baby drinks a typical 4-ounce quantity of breast milk. Let's assume that the baby absorbs the alcohol from the milk immediately and completely into the bloodstream (a considerable exaggeration). The baby will have a BAC of about 0.002 -- too low to have any recognized pharmacological effect.

Now let's eliminate the physiological exaggerations. Let's have the mother drink one glass of wine or beer, rather than three or four. Let's have her take this with a meal, which will both delay the absorption and reduce the level of alcohol in her blood and her milk. In this more realistic case, the baby will achieve a BAC well below 0.001 -- too low to measure with conventional instruments.

The Pediatrician's Recommendation

Two of nature's most eloquent triumphs in the liquid phase are mother's milk and fine wine. Mothers should provide the former in abundance and consume the latter in moderation.

There are no realistic scientific reasons to discourage truly moderate, healthy, nursing mothers from occasional beer or wine with meals, but there certainly is a dark side of alcohol and motherhood.

Abusive consumption of alcohol might conceivably cause some pharmacological effect on a baby, but that's still a minor issue. The real threat is that babies raised by intoxicated mothers face serious risks of being injured, burned, abused, malnourished and neglected.

The enemy is the disease of alcoholism. All citizens, winemakers and anti-alcohol crusaders alike, need to unite in the pursuit of meaningful solutions to this problem. Frightening or misinforming healthy mothers really will not save any souls, make babies walk earlier or smell better.