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CORK Bibliography: Breast Feeding

45 citations. 2003 to present

Prepared: June 2009

Abdel-Latif ME; Pinner J; Clews S; Cooke F; Lui K; Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 117(6): E1163-E1169, 2006. (30 refs.)

OBJECTIVE. The purpose of this research was to assess the effects of breast milk on the severity and outcome of neonatal abstinence syndrome. METHODS. We conducted a retrospective chart review of 190 drug-dependent mother and infant pairs. Patients were categorized according to the predominant type of milk consumed by the infant on the fifth day of life (breast milk: n = 85 or formula: n = 105). The Finnegan's scoring system was used to monitor withdrawal, and medication was commenced if there were 2 scores of >= 8. RESULTS. Mean Finnegan scores were significantly lower in the breast milk group during the first 9 days of life even after stratifying for prematurity and exposure to polydrug and methadone. Significantly fewer infants required withdrawal treatment in the breast milk group. The median time to withdrawal occurred considerably later in breast milk group. In a multivariate analysis controlled for exposure to drugs of high risk of neonatal abstinence syndrome, polydrug, and prematurity, breast milk group was associated with lower need for neonatal abstinence syndrome treatment. CONCLUSIONS. Breast milk intake is associated with reduced neonatal abstinence syndrome severity, delayed onset of neonatal abstinence syndrome, and decreased need for pharmacologic treatment, regardless of the gestation and the type of drug exposure.

Alm B; Lagercrantz H; Wennergren G. Stop SIDS: Sleeping solitary supine, sucking soother, stopping smoking substitutes. Acta Paediatrica 95(3): 260-262, 2006. (23 refs.)

The recognition of prone sleeping and maternal smoking as modifiable risk factors for sudden infant death syndrome (SIDS), has drastically decreased SIDS incidence. However, during the last years other factors have become necessary to consider to further reduce the risk of SIDS. Side sleeping implies a greater risk than supine sleeping but is still common. Bed sharing may increase the risk of SIDS, while use of a pacifier seems to be protective. Replacement of maternal smoking with nicotine substitutes is not harmless. Conclusion: To further reduce the risk of SIDS, exclusive supine sleeping should be encouraged and side sleeping discouraged. When the breast-feeding is established, a pacifier can very well be used at bedtime. Bed sharing can increase the risk of SIDS if the infant is below 2-3 months of age, especially if the mother is a smoker. Any nicotine use should be avoided during pregnancy and breast-feeding.

Alvik A; Haldorsen T; Lindemann R. Alcohol consumption, smoking and breastfeeding in the first six months after delivery. Acta Paediatrica 95(6): 686-693, 2006. (31 refs.)

Aim: To study alcohol use and smoking after delivery, and to relate this to breastfeeding. Methods: A longitudinal questionnaire study, representative of pregnant women in Oslo. Ninety-two per cent agreed to join the study. Non-Norwegian speaking and/or immigrants from non-western countries were not invited. Questionnaires were answered at 17 (T1) and 30 (T2) wk of pregnancy, and 6 mo after term (T3). They were completed by 93% (1749 women) at T1, 82% at T2, and 92% at T3. Results: Six months after delivery, 80% reported alcohol use. The mean alcohol consumption per week was less than half compared to the last 6 mo before pregnancy. The women with the highest pre-pregnancy use reduced the most. Binge drinking (>= 5 drinks) was also reported by half as many women (29%). However, 6% reported 12 or more drinks per occasion at least once. No demographic or mental health variables predicted binge drinking after pregnancy. Smoking 6 mo after pregnancy was reported by 18%, a reduction of 50% from before pregnancy. Women breastfeeding for at least 6 mo had higher education, less frequently reported binge drinking after delivery and less frequently suffered postnatal depression. Conclusion: In this population-based sample were 86% breastfed for at least 6 mo, the level of binge drinking is concerning.

Backstrand JR; Goodman AH; Allen LH; Pelto GH. Pulque intake during pregnancy and lactation in rural Mexico: Alcohol and child growth from 1 to 57 months. European Journal of Clinical Nutrition 58(12): 1626-1634, 2004. (29 refs.)

Objective: To examine maternal intake of a mildly alcoholic beverage (pulque) during pregnancy and lactation, and its potential effect on postpartum child growth and attained size. Design: A prospective cohort study that followed mothers (during pregnancy and lactation) and their offspring (from birth to approximately 57 months of age). Setting: Six villages in rural, central Mexico. Subjects: Subjects are 58 mother - child pairs. Pulque intake was measured as part of a dietary assessment that was conducted for 2days/month during pregnancy and early lactation. Results: Most mothers consumed pulque during pregnancy (69.0%) and lactation (72.4%). Among pulque drinkers, the average ethanol intake was 125.1 g/week during pregnancy and 113.8 g/week during lactation. Greater pulque intake during lactation, independent of intake during pregnancy, was associated with slower weight and linear growth from 1 to 57 months, and smaller attained size at 57 months. Low-to-moderate pulque intake during pregnancy, in comparison to either nonconsumption or heavy intake, was also associated with greater stature at 57 months. Conclusions: Pulque intake during lactation may have adversely influenced postnatal growth in this population. Public health interventions are urgently needed in Mexico to reduce heavy intake of pulque by pregnant and lactating women, and to replace intake with foods that provide the vitamins and minerals present in the traditional alcoholic beverage.

Bajanowski T; Brinkmann B; Mitchell EA; Vennemann MM; Leukel HW; Larsch KP et al. Nicotine and cotinine in infants dying from sudden infant death syndrome. International Journal of Legal Medicine 122(1): 23-28, 2008. (31 refs.)

The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p=0.008). Furthermore, there was a weak but statistically significant relationship between NCH's and the daily cigarette consumption of the mother during pregnancy (n=64, r=0.24, p=0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant's hair. CCP's were strongly correlated with CCL's (r=0.62, p=0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.

Bartu A; Dusci LJ; Ilett KF. Transfer of methylamphetamine and amphetamine into breast milk following recreational use of methylamphetamine. British Journal of Clinical Pharmacology 67(4): 455-459, 2009. (14 refs.)

What is already known aout this subject? The extent of drug transfer into milk during recreational intravenous use of methylamphetamine has not previously been studied. What this study adds. We have shown that methylamphetamine transfers into breast milk. center dot The amount a breastfed infant would receive varied over 2.5-fold range. A 48-h withholding period for breastfeeding is recommended following recreational use. To investigate the transfer of amphetamines into breast milk following their recreational use and estimate drug exposure for the breastfed infant. Two breastfeeding mothers who were occasional recreational users of intravenous amphetamines were studied. A urine sample was collected 4 h after dose, and milk samples were collected over 24 h. Drug in urine was qualitatively identified by gas chromatography-mass spectrometry and quantification in milk was by high-performance liquid chromatography. Absolute infant dose via milk was estimated. The urines contained predominantly methylamphetamine together with smaller amounts of amphetamine. In the 24 h after dose, average concentrations in milk were 111 mu g l(-1) and 281 mu g l(-1) for methylamphetamine and 4 mu g l(-1) and 15 mu g l(-1) for amphetamine in cases 1 and 2, respectively. Absolute infant doses for methylamphetamine plus amphetamine (as methylamphetamine equivalents) were 17.5 mu g kg(-1) day(-1) and 44.7 mu g kg(-1) day(-1), respectively, for cases 1 and 2. These limited data suggest that breastfeeding should be withheld for 48 h after recreational amphetamine use.

