Can CBD help with breastfeeding, and is it safe to use for nursing mothers and their babies?
- Cannabinoids naturally exist in breast milk, as a 2016 research published by the National Institutes of Health indicates(1). However, CBD is entirely fat-soluble, making it nearly impossible to accurately measure the CBD component in breast milk, which is also full of fats.
- According to the U. S. Food and Drug Administration (FDA), based on what the experts already know about CBD, some amount of CBD may be transferred to babies through breast milk.
- While there is no evidence that explicitly confirms the presence of CBD or THC in human breast milk, the data remain inconclusive about the potential interactions between CBD and nursing mothers and their babies.
- There have been no studies on the effects of CBD alone on pregnancy and breastfeeding. However, there have been studies done on subjects with prolonged exposure to marijuana. Thus, doctors are cautious about recommending the non-psychoactive CBD because of its close association with marijuana, and because of the lack of research around CBD alone.
- Meanwhile, the FDA continues to investigate reports of CBD products containing contaminants, such as pesticides, heavy metals, bacteria, and fungus, that may pose a risk to the fetus or breastfed baby.
Why Some Women May Be Thinking of Taking CBD During Breastfeeding
The many changes that happen to a woman’s body after giving birth may bring about several pains, mental health issues, postpartum anxiety, stress, and nausea-related problems. Postpartum nausea warrants a prompt medical evaluation of the thyroid, gallbladder, or liver.
Unfortunately, the verified safe options available are limited, as many prescription medications can bring about adverse side effects that may harm both the nursing mother and her new baby.
But as new moms look to CBD as a natural alternative to pharmaceuticals, they must also know whether or not CBD is safe for them and their babies.
CBD and Breastmilk: What Research Says
The critical issue surrounding CBD oil and breastfeeding is the necessity for more deductive and conclusive research on nursing mothers and their infants.
Considering the dearth of evidence on the effects of CBD oil and breastfeeding, complete abstinence is the safest course of action.
The limited clinical studies that exist on only CBD were either done in vitro or on non-human subjects.
The Risks of Using CBD While Breastfeeding
A 2011 study led by Chia-Shan Wu, Ph.D. of The Cain Foundation Laboratories, suggested that prenatally cannabis-exposed children display neurological and behavioral problems(2).
Another study from 2016, published by the National Institutes of Health, had shown that prenatal exposure to cannabis might increase adverse outcomes for women and their babies, such as low birth weight, placement in the neonatal intensive care unit, and preterm birth(3).
Studies that show the impact of cannabis on pregnancy are limited. However, there have been studies done on subjects with prolonged exposure to marijuana.
A 2013 study, “Cannabidiol changes P-gp and BCRP expression in trophoblast cell lines”, conducted by the Department of Clinical Biochemistry and Pharmacology at Ben-Gurion University of the Negev, Israel, concluded that CBD use during pregnancy might change the physiological characteristics of the placenta.
However, it must be noted that the aforementioned study was not based on the exclusive use of CBD which traditionally contains low to zero levels of THC, but rather on marijuana, which contains high levels of THC.
CBD and marijuana are not the same thing. Thus, it is difficult to draw any conclusions from this study.
Studies like this make doctors cautious about recommending the non-psychoactive CBD because of its close association to marijuana and because of the lack of research around CBD alone.
Also, CBD has to be measurable to determine how much CBD ends up in breast milk. However, CBD is a highly lipophilic molecule, which means it is entirely fat-soluble. Thus, it is nearly impossible to accurately measure the CBD component in breast milk, which is full of fats.
In 2006, some CBD products were tested by the U. S. Food and Drug Administration (FDA), and they were found to contain trace amounts of other cannabinoids, like THC (tetrahydrocannabinol).
THC is the main psychoactive component of marijuana. While there are methods used to detect concentrations of THC in breast milk, nothing is conclusive as of yet for CBD.
Researchers at the Centers for Disease Control and Prevention developed a novel technique that begins with saponification to separate cannabinoids from fat in milk.
Saponification, a process often used in soap-making, is a chemical reaction that occurs when fatty acids come into contact with lye. With this novel approach involving saponification, the team can detect trace levels of active marijuana compounds, including cannabinol (CBN) and cannabidiol (CBD).
