Mass General Hospital

Harvard Medical School

Smoking While Breastfeeding: What Are the Risks?

Approximately 25% of American women of reproductive age smoke tobacco, and many continue to smoke during and after pregnancy despite the known potential harm to their own health and to their child’s health. These health threats remain after the child’s birth as the baby is exposed to nicotine and other toxins in both ambient air and breast milk.

Despite the fact that the amount of nicotine transferred into breast milk is more than double the quantity transferred through the placenta during pregnancy, there is strong evidence that breast milk itself provides protection: the incidence of respiratory illness among infants who were breastfed by mothers who smoked was lower when compared with babies who were formula fed. As it appears that the benefits of breastfeeding outweigh the risks of nicotine exposure, nicotine is no longer listed as a drug that is contraindicated during breastfeeding.

Women are strongly encouraged to breastfeed but the ones who smoke are more likely to have a lower milk supply, and those who do breastfeed tend to wean their babies earlier than women who don’t smoke. Studies indicate that smoking more than 10 cigarettes per day decreases milk production and alters milk composition. Furthermore, mothers who smoke are more likely to think that their milk supply is inadequate and are less motivated to breastfeed. Finally, breastfed babies whose mothers smoke more than 5 cigarettes daily exhibit behaviors (e.g. colic and crying) that may promote early weaning.

In addition, because smoking is associated with sleep disturbances in adolescents and adults, researchers have begun to look at the sleeping patterns of babies breastfed by mothers who smoke. They found that the infants of mothers who smoke just before nursing have shorter sleep times and altered sleep architecture.

While there is still little evidence to suggest that smoking mothers has significant adverse effects on their infants, the lack of evidence may be due to the insufficiency of investigation. More research needs to done to address the effects of smoking and breastfeeding not only in the acute phase but also in the long-term, analyzing the possible developmental and behavioral impairments associated with nicotine exposure. Furthermore, there is a clear need for effective smoking cessation treatments for breastfeeding women and also awareness about the consequences of smoking.

M. Pia Rogines Velo Sardi, MD PhD

Mennella JA, Yourshaw LM, Morgan LK. Breastfeeding and smoking: short-term effects on infant feeding and sleep. Pediatrics. 2007 Sep;120(3):497-502.

, , ,

23 Responses to Smoking While Breastfeeding: What Are the Risks?

  1. jane g. September 3, 2009 at 1:52 am #

    i am a smoker and just had a baby 2 months ago. i never smoked during my pregnancy and waited until she was 3 weeks old before i started smoking again. during my pregnancy i always craved the nicotine but never gave in because i was scared.im glad to read this link online because it gave me more info about my baby’s health.i do wait to nurse her 2-3 hours after i smoke and also supplement her with one bottle a day. my question is how long does the nicotine stay in our body and is waiting a couple of hours before i nurse her better than nursing her right after i smoke?

  2. mghcwmh September 4, 2009 at 1:14 pm #

    Nicotine has a short half-life (2-4 hours); it is metabolized to cotinine, which has a much longer half-life of 16-19 hours and is detectable for 4-7 days, depending upon the amount of consumption. While cotinine probably does not have the same cardiovascular and neuopharmacologic effects that nicotine carries, it has not been as well-characterized.

    While exposure to nicotine may not pose significant risk, there is ample data to indicate that exposure to secondhand smoke carries certain risks. Infants and children exposed to SHS are more like to have respiratory infections and asthmatic symptoms.

    http://www.ncbi.nlm.nih.gov/pubmed/10781876?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    http://www.lungusa.org/site/c.dvLUK9O0E/b.39857/

  3. mayra October 13, 2009 at 4:33 am #

    wow… I was a person who did smoke previously before getting pregnant. I stoped the day i found out i was… but now that i had my baby i started up again. I have about 5 cigs a day but after reading this article im definitely stopping. Even though there’s really not concrete studies i still wouldn’t risk the health of my baby for anything. I just rather avoid it then to me sorry later on in life. I also think there should be more studies done… Because there are a lot of women out there who are breastfeeding without really knowing the risk.