Bartu A; Sharp J; Ludlow J; Doherty DA. Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trial. Australian & New Zealand Journal of Obstetrics & Gynaecology 46(5): 419-426, 2006. (15 refs.)

Background: Postnatal home-visiting programs for illicit drug-using mothers have reported some success in reducing harms in some areas but there is a lack of data on their impact on breastfeeding and immunisation rates. Aims: To investigate the effect on breastfeeding, immunisation and parental drug use. The hypothesis was that the outcomes of the home-visiting group (HVG) would be superior to the control group (CG). Method: One hundred and fifty-two illicit drug-using women were recruited at 35-40 weeks gestation from King Edward Memorial Hospitalital, Perth, Western Australia and randomised after delivery to the HVG or the CG. The HVG had eight home visits; the CG had telephone contact at two months and a home visit at six months. The HVG received education and support for parenting, breastfeeding and child development. This was not provided by the research midwives for the CG. Results: The main drugs were heroin, amphetamines, cannabis and benzodiazepines. Immunisation rates were similar for each group. Median duration of breastfeeding for the HVG was eight weeks (95% CI, 3.8-12.2); for the CG ten weeks (95% CI, 7.3-12.7). Drug use was reduced during pregnancy but increased by six months post-partum in both groups. The retention rates were: HVG 93%; CG 86%. Conclusion: The hypothesis for this study was not supported. Long-term studies are urgently required to assess the effects of parental drug use on infant and child development.

Bogen DL; Perel J; Hanusa BH; Helsel J; Wisner KL. R- and S-Methadone levels in breast milk. (meeting abstract). Journal of Women's Health & Gender-based Medicine 16(8): 1104-1104, 2007. (0 refs.)

Canivet CA; Ostergren PO; Jakobsson IL; Dejin-Karlsson E; Hagander BM. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scandinavian Journal of Public Health 36(3): 284-291, 2008. (30 refs.)

Background: Many parents seek help from health professionals because of their infants' persistent crying in the early months. The aetiology of this condition, often labelled "infantile colic", is still unclear. Aims: To assess whether smoking during pregnancy, and/or smoking at infant age 5 weeks, is associated with infantile colic, and to describe how feeding at infant age 5 weeks and smoking are related to colic. Methods: This was a community-based study, with telephone interviews in late pregnancy, and at infant age 5 weeks, covering 1,625 mother-infant dyads, i.e. 86% of the eligible population. Results: Daily maternal smoking in pregnancy was related to subsequent colic, with an age-adjusted odds ratio (OR) of 1.74 (95% confidence interval 1.08-2.82). In the multivariate model, the OR was largely unaltered. The association between smoking at infant age 5 weeks and colic did not reach statistical significance. The subgroups based on smoking and infant feeding were small, but the results suggest that exclusive breast-feeding was protective against colic, including for infants of smoking mothers. Conclusions: This study presents yet another argument why smoking in pregnancy should be discouraged - some cases of infantile colic may be avoided. With regard to mothers who are not able to give up smoking, the results add some support for the conclusion that if a mother is worried about colic, she certainly should not refrain from breast-feeding even if she smokes.

Chan CF; Page-Sharp M; Kristensen JH; O'Neil G; Ilett KF. Transfer of naltrexone and its metabolite 6,beta-naltrexol into human milk. Journal of Human Lactation 20(3): 322-326, 2004. (16 refs.)

The excretion of naltrexone and its primary metabolite 6,beta-naltrexol in breast milk from a 30-year-old lactating opiate addict undergoing oral naltrexone pharmacotherapy (5 mg/d) was studied. Concentrations of naltrexone and 6,beta-naltrexol in serial milk and plasma samples taken over a 19.3-hour period of a dose interval at steady state were measured by gas chromatography. The calculated infant dose relative to the maternal weight was 0.03% for naltrexone and 0.83% (as naltrexone equivalents) for 6,beta-naltrexol. Total relative infant dose estimated for the complete 24-hour dose interval was 1.06%. Her 6-week-old breastfed infant was healthy, achieving expected milestones, and showed no adverse effects. Only 6,beta-naltrexol was detected in infant plasma and at a very low concentration of 1.1 mug/L. Use of naltrexone during breastfeeding should be undertaken only after an individual risk-benefit analysis.

Chien YC; Huang YJ; Hsu CS; Chao JCJ; Liu JF. Maternal lactation characteristics after consumption of an alcoholic soup during the postpartum 'doing-the-month' ritual. Public Health Nutrition 12(3): 382-388, 2009. (53 refs.)

Objective: The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and die lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum 'doing-the-month' ritual. Design: Twenty-three lactating mothers were examined. informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0.3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured. Results: Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the Soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, P-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant. Conclusion: Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.

Chien YC; Liu JF; Huang YJ; Hsu CS; Chao JCJ. Alcohol levels in Chinese lactating mothers after consumption of alcoholic diet during postpartum "doing-the-month" ritual. Alcohol 37(3): 143-150, 2005. (54 refs.)

This study examined the effects of exposure to ethanol through cultural practices by lactating mothers. Specifically, the pharmacokinetics of alcohol in Chinese lactating mothers was investigated after they consumed chicken soup flavored with sesame oil and rice wine (CSSR), a typically prescribed diet during the postpartum "doing-the-month" period. Experimental findings were employed to estimate the potential ethanol dose to neonates and determine associated health risks. Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. The target alcohol dosage was 0.3 g/kg. Milk and blood samples were collected at fixed time intervals from each subject following exposure to CSSR, and alcohol levels were determined. Acute health risks to infants were estimated by comparing the potential infant dosage to an established criterion dose. Blood alcohol level peaked at 20 min after exposure to CSSR and decreased almost linearly thereafter. Alcohol in milk reached a plateau roughly at 20-40 min after exposure to CSSR and then decreased. Alcohol pharmacokinetics among subjects varied widely. The coefficients of variation in subject alcohol concentrations were 16.5-46.2% (mean, 30.0%) for blood and 32.8-57.6% (mean, 44.4%) for milk. Mean maximal alcohol concentration in blood (30.2 +/- 5.0 mg/dl) was achieved at 23.5 +/- 7.6 min and in milk (31.6 +/- 10.3 mg/dl) at 31.7 +/- 12.7 min. Potential infant doses were 3.0-58.8 mg (mean, 13.4 mg), and the predicted time required for milk alcohol level to return to zero level was 175 min. The acute health risks for infants exposed to alcohol through their mothers' milk under the current exposure scenario are low (hazard index < 0.2). Nursing infants at least 3 hr. after ingesting a diet containing alcohol would further reduce potential health risks.

