Tobacco

Nicotine is a stimulant alkaloid from the tobacco plant. It is also used to alleviate nicotine withdrawal syndrome and as an aid to smoking cessation. Smoked, inhaled nasal, oral and transdermal administration.

Nicotine is excreted in breast milk in a moderate amount (RD: 5 - 10%) that could be significant. ^{(Ilett 2003)}

Plasma cotinine levels in infants born to mothers using nicotine patches for smoking cessation were 13% of maternal plasma levels. No developmental problems were observed in these infants. ^{(Ilett 2003)}

The milk of smoking mothers contains higher levels of Nicotine, Cotinine, Cadmium, Mercury, Lead and other heavy metals, and lower amount of proteins, Vitamin A, C and E and other antioxidants. ^{(Gaxiola 2013, Yilmaz 2009, Milnerowicz 2005, Dahlström 2004, Kwapuliński 2004, Mascola 1998, Labrecque 1989, Luck 1985)}

Urinary cotinine levels are elevated in infants of smoking mothers ^{(Yilmaz 2010)}. There is a higher risk of future obesity ^{(Wen 2013)} and lower stature among breastfed siblings of smoking mothers ^{(Yilmaz 2009, Berlanga 2002)}. Heavy smoking during pregnancy and / or breastfeeding was associated with an increased risk of childhood leukemia. ^{(Ferreira 2012)}

No relationship has been found between maternal tobacco use during lactation and psychomotor development at 10-11 years ^{(Gibson 2020)}.

Smoking may decrease milk production and induce alteration of lipid pattern of human milk. ^{(Baheiraei 2014, Hopkinson 1992, Vio 1991, Andersen 1982)}

Mother’s tobacco addiction, per se or by associated psychosocial factors, increases the risk of not initiating breastfeeding or early weaning. ^{(ABM 2015, Brownell 2012, Weiser 2009, Ladomenou 2007, Amir 2002, Moretti 2000, Horta 1997)}

Smoking cessation is associated with increased initiation and duration of breastfeeding. The risk of smoking relapse decreased with longer duration of breastfeeding; 12 months of breastfeeding prevent relapse in smoking. ^{(Issany 2022)}

A major health problem among infants who have been raised into a tobacco polluted environment is that they are more prone to suffer of respiratory tract infections (even bronchiolitis due to respiratory syncytial virus-RSV), asthma and more frequent hospital admissions for this reason ^{(Carbonell 2013, Jensen 2013, Yilmaz 2009, Ladomenou 2009, Einarson 2009, Chatzimichael 2007, Woodward 1990, McConnochie 1986)}. The risk for Sudden Infant Death is also increased ^{(ABM 2015, Sachs 2013, Moon 2012, Liebrechts 2011, Klonoff 1995)}.  All these risks are due not because of Nicotine excreted into the mother’s milk but because of the inhalation of smoke particles originated from combustion of tobacco, which are suspended in the air. ^{(ABM 2015, AAP 2012, CLM 2012)} 

Although tobacco should be discouraged in general and more during breastfeeding, smoking is not an absolute contraindication to breastfeeding ^{(Rowe 2013, AAP 2012, CLM 2012)}: all these risks described increases if in addition to mother smoking, the infant is formula fed. The latter is a reason to support breastfeeding among mothers who are not able to stop smoking since it is more effective whether the mother decreases smoking and avoids doing so inside the house. Most important, however, is that the mother would continue breastfeeding the baby. ^{(Phillips 2012, CLM 2012, Dorea 2007, Myr 2004, Nafstad 1996, Minchin 1991, Woodward 1990)}

Nicotine excretion into milk is decreased if the mother feeds the infant 2 or more hours after smoking. ^{(CLM 2012)}

Health promotion campaigns against tobacco addiction should be focused more on the families where the infants were artificially fed ^{(Chen 1989)}. Breastfeeding should be regarded as a unique opportunity to enhance good health practices as to quitting from an unhealthy habit as smoking which is harmful for mother’s health and other next people. Nicotine replacement therapy (gum, lozenges, or patches) may be a good option if the nursing mother cannot stop smoking without pharmacological help. ^{(Le Lous 2020, Baraona 2017, ABM 2015, Rowe 2013, Sachs 2013, Einarson 2009, Myr 2004, Ilett 2003)}. Some authors are against. ^{(Maritz 2011, Alm 2006)}

Bed-sharing is not recommended for mothers who smoke. ^{(UNICEF 2018, 2014 & 2006, Ball 2017, Landa 2012, ABM 2008, Myr 2004)}

See below the information of these related products:

• Electronic cigarette, E-Cigarette, Vape, Vaping (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
• Nicotine Replacement Therapy (NRT) (Safe substance and/or breastfeeding is the best option.)