酒精与母乳喂养（下）Drinking Alcohol and Breastfeeding

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接下来我们将继续深入探讨关于母乳喂养期间饮酒的一系列问题，涵盖诸如“一杯酒”的定义以及一些至关重要的注意事项。包括在饮用酒精饮料后是否需要泵奶并丢弃乳汁，以及在发生醉酒情况时应该如何处理。还将详细讨论酒精依赖或利用酒精进行自我治疗对母乳喂养婴儿可能产生的影响，如何在权衡风险和收益时做出明智的选择。


Next, we will continue to delve into a series of issues regarding alcohol consumption during breastfeeding, covering topics such as the definition of “one drink” and some crucial considerations. This includes whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations of intoxication. We will also discuss in detail the potential impact of alcohol dependence or using alcohol for self-treatment on infants during breastfeeding, as well as how to make informed decisions when balancing risks and benefits.


Par6


“一杯酒”是指多少？


在不同国家，一个“标准杯”的衡量标准会有差异。如果您选择了在母乳喂养期间饮酒，了解什么是“标准杯”很重要。
请查询当地的卫生部或其他相关政府资源，以获取您所在国家/地区的正确信息。
举几个例子：

欧洲

想要了解欧洲的标准杯衡量方法，请参阅欧洲标准饮酒准则 。在英国，国家医疗保健服务（NHS）建议使用以下这个酒精单位计算器：https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator

美国

在美国，国立卫生研究院（NIH）的定义如下：

一个“标准杯”的酒（或同等的酒精饮料）大约含14克纯酒精，相当于：

12盎司（约等于360ml）普通啤酒，其酒精含量通常约为5%

5盎司（约等于150ml）葡萄酒，其酒精含量通常约为12%

1.5盎司（约等于45ml）蒸馏酒，其酒精含量通常约为40%

中国（译者注）

《中国居民膳食指南2022》（https://www.cnsoc.org/notice/442220200.html）建议孕妇、乳母不应饮酒。成年人如饮酒，一天饮用的酒精量不超过15g。

15g酒精相当于

啤酒（4%计）：450ml

葡萄酒（12%计）：150ml

白酒（38%计）：50ml

高度白酒（52%计）：30ml

注册药剂师托马斯.W.黑尔博士在其《药物与母乳喂养》（第17版，2019年）一书中这样写道：      
“酒精很容易进入人乳，平均血浆/乳汁比值约为1。这并不一定意味着人乳中的酒精剂量很高，只是说血浆中的酒精含量与人乳中的酒精含量密切相关。转移到人乳中的酒精的绝对量（剂量）通常较低，并与母体血浆中的酒精水平相似。早期的研究（有些是动物试验）表明，啤酒(或更有可能是啤酒里的麦芽)可能会刺激泌乳素的分泌。有不少酒精会进入了人乳，但如果酒精的量和持续时间有限，则认为对婴儿无害。转移到人乳中的酒精的绝对量通常较低。   
酒精过量可能导致婴儿嗜睡、深度睡眠、虚弱和生长迟缓。母亲血液中的酒精含量必须达到3克/升，才会对婴儿产生明显的副作用。喷乳反射的减少显然与剂量有关，需要饮酒量达到1.5-1.9克/公斤体重才会发生。其他研究表明，中度饮酒者（每天喝2杯以上酒精饮料）的婴儿精神运动发育会落后。在饮酒期间和饮酒后 2-3 小时内应避免母乳喂养。酗酒者则应等待更长的时间。 
在一项观察酒精如何影响婴儿摄入母乳的有趣的研究中，12位母亲在接触酒精（0.3 g/kg）后4小时内，婴儿的吃奶量明显减少。随后在母亲停止饮酒后8-16小时内观察到吃奶量有代偿性的增加。
成人在3小时内大约能代谢1盎司（约等于30ml）的酒精，因此适量摄入酒精的母亲通常在神经方面感觉正常后可立即恢复母乳喂养。长期或重度饮酒者不应母乳喂养。”    

Part7


重要的注意事项  


宝宝的年龄

  • 新生儿的肝脏发育不成熟，受酒精的影响更大
  • 直到大约三个月大的时候，婴儿代谢酒精的速度约为成年人的一半
  • 年龄较大的婴儿比年幼婴儿能更快地代谢酒精，但仍然不如成人


您的体重
  • 一个人的体型会影响他们代谢酒精的速度
  • 体重较重的人比体重轻的人代谢酒精更快

酒精的量

  • 了解什么叫“一个标准杯的酒精饮料”