Chou SY; Hsu HH; Kuo HH; Kuo HW. Association between exposure to environmental tobacco smoke (ETS) and breastfeeding behaviour. Acta Paediatrica 97(1): 76-80, 2008. (25 refs.)

Aim: A cross-sectional study was conducted to investigate the association between breastfeeding behaviour and exposure to environmental tobacco smoke (ETS). Method: Questionnaires were collected from 552 women. Blood and urine specimens were taken from part of the population at the time of delivery. The study population was classified into two groups: those exposed to ETS and those unexposed, based on self-reports from the subjects involved in the study. Cotinine levels in the urine and blood specimens were analysed by HPLC-UV under strict quality control procedures. Results: There was a significant negative association between the exposure to ETS at home or in the workplace and the prevalence of breastfeeding in each of the 6 months following delivery using multiple logistic regression adjusted for other covariates. The cotinine levels in the urine and blood were dose-dependent, but not significantly so. However, women with lower cotinine levels had a higher probability of breastfeeding than those with higher levels. Conclusion: Women who are exposed to ETS have a low likelihood of breastfeeding. It is necessary for the government to regulate ETS in public areas and confined spaces in order to reduce the levels of ETS that women are exposed to.

Clarke CA; Purdie DM; Glaser SL. Population attributable risk of breast cancer in white women associated with immediately modifiable risk factors. BMC Cancer 6: article 170, 2006. (33 refs.)

Background: Estrogen/progestin replacement therapy (EPRT), alcohol consumption, physical activity, and breast-feeding duration differ from other factors associated with breast cancer in being immediately modifiable by the individual, thereby representing attractive targets for future breast cancer prevention efforts. To justify such efforts, it is vital to quantify the potential population-level impacts on breast cancer considering population variations in behavior prevalence, risk estimate, and baseline incidence. Methods: For each of these four factors, we calculated population attributable risk percents (PARs) using population-based survey ( 2001) and cancer registry data (1998-2002) for 41 subpopulations of white, non-Hispanic California women aged 40-79 years, and ranges of relative risk (RR) estimates from the literature. Results: Using a single RR estimate, subpopulation PARs ranged from 2.5% to 5.6% for hormone use, from 0.0% to 6.1% for recent consumption of >=2 alcoholic drinks daily, and 4.6% to 11.0% for physical inactivity. Using a range of RR estimates, PARs were 2-11% for EPRT use, 1-20% for alcohol consumption and 2-15% for physical inactivity. Subpopulation data were unavailable for breastfeeding, but PARs using published RR estimates ranged from 2% to 11% for lifetime breastfeeding >=31 months. Thus, of 13,019 breast cancers diagnosed annually in California, as many as 1,432 attributable to EPRT use, 2,604 attributable to alcohol consumption, 1,953 attributable to physical inactivity, and 1,432 attributable to never breastfeeding might be avoidable. Conclusion: The relatively feasible lifestyle changes of discontinuing EPRT use, reducing alcohol consumption, increasing physical activity, and lengthening breastfeeding duration could lower population breast cancer incidence substantially.

Clifford TJ; Campbell MK; Speechley KN; Gorodzinsky F. Factors influencing full breastfeeding in a southwestern Ontario community: Assessments at 1 week and at 6 months postpartum. Journal of Human Lactation 22(3): 292-304, 2006. (65 refs.)

Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breastfeeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.

Dahlstrom A; Ebersjo C; Lundell B. Nicotine exposure in breastfed infants. Acta Paediatrica 93(6): 810-816, 2004. (30 refs.)

Aim: To study exposure to nicotine in breastfed infants in relation to parental smoking habits. Material and Methods: Forty mother-infant pairs were studied. Twenty non-smoking mothers, 18 smoking (2-20 cigarettes per day) and two snuff-taking mothers were included. All infants were healthy, exclusively breastfed and their postnatal age was 6 wk. During a home visit, parental smoking habits were recorded, and the time of mothers' last smoke or taking of snuff and breastfeeding were recorded. Breast milk and infant urine samples were collected. Concentrations of nicotine and cotinine were analysed with gas chromatography. The amount of milk ingested during the home visit was calculated by weighing the infants. Results: Two non-smoking and non-snuff-taking women had milk containing nicotine (28 and 13 mug/1, respectively). Both had smoking spouses. In the smoking and snuff-taking group, the mean (SD) milk nicotine concentration was 44 (38) mug/1 (n = 36). When milk samples taken 7 h and 0.6 h after smoking were compared, the concentration of milk nicotine increased from 21 to 51 mug/1 (p < 0.01). The two snuff-taking mothers exposed their children to higher milk nicotine concentrations than all but two of the smokers. The concentrations of the metabolite cotinine in infant urine correlated with the dose of nicotine ingested during the home visit (r = 0.84, p < 0.01). Conclusions: Breastfed infants with a smoking or snuff-taking mother are exposed to nicotine in breast milk. The mean intake of nicotine via milk is 7 mug/kg/d. With a shorter time between the mothers' smoking and breastfeeding, the milk nicotine concentration will increase. Both passive smoking at home and snuff-taking were associated with measurable nicotine levels in milk. Healthcare personnel promoting breastfeeding should be aware of these factors influencing exposure to nicotine in the breastfed infant.

Dahlstrom A; Ebersjo C; Lundell B. Nicotine in breast milk influences heart rate variability in the infant. Acta Paediatrica 97(8): 1075-1079, 2008. (24 refs.)

Aim: To study the effects of postnatal exposure to nicotine on the regulation of heart rate and blood pressure in infants. Subjects and Methods: Thirty-eight mother-infant pairs were studied. Twenty nonsmoking and 18 smoking (2-20 cigarettes per day) mothers were included. All infants were healthy, exclusively breastfed and their postnatal age was 6 weeks. During a home visit infant's urine and mothers' milk were sampled and concentrations of nicotine and cotinine were analyzed. Infants' electrocardiogram (ECG) were recorded, sleep state documented and blood pressure during sleep was measured. Heart rate variability (HRV) was calculated with spectral analysis of R-R intervals. Results: The smoking mothers exposed their infants to nicotine in milk with a median nicotine concentration of 47 (8-192) mu g/L. Analysis of infants' urine showed that the nonsmoking group had 0.8 (0-5.2) and the smoke group 60 (17-139) mu g cotinine/L (p < 0.01). The frequency domain low-to-high frequency (LF/HF) ratio, was correlated to milk nicotine concentrations in the milk sample, from smoking mothers. HRV decreased, with increasing milk nicotine, ingested by the boys (r = -0.74, p = 0.02) but not the girls (r = -0.13, p = 0.76). The differences of mean arterial pressure between sleep states in the infants, were significantly lower in the smoke group 5.8(6.8) compared to the nonsmoke group 11.5(7.2) mmHg (p = 0.03). Conclusions: Postnatal exposure to nicotine influences autonomic cardiovascular control in infants.

Dewey WL, ed. Problems of Drug Dependence, 2003: Proceedings of the 65th Annual Scientific Meeting. NIDA Research Monograph 184. Rockville MD: National Institute on Drug Abuse, 2004. (Chapter refs.)