Researchers are hopeful that, in the future, saponification could help in detecting and measuring the exact amount of CBD in breast milk. When and if this takes effect, any doubts about CBD oil and breastfeeding can be cleared.
However, given the current lack of regulations on CBD products available in the market, there is a wide range of disparities in potency, quality, and general effectiveness.
Regardless of what the labels say, consumers, especially new mothers and breastfeeding women, should be wary of the brand of CBD that they consume.
In 2018, a group of researchers from the University of California San Diego conducted a study on marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk(4).
However, as CBD was not the focus of the study, the research is still limited in scope. Thus, the results of the study are still inconclusive with regards to the safety of CBD oil when used during breastfeeding.
The test also recognized psycho-motor deficits in more than half of the 12-month old infant participants involved in the study. However, the results of CBD on these breastfed children are not yet available.
Meanwhile, studies on THC and its effects on infants has been alarming. A 2017 research, “Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research”, published by the National Academy of Sciences, demonstrated that exposure to cannabis use in utero has an adverse influence on birth weight and increases the risk of an infant baby going into intensive care.
While the results are defeating to most people, it is essential to note that in the Pharmacology and Therapeutics Journal published in 2018, researchers of the study on “Cannabis Use during Pregnancy: Pharmacokinetics and Effects on Child Development” emphasized the fact that women should not smoke marijuana while pregnant. However, the study does not mention anything about CBD use during pregnancy.
Since CBD and marijuana are not the same thing, it is difficult to draw any conclusions from this study.
Still, studies like this make doctors cautious about recommending the non-psychoactive CBD because of its close association to marijuana and because of the lack of research around CBD alone.
There are potential dangers of THC in breast milk, according to the aforementioned 2018 study.
- THC can remain in breast milk for up to 6 days, according to the study.
- THC can affect the baby. The same study found that infants exposed to THC in breastmilk had a lower motor function by the time they were one year old.
- THC poses an enormous risk. Breastfed babies of mothers who smoked heavy amounts of marijuana would test positive for THC for up to three weeks.
Breast Milk and the Endocannabinoid System
It is only recently that scientists discovered the full potential of these cannabinoid receptors that exist within the endocannabinoid system (ECS). The primary function of the ECS is the regulation and homeostasis (balance) within the body.
- A developing fetus has a growing endocannabinoid system, which is the system that CBD benefits.
- Endocannabinoids in breast milk are crucial for a newborn baby’s development. They stimulate hunger and teach the infant how to suckle.
- Breast milk contains endocannabinoids that are very similar in structure to CBD.
- The lack of these endocannabinoids may result in a disorder called ‘non-organic ability to thrive’ wherein the infant has no desire to feed.
Endocannabinoids help teach a newborn baby how to feed by stimulating the process of suckling. In the absence of these endocannabinoids, babies would be unaware of how to feed, nor would they have the appetite to eat. The result could be fatal, as it could lead to malnourishment or death.
Cannabinoids naturally exist in breast milk, as the 2016 research published by the National Academies Press indicates(5).
There are dozens of cannabinoids, but there is no evidence that explicitly confirms the presence of CBD or THC in human breast milk.
Given that it is nearly impossible to find an accurate estimate of the amount of CBD that breast milk contains, it is potentially unsafe for babies to consume CBD.
CBD Oil and the Endocannabinoid System
CBD oil works by binding to cannabinoid receptors in the body. Through this method, CBD can influence the modulation of activities in the ESC.
The ESC impacts several bodily functions, such as mood and anxiety. Hence, ESC is involved in particular disorders as well, such as movement disorders such as Parkinson’s disease, mood and anxiety disorders, neuropathic pain, multiple sclerosis, and spinal cord injury, obesity, metabolic syndrome, and osteoporosis.
What Women Should Know
Women who are contemplating to take CBD while pregnant or nursing should consider the following imperatives:
- Consult with a medical professional about the risks and benefits of CBD, as well as interactions that CBD may have with any prescription medications that are being taken in conjunction with CBD.
- Ensure that the CBD product that would be purchased contains no THC. Read product labels and only purchase from reliable manufacturers.
- Select products that contain pure CBD, no heavy metals, solvents, or harmful pathogens. Third-party lab tests are essential under any circumstances, but for a breastfeeding mother, the availability of those tests should be non-negotiable.
