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

点击上方国际母乳会LLL 设为星标，获取哺乳信息

°睡眠障碍，包括睡眠时间缩短，更频繁醒来，以及在饮酒后3小时内总的浅睡眠时间和快眼动睡眠时间减少

°哭吵增加

°惊跳增加

°觉醒增加

°暴露于酒精后3.5小时至24小时内，快眼动睡眠增加

°婴儿的乳汁摄入量减少

°生长迟缓

°免疫功能受损

°运动发育落后

°认知发育可能受损

°学龄期(6-7岁)抽象推理能力下降

母乳喂养医学会临床指南#21指出，在哺乳期饮酒会产生一些负面影响，程度从轻微到严重不等。这取决于母亲的饮酒量，以及与身体处理酒精的速度相关的其他因素。

酒精能完全溶于水和脂肪，因此很容易进入血液和乳汁。喝了一杯标准杯酒之后，母乳中的酒精含量约为母亲血液中酒精含量的 95%。

另一篇由Nonacs撰写的综述显示，经常从母乳中接触酒精的婴儿，运动发育会更差或落后。婴儿通过母乳摄入的酒精越多，婴儿在运动发育指标上的得分就越低。因为婴儿不能像成人那样快速地代谢酒精；新生儿代谢酒精的速度甚至仅为成人的25%-50%。

基于动物研究中的发现，人们担心酒精也会对婴儿发育中的大脑产生负面影响。Oei指出，“可靠的来自动物研究的数据”表明“酒精可能对发育中的大脑有毒性，特别是在大脑快速发育的时期”，比如在出生后的第一年。婴儿饮酒也可能导致记忆力和抑制反应的损害。

尽管研究仍在继续，但Haastrup，Pottegård和Damkier表示，“母乳中的酒精可能产生的长期影响仍然未知”。

Part4

在决定是否以及何时饮酒时，我还要考虑哪些其他影响？

根据您的饮酒量，除了影响乳汁分泌和喷乳反射之外，您可能发现饮酒对您自身也会产生一定程度的其他影响。

酒精会产生镇静作用以及一些兴奋作用。有证据表明，哺乳期妈妈可能比非哺乳者更快代谢酒精。有明确的证据表明，喝酒时吃点东西也会降低饮酒后血液里的酒精含量。空腹饮酒会增加酒精对泌乳素和催产素以及身体的影响。如果您经常喝酒，就不要和宝宝一起睡觉，因为您的反应能力会大大下降。

关于母婴同床和酒精的信息，请查阅以下资讯：如何保证母乳宝宝在睡眠中的安全？Safer Sleep & the Breastfed Baby

酒精可能会通过干扰喷乳反射，进一步减少您的奶量：没有喷乳反射，您的宝宝就无法有效地吃奶并排空乳房。当乳汁滞留在乳房中时，它会“通知”您的身体减少产奶量。

Part5

在给宝宝喂奶期间，我可以偶尔喝点酒吗？

以下资讯提供了在母乳喂养期间饮酒时需要考虑的安全建议。

请注意，新生儿不能很好地代谢酒精；尽可能至少在宝宝8周龄大之前避免饮酒。

■如果可能的话，在喝任何酒精饮料之前立即母乳喂养宝宝，或者吸出并保存乳汁。

■酒精摄入量不要超过两杯葡萄酒（共8盎司，约相当于240ml）或一两杯啤酒，最好不要超过一杯。

■喝了一标准杯酒精饮料后，至少等2小时后再给宝宝喂奶。

■请注意，您喝得越多，清除酒精所需的时间就越长。

■如果您的宝宝等不及两个多小时就需要喂奶，请用您之前挤出的乳汁喂养宝宝。

■饮酒时喝点果汁。

■饮酒时吃点东西——它会减慢酒精进入血液的速度。

■仅在涨奶不舒服时才“吸奶并丢弃”。只要您的血液里有酒精，您的乳汁里就会含有酒精。

在接下来的文章中，我们将继续给大家带来关于酒精在母乳喂养中的一系列问题。

包括“一杯酒“是指多少？以及一些重要的注意事项，包括喝了酒精饮料后是否必须吸奶并丢弃乳汁，以及如果发生醉酒情况应该如何处理。我们还会深入讨论酒精依赖或使用酒精进行自我治疗是否会对母乳喂养的婴儿产生影响。最后，我们将探讨如何在权衡风险和获益之间做出明智的选择。

这些内容旨在为您提供关于母乳喂养和酒精相关问题的全面信息，帮助您做出正确的决策。

尽请期待

Drinking Alcohol and Breastfeeding

Can I drink alcohol and breastfeed? No harmful effects to babies have been from drinking no more than one drink a day. Our evidence-based article on Drinking Alcohol and Breastfeeding answers many questions you may have.