This volume represents the proceedings of The 65th Annual Scientific Meeting of The College on Problems of Drug Dependence. The report includes presented papers, poster sessions, and oral communications. There are reports of seventeen symposia that focus on the following topics: understanding the pathway from use to addiction; immunotherapies for substance abuse; drug reward in humans, the role of dopamine; sex differences in the addicted brain, neuroimaging studies of cocaine and alcohol-dependent men and women; current knowledge about exposure to buprenorphine during pregnancy and lactation; vocational rehabilitation models of substance users; controversies in the pharmacology and toxicology of substituted amphetamines; conceptions of drug dependence, theories, science and policy; changing proteins; changing brain; nicotine, addiction and immunomodulation; neuro-aids, and the role of recreational drugs; effectiveness of adolescent substance abuse treatment; abuse potential.

Di Napoli A; Di Lallo D; Pezzotti P; Forastiere F; Porta D. Effects of parental smoking and level of education on initiation and duration of breastfeeding. Acta Paediatrica 95(6): 678-685, 2006. (29 refs.)

Aim: To evaluate the effects of parental smoking and level of education on the initiation and duration of breastfeeding in a prospective cohort study on mother - infant pairs. Methods: We studied 543 mother - infant pairs enrolled after delivery at a hospital in Rome. Information about parents' characteristics were obtained from a questionnaire administered in hospital; the outcome of the study was the infant's feeding habits in the preceding 24 h, assessed by telephone every 2 wk. The effects of parental smoking and level of education on initiation and duration of breastfeeding were evaluated through multivariate logistic regression models and time-dependent Cox models. Results: After controlling for confounding factors, we found a negative effect for mothers' smoking both on breastfeeding initiation (odds ratio 2.19, 95% CI 1.05-4.55) and duration (hazard ratio 3.37, 95% CI 1.85-6.13) when at least one parent had a low level of education. Conclusion: Our study shows that maternal smoking, particularly when one of the parents has a low level of education, determines a negative effect on the initiation and duration of breastfeeding. Public health policy should promote educational programmes for both parents focused on quitting smoking, which could have positive effects on the initiation and duration of breastfeeding.

Djulus J; Moretti M; Koren G. Marijuana use and breastfeeding. Canadian Family Physician 51: 349-350, 2005. (10 refs.)

QUESTION One of my breastfeeding patients is using marijuana to combat chronic pain. Is it safe for her to breastfeed? ANSWER Lactating mothers should refrain from consuming cannabinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannabinoids must incorporate the known risks of formula feeding. Cannabinoid exposure through milk has not been shown to increase neonatal risk, but there are no appropriate studies of this. In every case, nursing babies should be closely monitored.

Dorea JG. Maternal smoking and infant feeding: Breastfeeding is better and safer. Maternal and Child Health Journal 11(3): 287-291, 2007. (52 refs.)

The rise in smoking rates among young women has implications for children's health aggravated in lower social strata where infant morbidity and mortality rates are higher. The protection afforded by breastfeeding is beneficial to infants in rich and poor countries alike. Women (especially when young, uneducated, and unsupported) who are smokers constitute a risk group for abandoning breastfeeding; moreover, their bottle-fed newborns run a greater risk of morbidity and mortality. Bottle-feeding is attendant on maternal cigarette smoking. The advantages of breastfeeding over bottle-feeding are discussed with regard to systemic effects and the specific effects of cyanide (which can affect the iodine metabolism of infants) and nicotine derived from food and maternal smoking. Despite great strides in bans on smoking, public health policies should be designed to keep in perspective that breastfeeding is an effective tool to counterbalance the health disadvantages that under-privileged infants of smoking mothers face. This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.

England L; Brenner R; Bhaskar B; Simons-Morton B; Das A; Revenis M et al. Breastfeeding practices in a cohort of inner-city women: the role of contraindications. BMC Public Health 3: article No. 28, 2003. (35 refs.)

Background: Little is known about the role of breastfeeding contraindications in breastfeeding practices. Our objectives were to 1) identify predictors of breastfeeding initiation and duration among a cohort of predominately low-income, inner-city women, and 2) evaluate the contribution of breastfeeding contraindications to breastfeeding practices. Methods: Mother-infant dyads were systematically selected from 3 District of Columbia hospitals between 1995 and 1996. Breastfeeding contraindications and potential predictors of breastfeeding practices were identified through medical record reviews and interviews conducted after delivery (baseline). Interviews were conducted at 3 - 7 months postpartum and again at 7 - 12 months postpartum to determine breastfeeding initiation rates and duration. Multivariable logistic regression analysis was used to identify baseline factors associated with initiation of breastfeeding. Cox proportional hazards models were generated to identify baseline factors associated with duration of breastfeeding. Results: Of 393 study participants, 201 (51%) initiated breastfeeding. A total of 61 women (16%) had at lease one documented contraindication to breastfeeding; 94% of these had a history of HIV infection and/or cocaine use. Of the 332 women with no documented contraindications, 58% initiated breastfeeding, vs. 13% of women with a contraindication. In adjusted analysis, factors most strongly associated with breastfeeding initiation were presence of a contraindication (adjusted odds ratio [AOR], 0.19; 95% confidence interval [CI], 0.08 - 0.47), and mother foreign-born (AOR, 4.90; 95% CI, 2.38 - 10.10). Twenty-five percent of study participants who did not initiate breastfeeding cited concern about passing dangerous things to their infants through breast milk. Factors associated with discontinuation of breastfeeding (all protective) included mother foreign-born (hazard ratio [HR], 0.55; 95% CI 0.39 - 0.77) increasing maternal age (HR for 5-year increments, 0.80; 95% CI, 0.69 - 0.92), and infant birth weight greater than or equal to 2500 grams (HR, 0.45; 95% CI, 0.26 - 0.80).Conclusions: Breastfeeding initiation rates and duration were suboptimal in this inner-city population. Many women who did not breastfeed had contraindications and/or were concerned about passing dangerous things to their infants through breast milk. It is important to consider the prevalence of contraindications to breastfeeding when evaluating breastfeeding practices in high-risk communities.

Giglia RC; Binns CW. Patterns of alcohol intake of pregnant and lactating women in Perth, Australia. Drug and Alcohol Review 26(5): 493-500, 2007. (37 refs.)

Introduction and Aims. Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-july 2003. Design and Methods. Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. Results. Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breast feeding women were consuming alcohol, respectively. Discussion and Conclusions. The majority of breast feeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage.

Giglia RC; Binns CW; Alfonso HS; Zhan Y. Which mothers smoke before, during and after pregnancy? Public Health 121(12): 942-949, 2007. (28 refs.)

Objective: To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy. Study design: A 12-month longitudinal study. Method: All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. White in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding. Results: A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum. Conclusions: Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally.

Glatstein MM; Garcia-Bournissen F; Finkelstein Y; Koren G. Methadone exposure during lactation. Canadian Family Physician 54(12): 1689-1690, 2008. (16 refs.)