  4. dania ezzeldin harid March 24, 2010 at 4:34 pm #

    I smoke sometimes not every day, and I am breast feeding my baby. I want to quit this bad habit, can you help me?

  5. jessica bills October 13, 2010 at 4:29 pm #

    I smoked for 4 years before i was pregnant and stopped the second i found out i was pregnant. I feel so much better health wise and about my self i have had a few smokes since i delivered my baby but never around her. Reading this has helped me not start again as hard as it is but its not worth risking my babies health and i want to be health and alive when she grows up she deserves to have a mom.

  6. anon daddy October 20, 2011 at 9:43 pm #

    Fascinating article but it does not touch on an important subject. Smoking during pregnancy and after birth can double or triple your babies chance of dying of SIDS. Why risk it? If you really need the nicotine use the patch or gum and abstain from nursing for at least a couple hours.

    Also- there is the risk for both bottle and breast fed babies of being harmed by second and third hand smoke. For those who don’t know, third hand is what happens when you smoke. The particles from the smoke remain on the clothes and there is a lot of research that indicates this is also harmful to your baby. It is less severe than secondhand but still bad. The only way to remove the particles is to shower, wash your hair and change your clothes.

    So simply smoking outside or in another room is not enough! Get support from the La Leche League and your pharmacist who can help you find smoking cessation products ASAP.

  7. MGH Center for Women's Mental Health December 20, 2011 at 2:42 pm #

    @anon daddy, All of these are great points. Thanks for your comment.

    For those of you who would like to learn more about third-hand smoke, here is an article from the Mayo Clinic on the topic.

    http://www.mayoclinic.com/health/third-hand-smoke/AN01985

  8. SavayK Mom January 5, 2012 at 3:58 pm #

    I stopped smoking as soon as I knew I was pregnant. Almost 11 months later, I started back. I only smoke 2-3 per day. After reading some literature on smoking and breastfeeding, I have decided to stop. However, I use to produce approximately 10-12 oz of milk within 8 hrs. Since smoking, that has decreased to 8-9oz. Now that I’ve stopped smoking, how long before my milk supply is back to normal?

  9. Dincel February 22, 2012 at 4:31 am #

    wow…i was a very heavy smoker (pack-a-day) for 7 years and stopped the day i found out i was pregnant and started again when my little one was 5 weeks old. He is now 6 weeks old and having read this article whist smoking ive bud it out and ill never smoke again! I thank God for providing me with this article that i may know what i can do to my only child!

  10. jacob February 23, 2012 at 11:47 am #

    @Dincel, good for you. I am glad you heard the message you needed to take car of your body and baby. Make sure you get the support you need to maintain a non-smoking lifestyle by talking to your physician, friends and family.

  11. Brittney March 3, 2012 at 11:43 pm #

    I never smoked during my pregnancy but i do want to smoke while breast feedsing but i wont smoke more than maybe 2 cigs a day and i only take a few hits at a time…. will that effect my baby the same as if i were to smoke more??? and i also smoke shortly after feeding so it gives it time to dissolve before next feeding.. Will everything be ok??

  12. marie March 4, 2012 at 12:40 am #

    I was a social smoker before my pregnancy. Only smoking if I was having a few drinks. Obviously I stopped both of these habits while pregnant. my question is can I smoke while having a night out as long as it is the next day and I have showered before breastfeeding without causing any harm to my baby?

  13. MGH Center for Women's Mental Health March 21, 2012 at 12:02 pm #

    @marie, First of all, congratulations on being able to cut down on your smoking during your pregnancy. I think one of the most difficult it difficult things in terms of assessing the risks associated with smoking is that smoking consists of exposure to many different chemicals. Most of the studies we have discussed focus on exposure to nicotine but there are other chemicals contained within cigarette smoke that may pose certain risks to those who are exposed, including breast-feeding infants. There is much about the negative effects of smoking that we do not know. To the best my knowledge, there is no known “safe” or risk-free level of smoking.

