Last update July 5, 2023


High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

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:


Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Tobacco is also known as

Tobacco in other languages or writings:


Tobacco belongs to this group or family:


Variable Value Unit
Oral Bioavail. 30 %
Molecular weight 162 daltons
Protein Binding 5 %
VD 2 - 3 l/Kg
Tmax 0.05 - 0.13 hours
2 (1 - 3). Cotinin.: 15 - 20 hours
M/P ratio Nicotin: 2 - 3 -
Theoretical Dose 0.01 - 0.026 mg/Kg/d
Relative Dose 7.5 - 9 %


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  2. Le Lous M, Torchin H. [Smoking and Breastfeeding - CNGOF-SFT Expert Report and Guidelines on the management for Smoking Management During Pregnancy]. Gynecol Obstet Fertil Senol. 2020 Jul - Aug;48(7-8):612-618. Abstract
  3. Gibson L, Porter M. Drinking or smoking while breastfeeding and later developmental health outcomes in children. BMC Res Notes. 2020 Apr 26;13(1):232. Abstract Full text (link to original source)
  4. UNICEF UK. Caring for your baby at night. A guide for parents. 2018 Full text (link to original source) Full text (in our servers)
  5. UNICEF. Ball H, Blair PS. (For UNICEF UK). Caring for your baby at night. Health professional´s guide. 2017 Full text (link to original source) Full text (in our servers)
  6. Baraona LK, Lovelace D, Daniels JL, McDaniel L. Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women. J Midwifery Womens Health. 2017 Abstract
  7. ABM Protocolo clínico de la ABM n.º 21: Pautas para la lactancia y el consumo de sustancias o trastorno por consumo de sustancias, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  8. ABM. Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  9. UNICEF UK. Statement on co-sleeping following publication of new NICE postnatal guidance. Infosheet. 2014 Full text (link to original source) Full text (in our servers)
  10. Baheiraei A, Shamsi A, Khaghani S, Shams S, Chamari M, Boushehri H, Khedri A. The effects of maternal passive smoking on maternal milk lipid. Acta Med Iran. 2014 Abstract
  11. Gaxiola-Robles R, Zenteno-Savín T, Labrada-Martagón V, Celis de la Rosa Ade J, Acosta Vargas B, Méndez-Rodríguez LC. Concentraciones de mercurio en leche de mujeres del noroeste de México; posible asociación a la dieta, tabaco y otros factores maternos. \ [Mercury concentration in breast milk of women from northwest Mexico; possible association with diet, tobacco and other maternal factors]. Nutr Hosp. 2013 Abstract Full text (link to original source) Full text (in our servers)
  12. Wen X, Shenassa ED, Paradis AD. Maternal smoking, breastfeeding, and risk of childhood overweight: findings from a national cohort. Matern Child Health J. 2013 Abstract
  13. Jensen RG, Koch A, Homøe P, Bjerregaard P. Tobacco smoke increases the risk of otitis media among Greenlandic Inuit children while exposure to organochlorines remain insignificant. Environ Int. 2013 Abstract
  14. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  15. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  16. UNICEF UK Baby Friendly Initiative statement on Bed-sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. None 2013 Full text (link to original source) Full text (in our servers)
  17. Carbonell-Estrany X, Fullarton JR, Gooch KL, Vo PG, Figueras-Aloy J, Lanari M, Gouyon JB, Liese JG. Effects of parental and household smoking on the risk of respiratory syncytial virus (RSV) hospitalisation in late-preterm infants and the potential impact of RSV prophylaxis. J Matern Fetal Neonatal Med. 2013 Abstract
  18. L.Landa Rivera, M.Díaz-Gómez, A.Gómez Papi, J.M.Paricio Talayero, C.Pallás Alonso, M.T.Hernández Aguilar, J.Aguayo Maldonado, J.M.Arena Ansotegui, S.Ares Segura, A.Jiménez Moya, J.J.Lasarte Velillas, J.Martín Calama, M.D.Romero Escós. El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres. Rev Pediatr Aten Primaria. 14:53-60 2012 Full text (link to original source) Full text (in our servers)