QUESTION One of my patients is currently using methadone for maintenance of opioid dependence. She wants to breastfeed. Is breastfeeding safe for her infant? ANSWER The exposure of infants to methadone through their mothers' breast milk is minimal. Women using methadone for treatment of opioid dependence should not be discouraged from breastfeeding. The benefits of breastfeeding largely outweigh any theoretical minimal risks.

Goldade K; Nichter M; Nichter M; Adrian S; Tesler L; Muramoto M. Breastfeeding and smoking among low-income women: Results of a longitudinal qualitative study. Birth Issues in Perinatal Care 35(3): 230-240, 2008. (32 refs.)

Background: The benefits of breastfeeding for infants and mothers have been well established, yet rates of breastfeeding remain well below national recommendations in the United States and even lower for women who smoke during pregnancy. Primary goals of this study were to explore contextual factors that contribute to breastfeeding intentions and behavior and to examine how smoking status affected women's decision making about breastfeeding. Methods: This paper is based on a longitudinal qualitative study of smoking, pregnancy, and breastfeeding among 44 low-income women in the southwest U.S. who smoked during pregnancy. Each woman was interviewed 9 times; 6 times during pregnancy and 3 times postpartum using semistructured questionnaires. Interviews lasted 1 to 3 hours and were tape-recorded, transcribed, and analyzed. Results: Despite 36 (82%) respondents stating that they intended to breastfeed for an average duration of 8 months, rates of breastfeeding initiation and duration were much lower than intentions. By 6 months postpartum, only two women were breastfeeding exclusively. Conclusions: Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months. The results indicate a need for more consistency and routine in educating women on the relationship between smoking and breastfeeding and in promoting breastfeeding in spite of smoking postpartum.

Gunzerath L; Faden V; Zakhari S; Warren K. National Institute on Alcohol Abuse and Alcoholism Report on Moderate Drinking. (editorial). Alcoholism: Clinical and Experimental Research 28(6): 829-847, 2004. (223 refs.)

In support of the 2005 update of the U.S. Department of Agriculture/U.S. Department of Health and Human Services Dietary Guidelines, the National Institute on Alcohol Abuse and Alcoholism was asked to assess the strength of the evidence related to health risks and potential benefits of moderate alcohol consumption, with particular focus on the areas of cardiovascular disease, breast cancer, obesity, birth defects, breastfeeding, and aging. The findings were reviewed by external researchers with extensive research backgrounds on the consequences and benefits of alcohol consumption. This report now serves as the National Institutes of Health's formal position paper on the health risks and potential benefits of moderate alcohol use.

Hemminki K; Chen B. Parental lung cancer as predictor of cancer risks in offspring: Clues about multiple routes of harmful influence? International Journal of Cancer 118(3): 744-748, 2006. (31 refs.)

The carcinogenic effects of active smoking have been demonstrated for many sites, but the effects of passive smoking and exposures during pregnancy and breastfeeding are. less well documented. We examined whether 0-70-year-old offspring of parents with lung cancer are at a risk of cancer that cannot be explained by their smoking or familial risk. It was assumed that known target sites for tobacco carcinogenesis would be affected, if any. The nationwide Swedish Family-Cancer Database with cancers recorded from 1958 to 2002 was used to calculate age-specific standardized incidence ratios (SIRs). Among offspring of affected mothers, increased risks were observed for upper aerodigestive (SIR 1.45), nasal (2.93), lung (1.71) and bladder (1.52) cancers and for kidney cancer (6.41) in one age group. The risk of bladder cancer was found in younger age groups than that of lung cancer. Cancers at many of these sites, but not the kidney or the bladder, were in excess in offspring of affected fathers. Nasal cancer was even increased when either parent was diagnosed with lung cancer; the highest risk was for nasal adenoid cystic carcinoma (7.73). The data suggest that passive smoking during childhood is associated with an increase risk of nasal cancer. For bladder and kidney cancers, a contribution by tobacco carcinogens is implicated through breastfeeding and in utero exposure.

Jagodzinski T; Fleming MF. Postpartum and alcohol-related factors associated with the relapse of risky drinking. Journal of Studies on Alcohol and Drugs 68(6): 879-885, 2007. (26 refs.)

Objective: The purposes of this investigation were (1) to describe postpartum drinking patterns among women who were frequent drinkers before pregnancy and (2) to identify factors correlated with postpartum "risky" drinking among women who were frequent drinkers before pregnancy Method: Information was gathered through a self-administered questionnaire completed at the postpartum visit and a subsequent face-to-face interview of 381 women, recruited from 35 obstetric/gynecologic clinics throughout Wisconsin, who reported frequent drinking before pregnancy. Multivariate analyses were used to identify correlates of postpartum risky drinking, defined as consuming four or more drinks per occasion (heavy episodic drinking) at least twice in the past 28 days or drinking an average of seven or more drinks per week. Results: Overall, 37.8% (n = 144) of women reported postpartum risky drinking. Eighteen percent reported heavy episodic drinking only, 5% reported frequent drinking only, and 15% reported both behaviors. Postpartum risky drinkers were more likely than other women to have had a partner who engaged in risky drinking (odds ratio [OR] = 2.6, 95% confidence interval [CI 1.5-4.5), to have been unemployed (OR = 3.0, 95% CI 1.2-7.7), to have smoked following pregnancy (OR = 1.9, 95% CI 1.0-3.5), and to have consumed alcohol after the recognition of pregnancy (OR = 4.8, 95% CI 2.2-10.6). Women who breast-fed their child were less likely to report risky drinking (OR = 0.3, 95% CI 0.2-0.5). Conclusions: In the postpartum period, health care providers may want to focus alcohol screening efforts on former frequent drinkers who are smokers, are unemployed, have a partner who is a risky drinker, or are not breast-feeding.

Jansson LM; Choo R; Velez ML; Harrow C; Schroeder JR; Shakleya DM et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 121(1): 106-114, 2008. (45 refs.)

OBJECTIVE. In a sample of methadone-maintained breastfeeding women and a matched group of formula-feeding women, this study evaluated concentrations of methadone in breast milk among breastfeeding women and concentrations of methadone in maternal and infant plasma in both groups. METHODS. Eight methadone-maintained (dose: 50-105 mg/day), lactating women provided blood and breast milk specimens on days 1, 2, 3, 4, 14, and 30 after delivery, at the times of trough and peak maternal methadone levels. Paired specimens of foremilk and hindmilk were obtained at each sampling time. Eight matched formula-feeding subjects provided blood samples on the same days. Infant blood samples for both groups were obtained on day 14. Urine toxicological screening between 36 weeks of gestation and 30 days after the birth confirmed that subjects were not using illicit substances in the perinatal period. RESULTS. Concentrations of methadone in breast milk were low (range: 21.0-462.0 ng/mL) and not related to maternal dose. There was a significant increase in methadone concentrations in breast milk over time for all 4 sampling times. Concentrations of methadone in maternal plasma were not different between groups and were unrelated to maternal dose. Concentrations of methadone in infant plasma were low (range: 2.2-8.1 ng/mL) in all samples. Infants in both groups underwent neurobehavioral assessments on days 3, 14, and 30; there were no significant effects of breastfeeding on neurobehavioral outcomes. Fewer infants in the breastfed group required pharmacotherapy for neonatal abstinence syndrome, but this was not a statistically significant finding. CONCLUSION. Results contribute to the recommendation of breastfeeding for methadone-maintained women.