酒精对婴儿的影响与饮酒量直接相关

  • 饮酒越多，身体就需要越长的时间来清除酒精。

（CDC指出，“喝了1杯酒精饮料后大约2-3小时内可以在母乳中检测到酒精，喝了2杯酒精饮料后大约4-5小时内可以在母乳中检测到酒精，喝了3杯酒精饮料后大约6-8小时内可以在母乳中检测到酒精，依此类推。”）   


Part8


喝了酒精饮料后我必须吸奶并丢弃乳汁吗？  


当酒精从血液中清除后，它也同时从母乳中消失。酒精不会以固定的量存在于母乳中（当血液中的酒精含量下降时，母乳中的酒精会回到血液），因此吸奶并丢弃乳汁并不能去除酒精。吸奶并丢弃乳汁、大量喝水、休息或喝咖啡都不会加快体内酒精的清除速度。             

Part9


如果我喝醉了怎么办？  


如果您喝醉了，就不应该母乳喂养，直到您完全清醒、大部分酒精离开身体之后才能再喂奶。已经证实，喝醉酒或纵酒会影响婴儿的睡眠方式。在母亲摄入大量酒精（0.3克/公斤体重）后一小时，婴儿通过母乳接触到的酒精含量就足以对睡眠产生负面影响。

Part10


酒精依赖/使用酒精来自我治疗会影响母乳喂养的婴儿吗？  


是的。哺乳期母亲如果有酒精依赖或使用酒精来自我治疗（译者注：有些妈妈会喝酒来缓解压力、抑郁或焦虑）可能导致婴儿体重增加缓慢或生长迟缓。如前面所说，即使是少量到中等量的酒精也会对喷乳反射产生负面影响，并减少婴儿的母乳摄入量。婴儿的睡眠可能会受到严重干扰，或者可能无法有效吸吮，从而导致乳汁摄入量减少。婴儿甚至可能发生运动发育迟缓。如果您担心自己或您认识的人过量饮酒，请联系医疗保健专业人员或靠谱的专业机构组织，为那些正在与酒精使用作斗争的人提供支持。

Part11


权衡风险和获益  


生活中经常会出现需要喝酒的情况。也许您要和家人一起出门、有约会，或者您好不容易熬过了极度紧张的一周而有人提议去喝杯啤酒放松一下。无论出于什么原因，您可能会担心饮酒可能对宝宝产生的任何影响。最好权衡一下母乳喂养的好处与饮酒的好处和可能的风险。以下建议可能会对您有帮助。

未雨绸缪    

  • 如果您选择喝酒，请尽可能好好计划，尽量减少宝宝接触酒精的机会；如果可能，提前挤出一些母乳并预存起来。

  • 在饮用任何酒精饮料之前立即母乳喂养，然后等待大约三小时后再次哺乳，这样将有助于确保宝宝从母乳中喝到的酒精很少。

  • 如果您在等待酒精从你体内清除的过程中开始涨奶，可以用手挤奶或者用吸奶器吸奶，并丢弃挤出的乳汁。


其他备选方案

  • 如果您打算大量喝酒，请确保找到一个负责任的看护人来代替您照顾好宝宝。

  • 如果您真的不想去参加家庭或职场的社交活动，请与值得信赖的朋友或当地的国际母乳会哺乳辅导(获取国际母乳会哺乳辅导联系方式)讨论去参加活动的利弊。

  • 您可以坚持喝不含酒精的饮料。

  • 在其他人都在喝酒的场合中，可以给值得信赖的朋友发消息或在线联系国际母乳会哺乳辅导。

  • 如果情况允许，就寻求并接受帮助，让您从哺乳育儿中缓口气休息一下，专注做一些您喜欢做的事情。
         
Drinking Alcohol and Breastfeeding
HOW IS ONE DRINK DEFINED?

A ‘standard drink’ is measured differently in different countries. It is important to understand what a ‘standard drink’ is if you choose to drink alcohol and breastfeed.

Please check with your Ministry of Health or other pertinent government resource for appropriate information in your country.


Some examples:
▏To determine standard drink measures in Europe, please refer to Standard Drink Measures in Europe.
In the UK, the NHS suggest using this unit calculator:  https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator. 