●Overview

●Can Drinking an Alcoholic Beverage Help Me Relax and Stimulate Milk Production?

●What are the Risks To My Baby?

●What Other Effects Should I Consider When Deciding Whether and When To Drink?

●Can I Nurse My Baby and Still Drink Occasionally?

●How Is One Drink Defined?

●Important Considerations

●Do I Have To Pump And Dump After Drinking an Alcoholic Beverage?

●What if I Get Drunk

●Can Alcohol Dependency/Self-medicating With Alcohol Affect A Breastfed Baby?

●Weighing The Risks And Benefits

●References

●Further resources

Overview

Breastfeeding mothers and lactating parents often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While warnings are often given not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding have not received as much research attention. A number of studies have focused on the effects of alcohol on lactation and the infant, but long-term outcomes are still unknown.

Especially when it is consumed in large amounts, alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant. There is also the possibility of decreased milk-ejection reflex in the mother. No harmful effects to babies have been found when breastfeeding mothers drink no more than one drink a day.

Depending on how much alcohol you consume before you nurse your baby, they may experience a number of effects from the alcohol in your milk. Even a small to moderate amount of alcohol may impair milk production and the milk ejection reflex. Some of the negative effects in the baby may be:

Sleep disturbances
Increased crying
Increased startling
Increased arousal
Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
Decreased milk intake by baby
Decreased weight gain

Potentially, depending on how much you drink and when you nurse your baby after drinking, there may be other, more severe effects on your baby as well. As a result, the guidance on drinking and nursing is changing. According to the CDC, “moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men”. We go into more detail below.

In brief, LactMed®, a database that contains information on drugs and other chemicals to which those who are breastfeeding may be exposed, offers the following information:

“Breastmilk alcohol levels closely parallel blood alcohol levels. The highest alcohol levels in milk occur 30 to 60 minutes after an alcoholic beverage, but food delays the time of peak milk alcohol levels. Nursing after 1 or 2 drinks (including beer) can decrease the infant’s milk intake by 20 to 23% and cause infant agitation and poor sleep patterns. Nursing or pumping within 1 hour before ingesting alcohol may slightly reduce the subsequent amounts of alcohol in breastmilk.”

Infants exposed to a significant amount of alcohol (0.3 g/kg parent’s body weight) through drinking human milk, spend significantly less time in both active and total sleep. REM sleep is also disrupted. As infants are less able to process alcohol than adults due to their immature systems, some researchers believe that the dosage they receive through their mother’s/lactating parent’s milk may be stronger than it would be in an adult. In research conducted by Mennella and Garcia-Gomez, when an infant’s exposure occurred within 3.5 hours of a mother consuming a significant amount of alcohol, the effects were stronger. In the following 24-hour period, sleep patterns continued to be disrupted as the infant makes up for the earlier disruption. In addition, the research showed that during times when the infants were awake, they were less active.

Here are some common questions people ask with recommendations supported by the evidence available. Below, we will answer these questions and look at the possible impacts of drinking alcohol while breastfeeding in more detail. We will end with some tips for increasing safety if you want to drink alcohol while breastfeeding/chestfeeding/nursing (see How Can I Nurse My Baby and Still Drink Occasionally?). Pumping and dumping will not remove the alcohol from your bloodstream, so it will not affect the alcohol level in your milk.

Can drinking an alcoholic beverage help me relax and stimulate milk production?

Along-standing “old wives’ tale” regarding consumption of alcohol, particularly beer, while breastfeeding, is that it can help boost milk production. While a barley component in beer–not the alcohol–does boost prolactin production, alcohol alone does so as well. However, in one study, milk production was actually decreased. In addition, in their research on alcohol consumption in lactating women (www.ncbi.nlm.nih.gov/pmc/articles/PMC1351273/)Menellaetal found alcohol also inhibits the milk ejection reflex and thus reduces the baby’s milk intake.

The research shows that nursing infants actually consumed less milk in the three-to-four-hour period after mothers consumed a small to moderate amount of alcohol. When a mother/lactating parent drinks alcohol and then breastfeeds their baby, their perception is that the baby nurses normally and for a normal time, so they do not realize that their baby is not getting as much milk. According to Menella, who conducted this research on this over a period of years, “infants consumed approximately 20% less breast milk”. This was the case even though the infants nursed a “similar number of times during the first 4 hr after exposure to alcohol in mothers’ milk” compared with nursing infants not exposed to alcohol in their mother’s milk. Similarly, additional research conducted by Mennella and Beauchamp showed that infants consumed about 23% less milk. Mennella also found that when pumping milk two hours after drinking alcohol, mothers obtained significantly less milk.

Current evidence shows that, rather than producing more milk for your baby by drinking alcohol, the effects of alcohol on your body actually mean your baby will get less of your valuable milk. Why is this?