Jansson LM; Choo RE; Harrow C; Velez M; Schroeder JR; Lowe R; Huestis MA. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. Journal of Human Lactation 23(2): 184-190, 2007. (44 refs.)

This study evaluates concentrations of methadone in breast milk and plasma among a sample of methadone-maintained women in the immediate perinatal period. Twelve methadone-maintained, lactating women provided blood and breast milk specimens 1, 2, 3, and 4 days after delivery. Specimens were collected at the time of trough (just before methadone dose) and peak (3 hours after dosing) maternal methadone levels. Paired specimens of foremilk (prefeed) and hindmilk (postfeed) were obtained at each sampling time. Although there was a significant increase in methadone concentration in breast milk over time for the peak postfeed sampling time, t(22) = 2.40, P = .0255, methadone concentrations in breast milk were small, ranging from 21 to 314 ng/mL, and were unrelated to maternal methadone dose. Results obtained from this study contribute to the recommendation of breastfeeding for methadone-maintaind women regardless of methadone dose.

Jansson LM; Velez M; Harrow C. Methadone maintenance and lactation: A review of the literature and current management guidelines. (review). Journal of Human Lactation 20(1): 62-71, 2004. (60 refs.)

Methadone offers significant therapeutic benefits to the population of pregnant, opiate-dependent women and is currently the treatment of choice for this group. Yet the problem of women who elect to breastfeed while on methadone maintenance frequently vexes providers. Although breast milk offers advantages clearly beneficial to the general population of infants, there is debate about recommending breastfeeding to postpartum women receiving methadone maintenance. Although previous research has shown that amounts of methadone in breast milk appear to be very small, and therefore breastfeeding seems to be safe, women on methadone do not often breastfeed, for a variety of reasons. This article provides an overview of the issues facing providers in treating methadone-maintained women who elect to breastfeed. A comprehensive review of existing literature on the subject is offered, along with clinical advice for practitioners providing care to this population of women and children.

LaGasse LL; Messinger D; Lester BM; Seifer R; Tronick EZ; Bauer CR et al. Prenatal drug exposure and maternal and infant feeding behaviour. Archives of Disease in Childhood 88(5, Special Issue): F391-F399, 2003. (47 refs.)

Objective: To evaluate feeding difficulties and maternal behaviour during a feeding session with 1 month old infants prenatally exposed to cocaine and/or opiates. Methods: The study is part of the maternal lifestyle study, which recruited 11 811 subjects at four urban hospitals, then followed 1388 from 1 to 36 months of age. Exposure to cocaine and opiates was determined by maternal interview and meconium assay. At the 1 month clinic visit, biological mothers were videotaped while bottle feeding their infants. This sample included 364 exposed to cocaine, 45 exposed to opiates, 31 exposed to both drugs, and 588 matched comparison infants. Mothers were mostly black, high school educated, and on public assistance. Videotapes were coded without knowledge of exposure status for frequency, duration and quality of infant sucking, arousal, feeding problems, and maternal feeding activity and interaction. Results: No cocaine effects were found on infant feeding measures, but cocaine-using mothers were less flexible (6.29 v 6.50), less engaged (5.77 v 6.22), and had shorter feeding sessions (638 v 683 seconds). Opiate exposed infants showed prolonged sucking bursts (29 v 20 seconds), fewer pauses (1.6 v 2.2 per minute), more feeding problems (0.55 v 0.38), and increased arousal (2.59 v 2.39). Their mothers showed increased activity (30 v 22), independent of their infants' feeding problems. Conclusions: Previous concerns about feeding behaviour in cocaine exposed infants may reflect the quality of the feeding interaction rather than infant feeding problems related to prenatal exposure. However, opiate exposed infants and their mothers both contributed to increased arousal and heightened feeding behaviour.

Ludvigsson JF; Ludvigsson J. Socio-economic determinants, maternal smoking and coffee consumption, and exclusive breastfeeding in 10205 children. Acta Paediatrica 94(9): 1310-1319, 2005. (40 refs.)

Aim: To examine socio-economic factors, smoking, coffee consumption and exclusive breastfeeding duration. Methods: This study was part of a prospective cohort study of children born between 1 October 1997 and 1 October 1999 (the All Babies in Southeast Sweden (ABIS) Study). Eleven socio-economic characteristics (parental employment, civil status, whether parents were born in Sweden, parental education, residence at birth and during child's first year, crowded living), maternal smoking, coffee consumption, infant sex, siblings, parental age, and maternal alcohol consumption during pregnancy were analysed using logistic regression and Cox's proportional hazards method. All data were obtained through questionnaires distributed at infant birth and at 1 y of age. Exclusive breastfeeding duration <4 mo and actual breastfeeding duration were our main outcome measures. Results: Out of 10205 infants, 2206 (21.6%) were exclusively breastfed for less than 4 mo ("short exclusive breastfeeding"; SEBF). Backward stepwise regression analysis identified the following risk factors for SEBF: maternal smoking (95% confidence interval for adjusted odds ratio, 95% CI AOR 2.00-2.82), low maternal education (95% CI AOR 1.45-2.19), maternal employment less than 3 mo during pregnancy (95% CI AOR 1.17-1.54), paternal age <= 29 y (95% CI AOR 1.14-1.47), maternal age <= 29 y (95% CI AOR 1.08-1.39) and low paternal education (95% CI AOR 1.08-1.48). The odds ratio for SEBF increased with the number of cigarettes smoked. Coffee consumption was not associated with duration of exclusive breastfeeding. Conclusion: This study indicates that socio-economic factors and smoking may be of importance to the risk of breastfeeding exclusively for less than 4 mo, while coffee consumption is not.

Malone K; Papagni K; Ramini S; Keltner NL. Biological perspectives: Antidepressants, antipsychotics, benzodiazepines, and the breastfeeding dyad. (editorial). Perspectives in Psychiatric Care 40(2): 73-85, 2004. (52 refs.)

Mennella JA; Pepino MY. Biphasic effects of moderate drinking on prolactin during lactation. Alcoholism: Clinical and Experimental Research 32(11): 1899-1908, 2008. (65 refs.)