- Monitor any changes in the baby’s behavior and feeding schedule. Any changes must be reported to the baby’s doctor.
Before considering CBD, it is important to remember that there is still a lack of enough evidence at this stage. Studies have also shown that the use of cannabis while pregnant or breastfeeding can lead to an increased risk of low birth weight, preterm labor, and neurological, and behavioral problems.
Other Benefits of CBD
Nursing mothers may be tempted to turn to CBD because it can provide a number of general benefits that is safe to those who are not pregnant or breastfeeding:
- A 2009 study, “The endocannabinoid system and the treatment of mood and anxiety disorders”, conducted by the Laboratory of Neuroendocrinology of Rockefeller University in New York, showed how CBD might impact mood by regulating the body’s response to stress. An improved stress response promotes a positive mood and increases energy levels.
- “The Profile of Immune Modulation by Cannabidiol (CBD) Involves Deregulation of Nuclear Factor of Activated T Cells (NFAT)”, a research conducted in 2018 by the Center for Integrative Toxicology and Department of Pharmacology and Toxicology in Michigan State University, demonstrated CBD as a potent immune suppressor, making it potentially beneficial for use in autoimmune disorders where the immune system is overactive. Since the immune system is linked to the endocannabinoid system (ECS), CBD also promotes a stable immune system.
- New moms typically suffer from a lack of sleep. On The Permanente Journal published online in 2019, results of the study on “Cannabidiol in Anxiety and Sleep: A Large Case Series” showed that CBD might help reduce anxiety levels, which can potentially result in improved sleep.
- CBD has been shown to be able to restore a sense of calm. According to a 2019 report on “Cannabinoid Regulation of Fear and Anxiety: an Update” by the School of Biosciences at the University of Nottingham, CBD may help balance the neurotransmitter anandamide, which can help alleviate feelings of unease.
- CBD allegedly stimulates the brain and improves cognitive performance. It is believed to respond to numerous receptors throughout the brain and the central nervous system. In a 2015 report presented by Nora D. Volkow, Director, National Institute on Drug Abuse, to the Senate Caucus on International Narcotics Control, cannabidiol was shown to possess therapeutic effects, indicating that it may also provide neuroprotective and anti-inflammatory benefits(6). Volkow says there is also growing evidence that CBD acts on other brain signaling systems, and that these actions may be important contributors to its therapeutic effects.
While the results of the aforementioned studies may seem beneficial for those who are not nursing a baby, at this stage, several studies have shown that the use of cannabis while pregnant or breastfeeding can lead to increased risk of low birth weight, preterm labor, and neurological and behavioral problems.
There has been limited research and not enough information on cannabis, breastfeeding mothers, and their infants. These studies primarily focus on the effects of THC on breast milk and children. However, THC and CBD are two vastly different cannabinoids.
To date, there have not been any conclusive studies about the safety of CBD oil use during breastfeeding, so it is not recommended until further studies are completed.
Wei B, McGuffey JE, Blount BC, Wang L. Sensitive Quantification of Cannabinoids in Milk by Alkaline Saponification-Solid Phase Extraction Combined with Isotope Dilution UPLC-MS/MS. ACS Omega. 2016;1(6):1307-1313. Doi: 10.1021/acsomega.6b00253. Epub 2016 Dec 20. PubMed PMID: 28956022; PubMed Central PMCID: PMC5611668.
Chia-Shan Wu, Christopher P Jew, and Hui-Chen Lu. “Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain.” Future Neurol. 2011 Jul 1; 6(4): 459–480.
Gunn JK, Rosales CB, Center KE, Nuñez A, Gibson SJ, Christ C, Ehiri JE.”Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis.” 2016 Apr 5;6(4):e009986. doi: 10.1136/bmjopen-2015-009986.
“Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk.” Kerri A. Bertrand, MPH, Nathan J. Hanan, PharmD, Gordon Honerkamp-Smith, MS, Brookie M. Best, PharmD, MAS, and Christina D. Chambers, PhD, MPH. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. 2018 Aug 31. doi: 10.1542/peds.2018-1076.
Wei, 2016, op. Cit.
Nora D. Volkow.”The Biology and Potential Therapeutic Effects of Cannabidiol.”
