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How Do Drugs Affect Breastfeeding?

alcohol caffeine drugs marijuana medications Oct 22, 2023
How Do Drugs Affect Breastfeeding?

The use of drugs affects breastfeeding in many ways. 

In the fall of 2019, Rosemary discovered that she was pregnant. Immediately, she was filled with joy and excitement. But despite her initial joy, fear began to set in as she realized how much she needed to change her life. Although Rosemary's life appeared put together from the outside, she was acutely aware of her addiction to painkillers. For the sake of her baby, she wanted to change her life. 

After some time, she sought out prenatal care for herself. She found an amazing obstetrician who took the time to understand her history of addiction and help her to find the help that she needed. With her doctor's help, she was able to get into an opiate abuse recovery program and began suboxone therapy. 

She learned about the importance of staying clean, sticking with her medication regimen and the benefits of breastfeeding her infant. 

While Rosemary's story of addiction recovery is unique, her story of drug addiction is not. According to the national center for drug abuse statistics, 24.7% of people with drug use disorders have an opioid use disorder. 

While not all substances are illegal, there are many things that you can ingest as a breastfeeding mother. In this article, we will look at different substances and their effects on breastfeeding. 


Caffeine is a natural stimulant found in coffee, tea, energy drinks and other beverages. Although caffeine can be abused and you can become addicted to it, it is not considered a drug of abuse. However, there are definite withdrawal effects of abruptly stopping caffeine after regular use. 

As a breastfeeding mother,  it is important to limit your caffeine intake. Infant exposure to caffeine through breast milk can lead to side effects. However, studies suggest that moderate levels of caffeine intake (about 300 mg per day) while breastfeeding do not pose harm to the baby. This is the amount of caffeine equivalent to drinking three cups of coffee in a day. 

Excess caffeine has adverse effects on baby's sleep patterns. Its stimulating properties lead to increased irritability or fussiness in the infant. Even if you are staying under the recommended limits for caffeine consumption, some babies are very sensitive to caffeine's effects. If you notice that your breastfeeding infant is more irritable after your morning cup of coffee, you may need to cut back on your caffeine use. 

In general, moderate amounts of caffeine are okay when breastfeeding. We give caffeine to premature babies in the NICU who are experiencing apnea of prematurity. Caffeine in small amounts is safe for babies, but you need to monitor your own infant for how it affects them. If you do choose to drink caffeinated beverages while nursing, do your best to drink your coffee or soda after you have nursed your baby.  


Smoking and tobacco pose significant risks to babies. Studies show that smoking increases the risk of SIDS (Sudden Infant Death Syndrome) in babies. While tobacco use is not a contraindication to breastfeeding, women completely eliminate or cut way back on smoking cigarettes while nursing.  Smoking causes decreased blood flow to parts of the body, including the breast. Breastfeeding mothers who smoke often have low milk production as a result. 

Infant exposure to smoking also leads to increased respiratory infections, risk for developing asthma as well as ear infections. Breastfeeding negates some of those consequences, but not all of them. 

Nicotine exists in high concentrations in human milk for breastfeeding mothers who smoke or use nicotine products. The infant dose of nicotine is highest right after the mother has used the drug, therefore health care providers recommend feeding the baby first and then using nicotine. 

What About E-Cigarettes?

E-cigarettes are not any safer than regular cigarettes, especially for breastfeeding mothers. These products still contain harmful chemicals that have adverse effects on infants. Additionally, they are not a safer way to quit smoking. In order to quit smoking, there are safer alternatives such as the nicotine patch, lozenges or gum. Cognitive behavioral therapy is also an important treatment for nicotine addiction.

If you continue to smoke or use nicotine, do so in the safest way possible: 

  • Do not smoke while you are feeding your baby. Feed your baby first and then smoke in a different place, preferably outside. 
  • Do not vape or smoke near your baby. Minimize the risk of secondhand smoke by not smoking in your car either. 
  • Change your clothes and wash your hands after smoking and before interacting with your baby. 
  • Nurse your baby BEFORE you smoke or vape so that the nicotine levels in your breast milk have time to decrease before your baby's next feeding. 
  • Keep trying to quit. Don't give up. It takes most people several attempts at quitting before finding success.


Safe use of alcohol during breastfeeding is possible as long as you follow some general guidelines.

