Smoking and Breastfeeding: To Quit or Not to Quit?

How long does nicotine stay in breast milk?

Not only does nicotine get in breast milk — it can also stay there for a significant period of time. If you’re wondering how long it takes for nicotine to get out of your system, the answer is that it depends. 

There are a number of factors that can determine how long it takes for nicotine to leave your system. These include how often you smoke, your age, genetics, and what medications you’re currently taking. For light smokers who smoke once or twice a week, nicotine can take two to three days to clear from the system. For heavy smokers who smoke a pack or more a day, it may take up to a full year for nicotine to completely leave your body. 

Still, when it comes to cigarettes and breastfeeding, the time between smoking a cigarette and breastfeeding is important to consider. In fact, nicotine (and its metabolite cotinine) peaks in breast milk 30 minutes after smoking a cigarette, and nicotine’s half-life in breast milk is approximately two hours. This means it’s better to have a cigarette immediately after breastfeeding than directly before nursing if you are going to smoke.

While the passage of time helps cut down on the amount of nicotine in breast milk, a small amount is always transferred during breastfeeding if you smoke. In fact, a nursing baby will actually get more nicotine from their mother while breastfeeding than in utero because nicotine levels are higher in breast milk than in plasma. 

Nicotine is not the only chemical from cigarettes that can be found in breast milk. Formaldehyde, lead, and cyanide are also passed from cigarettes to breast milk.

Can you smoke and breastfeed? Risks for your baby

Can you smoke and breastfeed? Technically, yes — the benefits of breastfeeding do outweigh the risks of smoking. Despite this, there are a number of potential hazards that are associated with smoking.

The American Academy of Pediatrics confirms that smoking while breastfeeding is better than not breastfeeding at all. In 2001, tobacco was removed from the list of substances not to be used while breastfeeding. 

This was done in large part because breastfed babies whose mothers smoked had fewer respiratory illnesses than bottle-fed babies. Still, the list of risks associated with smoking is long: 

• Smoking while breastfeeding affects babies’ sleep and wake patterns, causing more sleep disturbances and shorter sleep cycles.
• Smoking leads to reduced iodine in breast milk and may increase the risk of iodine deficiency and hypothyroidism.
• The breastmilk of smokers contains less vitamin C and vitamin E.
• Babies breastfed by smoking mothers have a higher risk for increased body weight and developing obesity.
• Babies who are exposed to cigarette smoke are more likely to suffer from colic. This may be because the nicotine passed through the milk upsets the baby’s stomach or from secondhand smoke in the home.
• Babies of smoking mothers have higher rates of sinus infections, pneumonia, and asthma.
• Exposure to high amounts of tobacco smoke can occasionally cause nausea or diarrhea.
• Babies exposed to nicotine spend more time in a doctor’s office, often for respiratory infections.
• Babies whose parents smoke are more likely to develop Sudden Infant Death Syndrome, or SIDS.

While there are plenty of studies on the impact of nicotine exposure, little is known about the effects of other chemicals present in cigarettes, such as cyanide and lead. 

Does smoking affect breastfeeding?

Determining how long nicotine stays in your system may not be straightforward, but the answer to whether smoking affects breastfeeding is very clear. For smokers, nicotine and breastfeeding are linked, and the negative effects can be significant. 

Milk supply is a concern for many new moms, and smoking can make things harder. That’s because nicotine has been linked to reduced milk supply. This happens because chronic nicotine use affects the production of prolactin. Prolactin is the primary hormone involved in milk production, so reduced prolactin levels cause a reduced milk supply. 

In addition to milk reduction, smoking while breastfeeding has also been linked with early weaning. However, there is some research to suggest that there may be reasons other than smoking for this trend. For example, mothers who want to limit their babies’ exposure to nicotine through breast milk may make the choice to wean early. In situations like these, weaning early is a personal decision, not a side effect of nicotine. Still, there is reason to believe that early weaning may be linked to smoking because of reduced milk supply. In addition to having less milk, nicotine also affects the flow (or let-down) of milk, causing it to be slowed down or delayed.

Mothers who are considering nursing for the WHO-recommended duration of six months to two years need to consider these factors.

Can you use e-cigarettes while breastfeeding?

You can use e-cigarettes or vape while breastfeeding, but should you? Despite the reputation e-cigarettes have as a safer smoking alternative, no long-term studies have been done on the impact of using e-cigarettes or vaping while breastfeeding. For this reason, while you can use them, they do come with risks, just like cigarettes.

Because e-cigarettes are available without nicotine, they are sometimes touted as safer than cigarettes. In addition e-cigarettes, unlike cigarettes, do not emit noxious gases such as carbon monoxide (CO). Further, they do not contain tar, the glue-like substance in cigarettes known to contain most of the carcinogenic substances. Does all this mean they are safer to use when you are breastfeeding?

The problem is that no long-term studies — or any studies at all — have been done on the impact of e-cigarettes and vapes on breastfeeding. But there is plenty of research that suggests they pose some risks. Although they do not contain tar or emit carbon monoxide, they do contain other harmful substances, such as formaldehyde. Flavored versions also contain diacetyl, a chemical found in some cases to cause permanent lung damage. And of course, they still contain nicotine, although it is possible to purchase nicotine-free e-cigarettes. 

When considering e-cigarettes or vapes as an alternative to tobacco, remember that they do still contain nicotine. Also keep in mind that we don’t yet know much about how the other chemicals they contain affect breastfeeding.

Ways to quit smoking while breastfeeding

It is possible to quit smoking while breastfeeding. But if you are having trouble quitting, there are still ways to help reduce the impact of smoking on your baby. Cutting back on smoking overall and making different choices about when and where to smoke can all help minimize its negative effects. 

For example, it’s better to smoke just after breastfeeding instead of just before. Another reason to smoke right after breastfeeding is that CO levels rise significantly within an hour of smoking. However, they also continue to remain elevated for up to 24 hours. To prevent CO exposure through exhalations, avoid sleeping directly beside the baby.

When you or a family member smokes, either step outside or at least into another room. This helps reduce baby’s exposure to environmental cigarette smoke and exhaled gases like carbon monoxide. Consider having a specific jacket or shirt that you only wear when you’re smoking and take it off when you’re finished. Washing your hands after smoking and before handling the baby is also important. Doing so reduces the baby’s exposure to thirdhand smoke. 

When you want to quit smoking, nicotine patches or gum can be very helpful. These smoking cessation aids eliminate the air irritants produced by tobacco smoke. Nicotine patches or gum should be treated like cigarettes and be used right after breastfeeding. This is so nicotine blood levels can have a chance to drop before the next nursing session. If you prefer a patch, keep in mind that although they do produce a continuous level of nicotine in your system, that level is lower than the level of nicotine produced by smoking. Before going to bed, consider removing the patch so nicotine levels are lower for nighttime feedings.

The takeaway

Smoking is an addiction that can be difficult to quit. Considering the adverse effects of chemicals contained in cigarettes that are secreted into breast milk, it’s best to quit entirely or at least cut back. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recognize pregnancy and lactation as an ideal time to promote tobacco and smoking cessation.