▏In the United States, it is defined by the National Institutes of Health (NIH) this way:
In the United States, one “standard” drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:
  • 12 ounces of regular beer, which is usually about 5% alcohol
  • 5 ounces of wine, which is typically about 12% alcohol
  • 1.5 ounces of distilled spirits, which is about 40% alcohol

Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers’ Milk (17th ed., 2019):

“Alcohol transfers into human milk readily, with an average plasma/milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight. Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2–3 hours after drinking alcohol. Heavy drinkers should wait longer.

In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less. Compensatory increases in intake were then observed during the 8–16 hours after exposure when mothers refrained from drinking.

Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”

IMPORTANT CONSIDERATIONS
Your baby’s age
  • A newborn has an immature liver, and will be more affected by alcohol
  • Up until around three months of age, infants metabolize alcohol at about half the rate of adults
  • An older baby can metabolize alcohol more quickly than a young infant but still not as well as an adult

Your weight

  • A person’s size has an impact on how quickly they metabolize alcohol

  • A heavier person can metabolize alcohol more quickly than a lighter person

Amount of alcohol

  • Know what constitutes a “standard drink”


The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed

  • The more alcohol consumed, the longer it takes to clear the body. The CDC state “Alcohol from 1 drink can be detected in breast milk for about 2-3 hours, alcohol from 2 drinks can be detected for about 4-5 hours, and alcohol from 3 drinks can be detected for about 6-8 hours, and so on.”


DO I HAVE TO PUMP AND DUMP AFTER DRINKING AN ALCOHOLIC BEVERAGE?

As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as your blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.


WHAT IF I GET DRUNK?

If you are intoxicated, you should not breastfeed until you are completely sober, at which time most of the alcohol will have left your body. Drinking to the point of intoxication, or binge drinking, has been shown to impact the way infants sleep. The negative impact on sleep occurs when the infants are exposed to alcohol through milk containing alcohol at the level it would be found in human milk one hour after a mother consumed a significant amount of alcohol (0.3 grams per kilogram of their body weight).

CAN ALCOHOL DEPENDENCY/SELF-MEDICATING WITH ALCOHOL AFFECT A BREASTFED BABY?

Yes. Alcohol dependence or self-medicating with alcohol by the mother/lactating parent can result in slow weight gain or failure to thrive in their baby. As noted earlier, even a small to moderate amount of alcohol negatively affects the milk ejection reflex (let-down) and reduces the baby’s milk intake. The baby can suffer significant disruption to their sleep or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is self-medicating with alcohol excessively, contact your healthcare professional or a reputable organisation supporting people who are struggling with alcohol use.


WEIGHING THE RISKS AND BENEFITS

Often, situations in which alcohol is being offered arise. Maybe you are going out with family, or on a date, or you have had an incredibly stressful week and someone suggests a beer. No matter the reason, you may have concerns about drinking and any possible effects on your baby. It is a good idea to weigh the benefits of breastfeeding against the benefits and possible risks of consuming alcohol. You might find the following suggestions helpful.

Plan Ahead
  • If you choose to drink alcohol, plan as well as you can to reduce your baby’s exposure to alcohol; If possible, store some expressed breastmilk in advance. 
  • Breastfeeding immediately before consuming any alcoholic beverage, then waiting to nurse again for about three hours, will help ensure that your baby gets very little alcohol from you.
  • If your breasts become full while waiting for the alcohol to clear, you can hand express or pump, discarding the milk that you express. 

Alternatives
  • If you plan to drink more than a moderate amount of alcohol, ensure that your baby has a responsible alternative caregiver.
  • If you don’t really want to go to a family or work event talk to a trusted friend or with your local La Leche League Leader about the pros and cons of going. 
  • You might prefer to stick to non-alcoholic drinks.
  • Have a trusted friend or an online La Leche League group on hand to message when at an event where everyone else is drinking.
  • Whenever possible, ask for and take up offers of help that allow you to have a short break from mothering and parenting to focus on something else you enjoy doing.
参考资源References: 


1.Centers for Disease Control (CDC).https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol

2.LactMed. Retrieved 11 May 2020 from 
https://www.ncbi.nlm.nih.gov/books/NBK501469/
3.Mennella, J. A., & Garcia-Gomez, P. L. (2001). Sleep disturbances after acute exposure to alcohol in mothers’ milk. Alcohol 25(3) pp. 153-158. DOI: 10.1016/s0741-8329(01)00175-6
4.Koletzko, B., & Lehner, F. (2000). Beer and breastfeeding. 
Advances in Experimental Medicine and Biology 478 pp. 23-8. doi: 10.1007/0-306-46830-1_2. PMID: 11065057    
5.Mennella, J. A., Pepino, M. Y., & Teff, K. L. (2005). Acute alcohol consumption disrupts the hormonal milieu of lactating women. The Journal of Clinical Endocrinology & Metabolism 90(4) pp. 1979-1985. doi: 10.1210/jc.2004-1593.
6.Mennella, J. A., & Pepino, M. Y. (2008). Biphasic effects of moderate drinking on prolactin during lactation. Alcoholism: Clinical and Experimental Research 32(11) pp. 1899-1908. Doi: 10.1111/j.1530-0277.2008.00774.x.
7.Mennella, J. A., & Beauchamp, G. K. (1993). Beer, breast feeding, and folklore. Developmental Psychobiology, 26(8) pp. 459-466. doi: 10.1002/dev.420260804
8.Haastrup, M. B., Pottegård, A., & Damkier, P. (2013). Alcohol and breastfeeding. Basic & Clinical Pharmacology & Toxicology 114 pp. 168-173. doi: 10.1111/bcpt.12149 
9.Mennella, J. A. (2001). Regulation of milk intake after exposure to alcohol in mothers’ milk. Alcoholism: Clinical and Experimental Research 25(4) pp. 590-593.
10.Mennella, J. A. (1998). Short-term effects of maternal alcohol consumption on lactational performance. Alcoholism: Clinical and Experimental Research 22(7) pp 1389-1392. doi: 10.1111/j.1530-0277.1998.tb03924.x
11.Brown, R. A., Dakkak, H., & Seabrook, J. A. (2018). Is breast best? Examining the effects of alcohol and cannabis use during lactation. Journal of Neonatal-Perinatal Medicine, 11(4) pp. 345-356. Doi: 10.3233/NPM-17125.
12.Reece-Stremtan, S., Marinelli, K. A., & The Academy of Breastfeeding Medicine. (2015). ABM Clinical Protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, Revised 2015. Breastfeeding Medicine 10(3) pp. 135-141. doi: 10.1089/bfm.2015.9992     
13.Anderson, P. O. (2018). Alcohol Use During Breastfeeding. Breastfeeding Medicine 13(5) pp. 315-317. DOI: 10.1089/bfm2018.0053.
14.Nonacs, R. (2018). Alcohol and breastfeeding: What are the risks? Contemporary OBGYN Net December 2018 24-28.
15.Oei, J-L. (2019). Risky maternal alcohol consumption during lactation decreases childhood abstract reasoning at school age. Evidence-based Nursing 22(10 p. 25. doi: 10.1136/ebnurs-2018-102999.
16.Gibson, L., & Porter, M. (2018). Drinking or smoking while breastfeeding and later cognition in children. Pediatrics 142(2). doi: https://doi.org/10.1542/peds.2017-4266.
17.Gibson, L., & Porter, M. (2020). Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes 13:232. doi.org/10.1186/s13104-020-05072-8.
18.Pepino, M. Y., Steinmeyer, A. L., & Mennella, J. A. (2007). Lactational state modifies alcohol pharmacokinetics in women. Alcoholism: Clinical and Experimental Research 31(6) pp. 909-918. doi: 10.1111/j.1530-0277.2007.00387.x. 
19.Tay, R. Y., Wilson, J. McCormack, C., et al. (2017) Alcohol consumption by breastfeeding mothers: Frequence, correlates and infant outcomes. Drug and Alcohol Review 36 pp. 667-676. doi: 10.1111/dar.12473.
20.Standard Drink Measures in Europe (2015). Published by RARHA (Reducing Alcohol Related Harm). Accessed 4 Dec 2020 from http://www.rarha.eu/Resources/Deliverables/Lists/Deliverables/Attachments/14/WP5%20Background%20paper%20Standard%20drink%20measures%20HRB.pdf 
21.National Institutes of Health. What Is a Standard Drink? Accessed 4 Dec 2020 from 
https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink
22.Drugs and Lactation Database (LactMed), Alcohol, May 11 2020 https://www.ncbi.nlm.nih.gov/books/NBK501469/          
Accessed 27 October 2020
Reviewed and revised December 2020, with minor language changes March 2021.

2020年12月审阅修订，2021年3月略作语言微调。

资料来源：https://llli.org/breastfeeding-info/alcohol/




END

翻译：许悦

审稿：Lynn、Marien 

编辑：斯琦



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