Marijuana Use and Breastfeeding
Breast milk is the best food for babies. It contains appropriate amounts of carbohydrates, proteins, fats, minerals, vitamins, and hormones as well as maternal antibodies. Psychologically, breastfeeding facilitates bonding between mother and child.
The passage of THC into breast milk has not been extensively studied. A study by Perez-Reyes and Wall in 1982 suggested that THC is excreted into human breast milk in moderate amounts. Based on their findings, 0.8% of the weight-adjusted maternal intake of one joint would be ingested by an infant in one feeding (i.e., the baby would receive 0.8% of its mother’s dose/kg). In heavy users, the milk-to-plasma ratio (i.e., levels in milk vs. levels in maternal blood) was as high as 8:1. Animal studies suggest that marijuana can decrease the amount of milk produced by suppressing prolactin production and possibly through a direct effect on the mammary glands. There are no human data to corroborate these observations.
In 1990, a study by Astley and Little suggested that exposure to THC through breast milk in the first month of life could result in decreased motor development at 1 year old. No studies have adequately addressed the effects on long-term neurodevelopment. Lethargy, less frequent feeding, and shorter feeding times are other observations reported after babies’ exposure to THC through breast milk. A mother’s ability to nurse and care for her child might be compromised because marijuana can affect mood and judgment.
With chronic use, THC can accumulate in human breast milk to high concentrations. Because a baby’s brain is still forming, THC could theoretically affect brain development. It is also important to avoid environmental exposure to maternal marijuana smoke. Nursing mothers should be referred to appropriate services for counseling.
Drinking alcohol while breastfeeding: Will it harm my baby?
Nursing mothers who choose to drink alcohol during the postpartum period should carefully plan a breastfeeding schedule by storing milk before drinking and waiting for the complete elimination of alcohol from their breast milk after drinking.
Several proven or potential adverse effects of alcohol on suckling infants have been reported, even after exposure to only moderate levels: impaired motor development, changes in sleep patterns, decrease in milk intake, and risk of hypoglycemia. In addition, drinking large amounts of alcohol could affect lactating women’s milk flow.
Some report that beer aids milk production and that infants prefer alcohol-flavored breast milk. Even though beer increases maternal milk production and alcohol enhances its flavor, evidence indicates that the presence of alcohol in breast milk has an overall effect of decreasing infant consumption by 23%. The underlying mechanism for this reduction is unknown.
At this time, there are no known benefits of exposing nursing infants to alcohol. Although occasional drinking while nursing has not been associated with overt harm to infants, the possibility of adverse effects has not been ruled out. Occasional drinking, however, does not warrant discontinuing breastfeeding, as the benefits of breastfeeding are extensive and well recognized. Until a safe level of alcohol in breast milk is established, no alcohol in breast milk is the safest for nursing babies. It is, therefore, prudent for mothers to delay breastfeeding their babies until the alcohol is completely cleared from their breast milk.
Some Myths and Facts about Alcohol and Substance Use
MYTH: “Alcohol or drugs taken after the first trimester do not affect the unborn baby.”
FACT: Most organ development is completed a few weeks after the first trimester. Brain development continues throughout pregnancy and after birth. Exposure to substances at any time in the pregnancy can affect the baby’s brain.
MYTH: “A breastfeeding mother can provide more breast milk for her baby by drinking beer.”
FACT: When a mother drinks alcohol, it passes into her breast milk. Studies have shown that infants take in less breast milk when the mother drinks any alcohol, including beer.
Marijuana Use in Pregnancy
While the effects of CBD in pregnancy remain widely unknown, medical marijuana is a different story. Studies done on women who smoked marijuana during pregnancy found that the THC content led to several problems in both the baby and the mother. This is because THC can cross the placental barrier and reach the baby in the womb.
- Low Birth Weight: Marijuana may prevent the baby from getting as many nutrients in the womb. It may also lead to the baby being born too early.
- Faintness or Dizziness in Mother: Some expectant mothers who used marijuana during pregnancy were more likely to feel faint or dizzy. This can make them more likely to fall or injure themselves.
- Neurodevelopmental Issues: Studies of mothers who smoked marijuana during pregnancy showed that once the child reaches 4 or 5 years of age, he or she may suffer from developmental issues. These children had more trouble concentrating, paying attention, and controlling impulses.