  19. Moon RY, Fu L. Sudden infant death syndrome: an update. Pediatr Rev. 2012 Abstract
  20. CLM - Comité de Lactancia Materna de la AEP. Preguntas frecuentes sobre lactancia materna. Folleto. 2012 Full text (link to original source) Full text (in our servers)
  21. Phillips JJ. Breastfeeding and maternal smoking. Pediatrics. 2012 Abstract Full text (link to original source) Full text (in our servers)
  22. Section on Breastfeeding.. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. Abstract
  23. Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr. 2012 Abstract
  24. Ferreira JD, Couto AC, Pombo-de-Oliveira MS, Koifman S; Brazilian Collaborative Study Group of Infant Acute Leukemia. Pregnancy, maternal tobacco smoking, and early age leukemia in Brazil. Front Oncol. 2012 Abstract Full text (link to original source) Full text (in our servers)
  25. Liebrechts-Akkerman G, Lao O, Liu F, van Sleuwen BE, Engelberts AC, L'hoir MP, Tiemeier HW, Kayser M. Postnatal parental smoking: an important risk factor for SIDS. Eur J Pediatr. 2011 Abstract Full text (link to original source) Full text (in our servers)
  26. Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011 Abstract Full text (link to original source) Full text (in our servers)
  27. Maritz GS, Harding R. Life-long programming implications of exposure to tobacco smoking and nicotine before and soon after birth: evidence for altered lung development. Int J Environ Res Public Health. 2011 Abstract Full text (link to original source) Full text (in our servers)
  28. Yilmaz G, Karacan C, Besler HT, Yurdakök K, Coşkun T. The urinary cotinine levels of infants and the determinants. Turk J Pediatr. 2010 Abstract Full text (link to original source) Full text (in our servers)
  29. Weiser TM, Lin M, Garikapaty V, Feyerharm RW, Bensyl DM, Zhu BP. Association of maternal smoking status with breastfeeding practices: Missouri, 2005. Pediatrics. 2009 Abstract Full text (link to original source) Full text (in our servers)
  30. Einarson A, Riordan S. Smoking in pregnancy and lactation: a review of risks and cessation strategies. Eur J Clin Pharmacol. 2009 Abstract
  31. Lucero CA, Moss DR, Davies ED, Colborn K, Barnhart WC, Bogen DL. An examination of attitudes, knowledge, and clinical practices among Pennsylvania pediatricians regarding breastfeeding and smoking. Breastfeed Med. 2009 Abstract Full text (link to original source) Full text (in our servers)
  32. Yilmaz G, Hizli S, Karacan C, Yurdakök K, Coşkun T, Dilmen U. Effect of passive smoking on growth and infection rates of breast-fed and non-breast-fed infants. Pediatr Int. 2009 Abstract
  33. Ladomenou F, Kafatos A, Galanakis E. Environmental tobacco smoke exposure as a risk factor for infections in infancy. Acta Paediatr. 2009 Abstract
  34. Yilmaz G, Isik Agras P, Hizli S, Karacan C, Besler HT, Yurdakok K, Coskun T. The effect of passive smoking and breast feeding on serum antioxidant vitamin (A, C, E) levels in infants. Acta Paediatr. 2009 Abstract
  35. Benowitz NL, Hukkanen J, Jacob P 3rd. Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol. 2009;(192):29-60. Abstract Full text (link to original source)
  36. ABM - The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine 2008 Abstract Full text (link to original source) Full text (in our servers)
  37. ABM - Comité de protocolos de la Academia médica de lactancia materna (Academy of Breastfeeding Medicine). Protocolo Clínico de la ABM #6: Lineamientos sobre la práctica de dormir al bebé junto con la madre y la lactancia materna Revisión, marzo de 2008. Breastfeeding Medicine 2008 Full text (link to original source) Full text (in our servers)