Mennella, Pepino, and Teff found that alcohol significantly reduces oxytocin levels while also increasing prolactin levels. Both hormones influence the milk ejection reflex. The lower the level of oxytocin, the longer the delay in ejection of milk. The higher the level of prolactin, the longer the delay. The combination of alcohol’s effect on the two hormones leads to a significant delay in milk ejection.

What are the risks to my baby?

Depending on the amount of alcohol consumed by the mother/lactating parent, and depending on when the baby is breastfed after alcohol consumption, various researchers have found the most common negative outcomes for the baby to be:

Sleep disturbances, including shorter sleep periods, more frequent wakefulness, and less total active and REM sleep in the three-hour-period after consuming alcohol
Increased crying
Increased startling
Increased arousal
Increased REM sleep in the period from 3.5 hours to 24 hours after exposure to alcohol
Decreased milk intake by the baby
Growth retardation
Impaired immune function
Delay of motor development
Potential impairment of cognitive development
Reduction in ability for abstract reasoning at school age (6-7 years)

The Academy of Breastfeeding Medicine state in Clinical Protocol #21 that consuming alcohol during lactation has several negative effects ranging from mild to severe. This is dependent on the amount of alcohol the mother/lactating parent has consumed and other factors related to how quickly their body processes alcohol.

As alcohol is completely water- and fat-soluble, it enters the bloodstream and human milk very easily. The amount of alcohol in human milk after consumption of one standard drink is about 95% that of the amount of alcohol in the mother/lactating parent’s bloodstream.

Another review, conducted by Nonacs, showed that motor development of infants who were exposed to alcohol in human milk regularly was decreased or delayed. The more alcohol the infants consumed through breast milk, the lower the infants scored on indices of motor development. Infants cannot metabolize alcohol as quickly as adults can; newborns can only metabolize alcohol at 25% to 50% of the rate at which adults can.

Concerns about negative effects on the infant’s developing brain are based on animal research. Oei notes that “robust animal data” indicate that “alcohol may be toxic to the developing brain, especially during periods of rapid brain development” such as occur in the first year after birth. Impairments to memory and inhibitory responses may also occur as a result of an infant’s consumption of alcohol.

Though research continues, Haastrup, Pottegård, and Damkier stated that “the possible long-term effects of alcohol in mother’s milk are unknown”.

What other effects should I consider when deciding whether and when to drink？

Depending on how much you drink, in addition to the effects on your milk production and ejection reflex, you can expect some degree of other effects on yourself.

Alcohol produces sedative effects as well as some stimulant effects. There is some evidence that suggests that people who are currently lactating may metabolize alcohol more quickly than non-lactating people. There is clear evidence that eating food while consuming alcohol also reduces blood alcohol levels after consumption. Drinking alcohol on an empty stomach increases the effects of alcohol on prolactin and oxytocin as well as on your body. You should not sleep with your baby if you have been drinking alcohol, as your natural reflexes have been impaired.

Information about bed-sharing and alcohol here:Safer Sleep & the Breastfed Baby

By interfering with your milk ejection reflex, alcohol may further reduce your milk production: without this reflex, your baby cannot nurse and empty the breast effectively. When milk stays in the breasts, it tells your body to reduce production.

Can I nurse my baby and still drink occasionally ?

Several sources offer safety suggestions to consider when breastfeeding and drinking alcohol.

Be aware that newborns cannot metabolize alcohol well; if possible avoid drinking alcohol until your baby is at least 8 weeks old or older.
Breastfeed your baby immediately before drinking any alcoholic beverage, if possible, or pump and save your milk.
Limit your alcohol intake to one (preferably) or two glasses of wine (8 ounces total) or one or two beers.
Wait at least 2 hours after drinking one standard drink before breastfeeding your baby.
Be aware that the more you drink, the longer it takes for the alcohol to clear your system.If your baby needs to be nursed before two hours or more is up, use your previously expressed milk to feed your baby.
Drink juice when drinking alcohol.
Eat food when drinking alcohol–it will slow the rate at which alcohol enters your bloodstream.
“Pump and dump” only if needed for comfort. As long as there is alcohol in your bloodstream, there will be alcohol in your milk.

In the upcoming article, we will continue to provide you with a series of questions regarding alcohol consumption during breastfeeding.

This includes addressing the question, “What does one drink mean?” We will also cover important considerations, such as whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations where intoxication occurs. Additionally, we will delve into the impact of alcohol dependence or using alcohol as a form of self-treatment on infants during breastfeeding. Finally, we will explore how to make informed decisions by balancing risks and benefits.

These contents are designed to offer you comprehensive information on breastfeeding and alcohol-related concerns, aiding you in making well-informed decisions.

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/