- Mental Disorders: In adulthood, children of mothers who used marijuana in pregnancy were more likely to suffer from mental disorders.
- Substance Abuse: Other studies have shown that children whose mothers smoked during pregnancy were more likely to abuse drugs during the teen years.
If a pregnant or breastfeeding woman feels that she cannot stop using marijuana, there are resources to help, such as the Substance Abuse and Mental Health Services Administration’s helpline.
Marijuana Use in Breastfeeding
After a woman has given birth, the THC in marijuana can be passed to her child, which can cause many of the problems listed above. Another problem of using marijuana while breastfeeding is that it can cause a mother’s body to produce less milk for the child. Mothers who are new to breastfeeding may especially struggle to produce enough milk in the first place, and so using marijuana is not a good idea for that reason alone.
Alternatives to CBD
There are several more natural ways a new mother can help ease her symptoms without using CBD.
Warm milk is known for helping people fall asleep at night. Bubble baths in the evening and relaxing foot massages can also both help women fall asleep in the evening. If these things are not working, women can talk to their doctors about using over-the-counter or prescription medications that are safe for breastfeeding.
Depression and Anxiety
Therapy can go a long way toward helping new mothers who are suffering from anxiety or depression. Taking care of themselves can also help mothers feel better. However, if they are still not feeling better, they can talk to their doctors about anti-anxiety or antidepressants that may help them feel better sooner.
Finding Safe Products
If a new mother does choose to use CBD during breastfeeding, it is essential for her to find the highest quality products available, because everything she ingests goes to her baby as well. It is best to choose CBD products with lower doses during breastfeeding. THC can remain in breast milk for up to six days after use, so it is best to choose CBD products that have no THC content. Products from reputable companies that are labeled CBD isolate contain only CBD and nothing else.
The Bottom Line
Breastfeeding women have many reasons to use CBD to help ease postpartum symptoms. However, research on the safety and long-term effects of these products are lacking, and many professional organizations do not recommend using them.
It is not uncommon for women to use marijuana during pregnancy. Some women find that it helps minimize side effects. Others use marijuana to manage anxiety or to get a better night of sleep. Women who use marijuana during pregnancy might want to continue to use afterwards. However, some research indicates that it can get into breast milk.
Many women abstain from use because of concerns over whether marijuana use during breastfeeding is safe for the child. Despite these concerns, most of the research on the topic is incomplete, outdated, or narrow in scope. This article aims to educate expecting or new mothers on the safety of using marijuana during breastfeeding, as well as how it could affect their children.
Is It Safe to Use Marijuana During Breastfeeding?
Compared to other drugs, the human body metabolizes marijuana very slowly. Since marijuana is stored in fat cells, it is often present in the body for weeks at a time. This is especially true for those who use marijuana frequently or heavily; the drug’s active chemicals accumulate in the body.
Breast milk cannot be created without any body fat, making it possible for marijuana to be present in breast milk and passed onto a child through breastfeeding. Even if the mother did not use marijuana that day or in the days before breastfeeding, it could still be present in the milk.
Research on the subject typically revolves around the amount of marijuana that is passed to the breastfed children and whether it is harmful. Some earlier studies show that the drug does pass to the child. However, there is no definite answer as to whether it has adverse effects.
Since there has not been a significant amount of research on the subject, it is quite difficult for doctors and industry experts to make concrete recommendations on using marijuana during breastfeeding. In this same vein, doctors cannot say whether there is a safe level of marijuana for breastfed babies. As a result, it is best to err on the side of caution.
Here are some potential side effects of using marijuana during breastfeeding:
- Developmental Issues: Although research is incomplete, some studies indicate that marijuana can hurt a baby’s development. These developmental issues include coordination, strength, and overall movement. Marijuana may also affect intellectual development.
- Low Weight: Sleepiness is a side effect of marijuana. This could cause a baby to eat less and sleep more. Slow weight gain can be an issue for babies, especially premature babies.
- Impaired Awareness: Marijuana use can affect a person’s awareness. This, in turn, can affect the level of care that users give their children.
- Less Breastfeeding: On average, women who use marijuana breastfeed their babies for a shorter amount of time than women who do not use marijuana.
As marijuana continues to become more accessible, its impact on breastfeeding gains more attention. Until more research is conducted, it is best to avoid using marijuana while breastfeeding to ensure the health of the baby.