  14. T Wayne May 15, 2012 at 8:56 am #

    I am really thankful to all your squad for sharing specified inspirational substance.

  15. essie June 14, 2012 at 2:06 am #

    Hi.
    I smoke pot 2-3 time a day.
    How bad is it for my month and 9 day old baby if am breastfeeding her???

  16. Chante Tanielu July 22, 2012 at 2:28 pm #

    I have a 3 month old son he is coughing now and then and i was just wondering if me smoking about 8 smokes a day, could it be causing his coughing and constant stuffy nose? I know its wrong too smoke but its so hard too quit? Please help !

  17. Alex August 21, 2012 at 5:06 am #

    Hello, i’m a mother of a 4 and a half month old baby girl.
    I quit smoking during pregnancy and restarted after giving birth.I’m a regular smoker, a little bit less than a pack per day.I breastfeed my daughter, and I never fed her with formula.She’s the most quiet baby I’ve ever seen.She slept through the night since she was 2 months old.She gains the proper weight and never had a health problem.

    I’m having a lot of milk supply.I never gave her anything else but my milk.

  18. JS October 1, 2012 at 12:13 am #

    @Alex,
    It’s wonderful that you are nursing and interested in learning more about the subject of tobacco use during pregnancy and lactation. However just because you have not experienced any complications thus far does not mean there will be no lasting impact.

    From my personal experience, I can attest to a lifelong problem with asthma and chronic illness. I ended up with strep throat and tonsilitis so many times I had my tonsils removed and tubes in my ears twice. Doctors confirmed that my mothers tobacco use while pregnant, lactating and also smoking in the home contributed greatly to this. Research also confirms the long term effects of tobacco use on infants.

    I know you love your child but do her a favor and cut way back if you cannot quit entirely. Don’t nurse after smoking, wait a couple hours. Change clothes after smoking and try to smoke only outside of the home. This will help a lot. Your child is worth it and it will save them a lifelong health deficit such as my own.

  19. jessy November 24, 2012 at 4:33 pm #

    Hey guys I use to smoke all the time & alwys tryed.to quit but it was so hard for me but then I found.out I.was prego then I stopped and it wasn’t even that hard my baby boy is a month and a week old today & I haven’t went back to smoking & don’t plan on it (:
    But honestly I think most of you who do still smoke you should try and stop for the health of your baby and yourself… (:

  20. e February 13, 2013 at 9:11 pm #

    Hey I’m an expecting father March 7 of a baby boy. My gf has been smoking a pack of newports for ten years and at first she said she would stop but she wont! Please help me help her!

  21. tibicheri May 19, 2014 at 11:58 am #

    @mayra October 13, 2009. I hope you meant you quit smoking and not quit breastfeeding. It is better to breastfeed, especially if you smoke. Just not sure because of your last sentence. By formula feeding your child will be at more risk because they still get all of the chemicals through the smoke and your skin but have no protection from the immune properties and nutrition in the breastmilk.

  22. Jodee June 18, 2014 at 7:20 am #

    I think each person and baby is different, I was able to quit during my 3 pregnancies but I knew I would start back after delivering. I would not smoke within an hour of breastfeeding but would smoke immediately after breastfeeding. I never had a problem producing milk and I am a pack a day smoker. Was it the healthiest thing for my babies, probably not. But all are healthy. I followed the suggestions by kellymom.com and found those to be helpful.

  23. Ashley September 4, 2014 at 5:39 pm #

    It is important to breastfeed on demand to give babies the best nutritional and comfort needs, so I wouldn’t limit this and make them wait or bottle substitute for the sake of smoking personally if at all possible.

Leave a Reply