  38. Ladomenou F, Kafatos A, Galanakis E. Risk factors related to intention to breastfeed, early weaning and suboptimal duration of breastfeeding. Acta Paediatr. 2007 Abstract
  39. Chatzimichael A, Tsalkidis A, Cassimos D, Gardikis S, Tripsianis G, Deftereos S, Ktenidou-Kartali S, Tsanakas I. The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants. Minerva Pediatr. 2007 Abstract
  40. Dorea JG. Maternal smoking and infant feeding: breastfeeding is better and safer. Matern Child Health J. 2007 Abstract
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  42. Alm B, Lagercrantz H, Wennergren G. Stop SIDS--sleeping solitary supine, sucking soother, stopping smoking substitutes. Acta Paediatr. 2006 Abstract
  43. Milnerowicz H, Chmarek M. Influence of smoking on metallothionein level and other proteins binding essential metals in human milk. Acta Paediatr. 2005 Abstract
  44. Kwapuliński J, Wiechuła D, Fischer A. [The influence of smoking and passive smoking to occurrence of metals in breast milk]. Przegl Lek. 2004 Abstract
  45. Myr R. Promoting, protecting, and supporting breastfeeding in a community with a high rate of tobacco use. J Hum Lact. 2004 Abstract
  46. Dahlström A, Ebersjö C, Lundell B. Nicotine exposure in breastfed infants. Acta Paediatr. 2004 Abstract
  47. Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Birth. 2002 Abstract
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  49. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
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  51. Horta BL, Victora CG, Menezes AM, Barros FC. Environmental tobacco smoke and breastfeeding duration. Am J Epidemiol. 1997 Abstract Full text (link to original source) Full text (in our servers)
  52. Nafstad P, Jaakkola JJ, Hagen JA, Botten G, Kongerud J. Breastfeeding, maternal smoking and lower respiratory tract infections. Eur Respir J. 1996 Abstract Full text (link to original source) Full text (in our servers)
  53. Klonoff-Cohen HS, Edelstein SL, Lefkowitz ES, Srinivasan IP, Kaegi D, Chang JC, Wiley KJ. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. JAMA. 1995 Abstract
  54. Hopkinson JM, Schanler RJ, Fraley JK, Garza C. Milk production by mothers of premature infants: influence of cigarette smoking. Pediatrics. 1992 Dec;90(6):934-8. Abstract
  55. Minchin MK. Smoking and breastfeeding: an overview. J Hum Lact. 1991 Abstract
  56. Vio F, Salazar G, Infante C. Smoking during pregnancy and lactation and its effects on breast-milk volume. Am J Clin Nutr. 1991 Dec;54(6):1011-6. Abstract
  57. Woodward A, Douglas RM, Graham NM, Miles H. Acute respiratory illness in Adelaide children: breast feeding modifies the effect of passive smoking. J Epidemiol Community Health. 1990 Abstract Full text (link to original source) Full text (in our servers)
  58. Chen Y. Synergistic effect of passive smoking and artificial feeding on hospitalization for respiratory illness in early childhood. Chest. 1989 Abstract Full text (link to original source) Full text (in our servers)
  59. Labrecque M, Marcoux S, Weber JP, Fabia J, Ferron L. Feeding and urine cotinine values in babies whose mothers smoke. Pediatrics. 1989 Abstract
  60. McConnochie KM, Roghmann KJ. Breast feeding and maternal smoking as predictors of wheezing in children age 6 to 10 years. Pediatr Pulmonol. 1986 Abstract
  61. Luck W, Nau H. Nicotine and cotinine concentrations in serum and urine of infants exposed via passive smoking or milk from smoking mothers. J Pediatr. 1985 Abstract
  62. Andersen AN, Lund-Andersen C, Larsen JF, Christensen NJ, Legros JJ, Louis F, Angelo H, Molin J. Suppressed prolactin but normal neurophysin levels in cigarette smoking breast-feeding women. Clin Endocrinol (Oxf). 1982 Oct;17(4):363-8. Abstract

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