What Is Marijuana’s Effect on Breast Milk?
Mothers who use marijuana while breastfeeding could transmit 2.5 percent of marijuana’s active chemicals to their babies through breast milk. Otherwise, marijuana has not been found to have a profound impact on breast milk. Prolactin, the hormone that tells the body to make breast milk, may be impacted by marijuana use. However, the prolactin level in a mother with established lactation does not affect her ability to breastfeed her child.
Will Marijuana Impact a Baby’s Brain Development?
There is a concern that tetrahydrocannabinol, more commonly known as THC, consumed through breast milk could affect baby brain development. Studies show that maternal marijuana use does affect a child’s development. These children are more likely to experience mental health problems, lower IQ scores, and behavioral issues. During their teen years, these children were significantly more likely to deal with depression or display delinquent behavior.
However, it is important to note that more studies must be done to truly understand the impact marijuana use during breastfeeding might have on children. Some of the behavioral outcomes observed in these studies might not be related to breast milk marijuana exposure. These behavioral issues could be due to other societal factors.
How Long Does Marijuana Stay in the Body?
Even though the effects of marijuana wear off after a few hours, traces of the substance can remain in the body for weeks at a time. Time can vary depending on how often someone uses marijuana. THC can be detected in urine several days after the subject last used marijuana. For frequent users, it is common for marijuana to be detected in urine anywhere from 30 to 45 days.
Although urine tests are most commonly used for detecting marijuana use, blood and hair tests may also be used. Traces of marijuana can be found in blood anywhere from 60 to 75 days. A hair follicle test can detect the drug for up to 90 days.
Although marijuana can be detected in the body several weeks after use, breast milk is different. A study found that lower levels of marijuana chemicals could only be found up to six days after the last use of the drug. This is a significantly shorter period than some might expect. Even so, breastfeeding mothers must still be careful if they wish to avoid feeding their children while it is still in their systems.
Aids to Stop Marijuana Use
Although withdrawal is not commonly thought of when stopping marijuana use, it can be an issue. When heavy users stop using marijuana, they may experience several symptoms. These symptoms include insomnia, irritability, flu-like sickness, and appetite changes. These symptoms can last up to a week or even longer.
Those who are struggling with marijuana addiction can receive therapy from American Addiction Centers. Therapy can give addicts the necessary skills to avoid triggers and cope with cravings.
Receiving professional medical supervision through rehabilitation can also help people make it through the withdrawal period. Otherwise, a few mental health treatments can help those suffering from marijuana addiction:
- Contingency Management
- Cognitive Behavioral Therapy
- Motivational Enhancement Therapy
Breastfeeding is an excellent way to enhance your child’s development. Typically, breast milk delivers all of the necessary nutrients in the perfect ratios for the nourishment of a growing baby. Additionally, breast milk helps build the immune system and protect your child from sickness, reduce the incidence and development of allergies, and even protect against infections, diabetes, and cancer.
Furthermore, breast milk is easily digested, allowing nutrition without the interference of indigestion, constipation, and diarrhea, and it also promotes weight regulation as the baby grows (breastfed children tend to maintain healthier weights as they age).
Breastfed children are widely regarded for being markedly healthier than their formula-fed counterparts, as formula-fed infants have higher rates of gastrointestinal upset, ear infections, and allergies. Formula-fed infants are at as much as 100% higher risk than that of babies who are breastfed for at least their first six months of life.
Breastfeeding is not always a feasible option, especially when the mother has a low breast milk supply due to (but not limited to): insufficient glandular tissue, Polycystic Ovarian Syndrome (PCOS), previous mastectomy or breast reduction, hypothyroidism, or radiation used to treat breast cancer before conception. Other factors that may prevent a mother from breastfeeding include addiction to illegal substances, a medication that is contraindicated during pregnancy, infectious diseases (such as HIV, HTLV, TB, and Herpes lesions on the breasts).
In cases when breastfeeding is an option, however, a mother should be well educated on what is within the realms of safety, including being aware that anything that a breastfeeding mother eats or drinks can pass through to the infant through her breast milk. When you consider this, it is critically important to monitor what you consume because it can pass to the baby. Most medications, while they do pass into breast milk, do so at low levels that are unlikely to pose any risk to the infants. However, some drugs are the exception as they can build up and become quite concentrated within breast milk, posing a risk to the infant.