  • Limit the number of drinks that you have in one setting 
  • Generally, one or two drinks over a several hour time period allows you to continue your breastfeeding relationship with minimal interruption.
  • Your blood alcohol level is equivalent to your breast milk alcohol level. While you are feeling the effects of an alcoholic beverage so will your breastfeeding baby.
  • Once you are no longer feeling the effects of the alcohol on your body, it is generally safe to breast feed with minimal infant exposure to the alcohol. (generally 2 hours after finishing your drink)
  • Generally speaking, you can feed your baby, have a glass of wine and then feed your baby again in 2-3 hours. Most of the adverse effects of alcohol from a standard drink will be out of your system and therefore your milk in that time period. 

On the other hand, chronic use of alcohol has detrimental effects on your prolactin levels and therefore your breast milk supply. 

A standard drink consists of 12 ounces of beer, 5 ounces of wine or 1.5 oz of 80 proof spirits. 


As marijuana becomes legal in more and more states, its use continues to grow in popularity. Additionally, there are medicinal uses for marijuana as well. Even in states where it is still considered an illegal drug, men and women alike are still using this substance.

While the occasional use of recreational marijuana is not a contraindication for breastfeeding, it is important to understand the effects of this drug in breast milk. THC is the psychoactive component of marijuana and it likes to concentrate in fatty tissues. Since a baby's brain is high in fat levels, this drug can make the baby drowsy. THC potentially causes other neurological symptoms such as poor sucking. 

At this time, we don't have enough information to understand the potential long term effects that THC could have on a child's development and brain function. 

Many people self medicate with marijauna for conditions such as pain, depression or anxiety. While there are definite drawbacks to prescription drugs that treat those conditions, we definitely have much more safety data on these medications. 


Opiates are highly addictive medications that treat pain. These potent medications cover specific receptors in the brain to cause a dissociative effect. These drugs change your brain's perception of pain. Additionally, certain formulations give you a "high" feeling that is addicting.

As the opiate crisis continues to wreak havoc on our country, health professionals are working hard to decrease prescriptions for these medications.

Pregnant women who use opiates regularly during pregnancy run the risk of giving birth to a drug addicted baby. Transfer of drugs through the placenta to the baby allows them to get regular doses of the medication. When the placenta is delivered and the baby is out in the world, these infants are at risk for opiate withdrawal. 

These prescription medications also transfer into breast milk. Women who are in opiate treatment programs often use methadone or buprenorphine to treat their addictions. Health professionals like myself encourage mothers who are taking these medications to breastfeed their babies. Infants who consume these drugs in breast milk are less likely to experience opiate withdrawal. 

Other Illicit Drugs

Use of cocaine, heroin and other drugs of abuse are contraindicated for breastfeeding mothers. Most of these drugs pass easily into human breast milk and harm breastfeeding babies. 

For example, these drugs can cause symptoms such as poor weight gain, jitteriness, difficulty sleeping, irritability, and feeding problems. In addition, the effects of these drugs on a breastfeeding infant's brain development may be long-lasting.

Additionally, mothers who are under the influence of a substance are not able to safely care for their babies. These babies suffer not only the effects of drugs, but often abuse and neglect as well. 

Pregnant women as well as breastfeeding women can get help for their drug addiction by calling the SAMHSA National Helpline. You will receive free and confidential help by calling 1-800-662-4357

Prescription Medications and Breastfeeding 

Just like recreational drugs can passively diffuse into breast milk, certain prescription and over the counter medications can as well. You can read more about safely using drugs during breastfeeding in my article "Do all medications pass through breast milk?" 

Closing Thoughts 

Infant exposure to drugs through breast milk is a topic that needs to be addressed in all social circles. No one is immune to the effects of drug use in pregnancy and breastfeeding. Hopefully, this article helped you to understand the risks and benefits of how a mother cares for herself during breastfeeding. Women who breastfeed are almost entirely in control of drug exposure to their infants. If you need help in changing your habits, please reach out to your trusted health care provider for assistance. 

© 127 Pediatrics; October 2023

This article is for informational purposes only and should not be construed as medical advice.

Dr. Wadley, 127 Pediatrics
Andrea Wadley, MD, IBCLC

Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls only pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.


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