Background: Contrary to the popular lore that encourages women to drink alcohol as an aid to lactation, we previously showed that alcohol consumption disrupted lactational performance and the hormonal milieu of the lactating mother in the short term. Methods: Thirteen lactating women participated in a 4-session, double-blind, 2 x 2 within-subject study to test several hypotheses related to the effects of alcohol on prolactin (PRL) responses and milk yield over time. The two within-subject factors were beverage condition (control or 0.4 g/kg dose of alcohol) and pumping condition (pumping occurred at fixed intervals once or twice during the 5.3-hour session). Plasma PRL, blood alcohol concentrations (BAC), and milk yield were measured. Results: Alcohol consumption increased basal PRL levels (p < 0.0001) and modified the PRL response to pumping (p < 0.0001) but the directionality of the response depended on when pumping occurred along the BAC curve. Pumping enhanced PRL response when it occurred during the ascending BAC limb but blunted the response when it occurred during the descending limb, providing evidence that the effects were transient and of a biphasic nature. The slower the alcohol was metabolized, the greater the relative PRL response to breast pumping (p < 0.05). The dynamics of the PRL response between pumping sessions was also altered if women drank. If women pumped within the hour after drinking alcohol, the PRL response during the next pumping some 1.5 hours later, was delayed by a few minutes. Milk yield was significantly lower after drinking alcohol but such deficits were not significantly related to PRL or the speed at which alcohol was eliminated. Conclusions: Effects of alcohol on suckling-induced PRL were biphasic in nature, but could not explain the deficits in lactational performance. Such findings provide further evidence that the dynamic changes in neuroendocrine state are integrally involved in alcohol's effects over time and underscore the complexity of lactation.

Ozkan B; Ermis B; Tastekin A; Doneray H; Yildirim A; Ors R. Effect of smoking on neonatal and maternal serum and breast milk leptin levels. Endocrine Research 31(3): 177-183, 2005. (25 refs.)

Maternal smoking is considered to be a risk factor for low birth weight. It is hypothesized that alteration in leptin concentration may be associated with reduced fetal growth. In this study, we assess the effect of smoking during pregnancy on maternal and neonatal serum leptin concentrations, and also on breast milk leptin levels. When the infants were brought to routine physical examination at 7 days old, blood samples and breast milk specimens were taken for leptin measurement from mothers who smoked during pregnancy and their newborns. Nonsmoking mothers and their infants were recruited randomly over the same period as a control group. Maternal age, number of pregnancy, weight of the mothers, birth weight, and gestational age of the infants were similar in both groups ( p > 0.05). There was no significant difference between groups in maternal serum and breast milk leptin levels ( p = 0.14 and p = 0.96, respectively). However, serum leptin levels were found significantly lower in neonates born to smoking mothers compared with infants born to nonsmoking mothers ( p = 0.02). Our findings suggest that maternal smoking dose not have an effect on maternal serum and breast milk leptin levels but decreases neonatal serum leptin concentration independent of birth weight.

Page-Sharp M; Hale TW; Hackett LP; Kristensen JH; Ilett KF. Measurement of nicotine and cotinine in human milk by high-performance liquid chromatography with ultraviolet absorbance detection. Journal of Chromatography B 796(1): 173-180, 2003. (31 refs.)

A high-performance liquid chromatographic (HPLC) assay for the determination of nicotine and cotinine in human milk was developed using an extraction by liquid-liquid partition combined with back extraction into acid, and followed by reverse-phase chromatography with UV detection of analytes. The assay was linear up to 500 mug/l for both nicotine and cotinine. Intra- and inter-day relative standard deviations (R.S.D.) were <10% (25-500 mug/l) for both nicotine and cotinine. Limits of quantitation (LOQ) were 10 and 12 mug/l for nicotine and cotinine, respectively, while the limits of detection (LOD) were 8 and 10 mug/l for nicotine and cotinine, respectively. The mean recoveries were 79-93% (range 25-500 mug/l) for nicotine and 78-89% (range 25-500 mug/l) for cotinine. The amount of fat in the milk did not affect the recovery. We found that this method was sensitive and reliable in measuring nicotine and cotinine concentrations in milk from a nursing mother who participated in a trial of the nicotine patch for smoking cessation.

Pepino MY; Abate P; Spear NE; Molina JC. Heightened ethanol intake in infant and adolescent rats after nursing experiences with an ethanol-intoxicated dam. Alcoholism: Clinical and Experimental Research 28(6): 895-905, 2004. (77 refs.)

Background: Preweanling rats detect ethanol (175 mg/100 ml) in maternal milk when the dam is moderately intoxicated. Repeated experiences with the intoxicated dam facilitate subsequent recognition of ethanol's chemosensory attributes and promote ethanol-related memories with a negative hedonic content. This memory has been attributed to the infant's acquired association between ethanol's chemosensory attributes and its disruptive effects on maternal care. In this study, infant and adolescent ethanol intake patterns were analyzed as a function of prior interactions, during early infancy, with their intoxicated dams. Methods: During postpartum days 3, 5, 7, 9, 11, and 13, breast-feeding dams received an intragastric administration of either 2.5 g/kg of ethanol or water. Pups whose dams had been given one of these two maternal treatments were tested on postnatal day 15 for ingestion of 0% (water), 2.5, 5.0, or 10% v/v ethanol solution. During adolescence, remaining animals from these litters were first adapted to ingest water from drinking tubes and then were given simultaneous access to tap water and a given ethanol solution. The first day, a 3% v/v ethanol solution was used. This solution was increased by 1% ethanol each following day until the solution was 6% v/v ethanol. Results: Maternal drug treatment did not affect the body weights of dams, infants, or adolescents. Water intake during infancy and adolescence also was unaffected by prior maternal treatment. However, infants that had previously interacted with ethanol-intoxicated dams exhibited heightened ethanol intake scores (grams per kilogram and percentage body weight gains), especially when tested with 5 or 10% v/v ethanol solutions. Similarly, adolescent males (but not females) that had interacted with an intoxicated dam during infancy also had higher ethanol consumption levels than those that had interacted with a nonintoxicated dam. Conclusions: Contrary to what might be expected in animals that acquire an aversive memory for ethanol's chemosensory cues as a function of prior interactions with an intoxicated mother, these results indicate that such interactions promote a long-lasting increase in ethanol intake. These results suggest that rats reared by intoxicated dams become sensitive to the negative reinforcing properties of ethanol.

Pepino MY; Steinmeyer AL; Mennella JA. Lactational state modifies alcohol pharmacokinetics in women. Alcoholism: Clinical and Experimental Research 31(6): 909-918, 2007. (62 refs.)

Background: Given the physiological adaptations of the digestive system during lactation, the present study tested the hypothesis that lactation alters alcohol pharmacokinetics. Methods: Lactating women who were exclusively breastfeeding a 2- to 5-month-old infant and 2 control groups of nonlactating women were studied. The first control group consisted of women who were exclusively formula-feeding similarly aged infants, whereas the other consisted of women who had never given birth. A within-subjects design study was conducted such that women drank a 0.4 g/kg dose of alcohol following a 12-hour overnight fast during one test session (fasted condition) or 60 minutes after consuming a standard breakfast during the other (fed condition). Blood alcohol concentration (BAC) levels and mood states were obtained at fixed intervals before and after alcohol consumption. Results: Under both conditions, the resultant BAC levels at each time point were significantly lower and the area under the blood alcohol time curve were significantly smaller in lactating women when compared with the 2 groups of nonlactating women. That such changes were due to lactation per se and not due to recent parturient events was suggested by the finding that alcohol pharmacokinetics of nonlactating mothers, who were tested at a similar time postpartum, were no different from women who had never given birth. Despite lower BAC levels in lactating mothers, there were no significant differences among the 3 groups of women in the stimulant effects of alcohol. However, lactating women did differ in the sedative effects of alcohol when compared with nulliparous but not formula-feeding mothers. That is, both groups of parous women felt sedated for shorter periods of time when compared with nulliparous women. Conclusions: The systemic availability of alcohol was diminished during lactation. However, the reduced availability of alcohol in lactating women did not result in corresponding changes in the subjective effects of alcohol.