As a general rule, babies six months or older are at a much lower risk for adverse reactions to medications whereas newborns, babies born prematurely, and medically unstable infants are at higher risk for adverse reactions upon exposure to certain medicines.
Always consult your doctor before continuing, discontinuing, or altering the dosage of any medicine, medication, or prescription drugs. Always consult with your doctor about potential risks to your infant and contraindications while pregnant or breastfeeding.
So, is it safe to take over-the-counter medicine while breastfeeding?
The short answer is yes.
As stated before, only trace amounts of medicine taken by the mother pass into her breast milk, and as a result, there are only a few that arguably shouldn’t be taken by a mother who is breastfeeding.
When in doubt, a couple of rules of thumb are effective for determining whether or not it is safe to take a medication while breastfeeding, such as:
Is the drug regularly prescribed for infants? If it is regularly prescribed, it’s most likely not contraindicated, and it is safe for mothers to take while breastfeeding. This is an easy conclusion, especially when given that the amount that would be ingested by the infant would be far less than if the infant had been administered a dose. Additionally, if it is safe at an administered dose, a trace amount is unlikely to pose a risk. Of course, consult your physician to discuss contraindications specific to you and your baby.
Is the drug safe to take during pregnancy? If the drug is deemed safe during pregnancy, it is probably safe to take while breastfeeding, though some exceptions do apply. As always, consult your physician.
The Center for Disease Control (CDC) offers numerous resources for referencing general information regarding the safety of medicine while breastfeeding, such as LactMed, a Toxnet Database – which is an online database for drugs and lactation. It is hosted by the U.S. National Library of Medicine and offers a search engine for breastfeeding mothers to find extensive information about drug safety and contraindications pertaining to breastfeeding. On the front page under the subject, “What is LactMed?” the website states,
“The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency.”[ref. 3]
Additionally, the database is updated on a monthly basis, making it a substantially reliable source for breastfeeding mothers.
The Basics: What Medications are Safe to Take While Breastfeeding?
While it is always important to consult with your primary physician before taking any medications (breastfeeding or not), below is a basic (and by no means exhaustive) list of medications that are generally safe to take while breastfeeding. If you are considering a medication that is not on this list, we recommend that you reference LactMed’s database for a quick check before consulting your physician for confirmation.
Pain Relievers/Fever Reducers:
- Brands included: Advil, Motrin, IBU
- Brands included: Tylenol, Paracetamol, Panadol, Mapap, etc.
- Brands included: Claritin, Alavert, etc.
- Brands included: Allegra Allergy, Allegra, Allegra Hives, Aller-Ease, etc.
- Brands included: Diflucan
- Brands included: Oravig, Monistat, Micatin, Vusian, Rash Relief Antifungal (use all sparingly)
- Brands included: Mycelex, Lotrimin, Lotrisone, etc. (use sparingly)
- Such as amoxicillin and ampicillin
- Cephalosporins, such as Cephalexin
- Brands included: Keflex, Zartan, Daxbia, Keftab
- Brands included: Sudafed, SudoGest, Entex, Zyrtec D, Nexafed, etc.
Use with caution. Pseudoephedrine has been associated with decreased milk supply, so consider natural alternatives when possible, especially while breastfeeding.
Selective Serotonin Reuptake Inhibitors (SSRS, Antidepressants):
- Brands included: Paxil, Brisdelle, Pexeva
- Brands included: Zoloft
- Brands included: Luvox, Luvox CR
- Brands included: Pepcid, Pepcid AC, Heartburn Relief, Fluxid
- Brands included: Tagamet HB, Tagamet, Leader Heartburn Relief, Equaline Acid Reducer
What about Nyquil and Gravol?
Both Nyquil and Gravol, while not dangerous, may contain ingredients that can be unsafe for the infant if you are breastfeeding (for example, Nyquil often contains a significant amount of alcohol).
Generally, cold medicine (acetaminophen, ibuprofen), allergy medicine, and cough medicine are safe to take while breastfeeding.
Additionally, it is recommended for breastfeeding mothers to use Menthol products (such as cough drops) with caution, as some women report decreased milk supply when using menthol products though there have not been any studies to confirm this. There is published literature regarding Peppermint and its use during lactation, though there is no mention regarding Peppermint’s potential effects on milk supply.
Natural Alternatives to Medications
While breastfeeding, many mothers may prefer to avoid medicine and pharmaceutical medications altogether (when possible) by utilizing natural alternatives.
Unfortunately, regulatory standards for dietary supplements, including (but not limited to) herbs, botanicals, vitamins, minerals, and enzymes, should always be purchased from a reputable source. A registered dietitian, nutritionist, or physician should direct the dose to ensure that the supplements used are potent, high quality, and at an optimal and safe dose.
Some safe and good natural remedies include honey (a natural analgesic, or a component used for sore throat), garlic (high in quercetin, a flavonoid antioxidant known for its ability to reduce histamines), and herbs, such as elderberry and echinacea, to improve immune health.
Most medications are safe in moderation, though it is always a must to consult with a primary physician or naturopath. Ibuprofen and Acetaminophen tend to be safer options than Nyquil or Gravol. Natural alternatives are available but should be used with direction from a Naturopath, Registered Dietician, or Nutritionist.
Caffeine and alcohol should be monitored while pregnant and breastfeeding. While breastfeeding, an occasional glass of wine is not harmful (though it is recommended to dilute with fruit juice or water), and drinking up to 10-ounces of coffee per day is generally regarded as safe.
If you have taken any medications and notice your child is exhibiting signs of a reaction, such as altered sleeping patterns, changes in hunger, fussiness, rash, or any other concerning symptoms, consult your baby’s primary physician immediately.
After nine months of staying away from alcohol during pregnancy, a new mother may want to have a drink. However, if she is planning on breastfeeding her child, she may want to think twice about having that drink. This is because everything a mother ingests can pass into her breastmilk and to her child.
Is It Safe?
A newborn infant eliminates alcohol from his or her bloodstream only half as quickly as adults do. The CDC does not recommend breastfeeding mothers to drink any alcohol. However, a single drink a day is safe, mainly if the mother does not feed her child right after the drink. Waiting at least two hours ensures that her body has eliminated most of the alcohol.
How Long Does Alcohol Stay in Breastmilk?
If a mother drank alcohol without food, alcohol levels are at their highest for about 30 to 60 minutes after the drink. If she drank alcohol with a meal, alcohol levels would be highest for about an hour to an hour and a half after the drink. It takes about one to two hours for a unit of alcohol to altogether leave the breastmilk supply.
However, if the mother had more than one drink, it takes longer for the alcohol to leave the breastmilk. If she had two drinks, it would take about four to five hours for the alcohol to leave her breastmilk. If she had three drinks, it might take as long as eight hours before her breastmilk is free of alcohol.
Other factors like how quickly the mother drinks alcohol and how much she weighs also play into how long the alcohol stays in her breastmilk.
Drinking and Breastfeeding
If a mother drinks more than a small amount of alcohol while breastfeeding, her infant may have problems such as impaired motor development.
When there is alcohol in breastmilk, babies often do not drink as much milk, and they may not grow as well. One study found that babies who had alcohol through breastmilk drank 20 percent less than babies who did not have any alcohol. Especially in the first three months of an infant’s life, his or her brain is still developing, and alcohol may harm the brain.
Another study found that babies who had ingested alcohol through breastmilk slept 25 percent less than those who had no alcohol. When a baby does not sleep enough, he or she may be more irritable, and he or she may have trouble learning. Over time, lack of proper sleep may lead to anxiety and depression when the child is older.
Drinking alcohol may lead to the let-down reflex being inhibited, which ultimately leads to less production of milk. When the baby sucks the nipple, breast milk comes from the glands to the breast. The hormone oxytocin is responsible for this reflex, and this hormone comes from the hypothalamus.
Alcohol can inhibit the hypothalamus, meaning that when a mother has been drinking alcohol, the let-down reflex is inhibited. This means that milk production temporarily stops. Breastfeeding women who already have trouble producing enough milk may want to consider avoiding alcohol until they have weaned their baby.
The good news is that any alcohol a baby ingests through breastmilk is likely to be a minimal amount. But while having an occasional drink while breastfeeding is unlikely to harm the baby, it may still be best not to drink as official guidelines do not recommend any drinks while breastfeeding.