Sarkar M; Djulus J; Koren G. When a cocaine-using mother wishes to breastfeed: Proposed guidelines. (editorial). Therapeutic Drug Monitoring 27(1): 1-2, 2005. (9 refs.)

Sorensen HJ; Mortensen EL; Reinisch JM; Mednick SA. Early weaning and hospitalization with alcohol-related diagnoses in adult life. American Journal of Psychiatry 163(4): 704-709, 2006. (28 refs.)

Objective: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. Method: The study was a prospective longitudinal birth cohort design conducted in a sample of 6,562 men and women, all of whom were born in Copenhagen, Denmark, between October 1959 and December 1961. The sample was divided into two categories based on duration of breast-feeding, as assessed by a physician interview with mothers at a 1-year examination. Psychiatric hospitalizations with alcohol-related diagnoses according to ICD-8 or ICD-10 were identified in the Danish Psychiatric Central Register in 1999. Nine potential confounders were included as covariates: gender of the cohort member, maternal age, parental social status, maternal prenatal smoking, unwanted pregnancy, maternal and paternal psychiatric hospitalization with alcohol-related diagnosis, and maternal and paternal psychiatric hospitalization with other diagnosis. Results: Alcohol-related diagnoses were more frequent in men, but the results were comparable for men and women. The adjusted predictive effect of early weaning was 1.47. Elevated relative risks were also associated with maternal smoking during pregnancy ( 1.52) and unwanted pregnancy status ( 1.59). Other independent predictors were male gender, maternal psychiatric hospitalization with alcohol-related diagnosis, and low parental social status. Conclusions: Independent of a number of other risk factors for alcoholism, a significant association between early weaning and elevated risk of hospitalization with alcohol-related diagnoses was observed.

Stepans MBF; Wilhelm SL; Dolence K. Smoking hygiene: Reducing infant exposure to tobacco. Biological Research for Nursing 8(2): 104-114, 2006. (53 refs.)

The American Academy of Pediatrics recently removed nicotine from the list of drugs contraindicated during breastfeeding. The objective of this study was to evaluate the feasibility of determining the effect of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes. An experimental design with repeated measures was used. A convenience sample of 35 mother-infant dyads from seven sites was recruited and randomly assigned to the intervention or control group. Of the 27 dyads completing the study, 16 were in the experimental group and 11 were in the control group. Smoking hygiene was introduced when infants were 2 weeks old and reinforced when they were 3 and 5 weeks old. At these three data points, infant health and urinary nicotine and cotinine levels were measured, as well as the mothers' breast-milk nicotine and cotinine levels and smoking hygiene behaviors. Recruiting and retaining a sample of breastfeeding mothers who smoke proved difficult. Only 27% of women in the intervention group implemented all aspects of the smoking hygiene intervention behaviors. Repeated-measures ANOVA revealed no difference in a) infant urinary nicotine and cotinine levels or b) breast-milk nicotine and cotinine levels between the two groups. The McNemar test for related samples revealed no difference between frequency of respiratory symptoms in either the control or intervention groups when Week 2 levels were compared with levels at Weeks 3 and 5. Mothers were not successful in adhering to the smoking hygiene intervention. To adequately test interventions, strategies must be developed to help women incorporate health-promoting behaviors into their lives.

Wallace C; Burns L; Gilmour S; Hutchinson D. Substance use, psychological distress and violence among pregnant and breastfeeding Australian women. Australian and New Zealand Journal of Public Health 31(1): 51-56, 2007. (23 refs.)

Objective: To identify the population prevalence and demographic characteristics of pregnant and/or breastfeeding Australian women who use licit and illicit substances and their experience of psychological distress and violence. Methods: Data from the 2004 National Drug Strategy Household Survey were used to determine the prevalence of substance use, psychological distress and violence experienced by pregnant and/or breastfeeding women. Results: A total of 976 pregnant and/or breastfeeding women were included. These women were significantly less likely than non-pregnant women to consume alcohol (47% vs. 85%) or any illicit drug (6% vs. 17%); however, there was no significant difference in tobacco smoking (20% vs. 25%). Self-reported psychological distress was significantly more frequent in the non-pregnant group (42%) than in the pregnant group, irrespective of substance use status. At a population level, pregnant and/or breastfeeding women were not at a heightened risk of psychological distress or violence. Discussion: These findings highlight the importance of targeting older, tertiary-educated and relatively affluent mothers and those living in regional areas for drug and alcohol education campaigns and treatment. Implications: Simplifying the National Health and Medical Research Council pregnancy-specific alcohol guidelines, improving clinician training, and increasing the availability of treatment options in rural and regional areas may assist in the identification, referral and provision of assistance to substance using pregnant/breastfeeding women.

Zanardo V; Nicolussi S; Cavallin S; Trevisanuto D; Barbato A; Faggian D et al. Effect of maternal smoking on breast milk interleukin-1 alpha, beta-endorphin, and leptin concentrations. Environmental Health Perspectives 113(10): 1410-1413, 2005. (33 refs.)

Tobacco smoke is immunotoxic, but the effect of smoking on the immunologic function of the mammary gland of mothers who smoke cigarettes ("smoker mothers") has not been studied. Our objective was to test, in smoker mothers, the colostral and transitional milk concentrations of interieukin-(IL)1 alpha. The immunomodulators beta-endorphin and leptin were also tested. Pregnant women who self-identified as smokers (>= 5 cigarettes per day through pregnancy) or nonsmokers were recruited for study participation. The study population included 42 smoker and 40 nonsmoker nursing mothers, with otherwise uncomplicated gestation, delivery, and puerperium, who were breast-feeding ad libitum their healthy neonates. Colostrum was obtained on the third postpartum day at 0900 hr and transitional milk on the 10th postpartum day at 0900 hr. IL-1 alpha concentrations were significantly reduced in the colostrum of smoker mothers compared with nonsmoker mothers (p < 0.01). Colostral P-endorphin and leptin concentrations were comparable. No significant differences were found between smoker and nonsmoker lactating mothers in transitional milk concentrations of IL-1 alpha, beta-endorphin, and leptin. Moreover, P-endorphin and leptin concentrations were significantly reduced in transitional milk samples compared with colostrum of both smoker and nonsmoker mothers (p < 0.05); also, IL-1 alpha transitional milk concentrations were reduced compared with colostrum, but without any significance. This analysis shows that maternal smoking alters the colostral milk levels of the proinflammatory cytokine IL-1 alpha. The altered postnatal provision of alternative source of the proinflammatory cytokine IL-1 alpha adds understanding to how breast-feeding could be nonprotective against infections among the neonates nursed by smoker mothers.

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