It’s no wonder that pregnant women are confused about whether or not alcohol is off-limits during pregnancy. The National Organization on Fetal Alcohol Syndrome (NOFAS) warns that there is “No safe amount. No safe time. No safe alcohol. Period.”—a position echoed by the American Academy of Pediatrics (AAP) in its 2015 clinical report. Nonetheless, some parents and health care providers want to speculate about “safe” levels and compare the risks of light, moderate, and heavy drinking.
What are the risks of drinking alcohol when pregnant?
The risks associated with consuming alcohol during pregnancy include:
- preterm birth
- low birth weight for baby
- language and speech delays in the child
- behavioral problems, such as hyperactivity
- fetal alcohol syndrome (characterized by physical defects, poor growth, heart defects, and central nervous system damage)
A 2015 review article acknowledged that while the studies “are not fully conclusive,” some suggest that even low or moderate “consumption of alcohol during pregnancy may adversely affect children’s intelligence quotient (IQ), mental health, memory and verbal of visual performance.”
Another study which included nearly 1,000 mothers and their babies and specifically looked at alcohol exposure during certain periods of pregnancy found a fetus’s alcohol exposure — even small amounts — during the second half of the first trimester was most strongly associated with the development of fetal alcohol syndrome. However, the study concluded that women who are pregnant and those who may become pregnant should abstain from alcohol altogether.
Perhaps most important to pregnant women making decisions about consuming alcohol, studies have often shown a dose-response effect. The risk of fetal alcohol syndrome and adverse neurological effects increases as the number of drinks consumed daily—or even during a single occasion—increases.
What are some alternatives to alcohol during pregnancy?
If you drink to relax, try other techniques like warm baths, massages, meditation, and/or acupuncture. If you drink out of habit, try non-alcoholic beverages or “mocktails.”
Although pregnant women are urged to avoid alcohol completely, breastfeeding mothers are simply cautioned to consume it in small amounts.
Why only small amounts? Alcohol (beer, wine, liquor) passes easily into breast milk. Research shows that it can change the flavor of your milk, shorten your breastfeeding sessions, decrease your milk supply, and limit your baby’s weight gain.
Drinking small amounts (4 ounces of wine, 12 ounces of beer, or 1 ounce of liquor such as whiskey, rum, vodka, or gin) no more than once a week is thought to be safe. However, daily use of alcohol, even in small amounts, can affect your baby’s motor development and your ability to care for your baby.
To limit the effects of alcohol on you and your baby, have no more than one or two drinks a week, and wait at least two hours after you drink before breastfeeding.
The outdated suggestion to “pump and dump” was based on the belief that alcohol stays in the milk until it is removed from the breasts. We now know that this is false. The amount of alcohol in your milk depends on the amount in your blood. Even if you express and discard your milk, alcohol will re-accumulate in newly produced milk as long as there is alcohol in your blood. Alcohol is broken down (metabolized) and removed from your blood (and your milk) by the liver. It takes about two hours for the liver to break down the alcohol found in one drink.
It is important to remember that alcohol can make you sleep more soundly, so you should not sleep with your baby after drinking alcohol, due to the increased risk of suffocation and SIDS.
Whether caffeine affects your baby depends on your baby’s age and health. If you have a healthy, full-term baby, small amounts of caffeine are thought to be safe. But there is evidence to suggest that large amounts of caffeine—more than 750 mg per day—may cause fussy, wakeful babies.
If you notice your baby becoming fussy, you may want to limit your intake of caffeine-containing drinks and foods such as coffee, tea, chocolate, and some carbonated beverages for 2-3 weeks to see if your baby’s symptoms improve.
Check the ingredients listed on the package for caffeine content. The amount of caffeine in a cup of coffee or tea depends upon the equipment used for brewing and can range from 50-500 mg per 8 ounce serving.
Although women are cautioned against eating sushi and other raw seafood (such as sashimi, oysters, clams, and mussels) when pregnant, there is no need to forgo this seafood when breastfeeding. Sushi can be a part of a well-balanced diet. Be sure the sushi, sashimi, or other raw seafood you consume is fresh, and follow the seafood recommendations for breastfeeding mothers issued by the Food and Drug Administration (FDA) and Environmental Protection Agency (EPA). Be selective about which fish you choose and how much of it you eat.
- Eat 2–3 servings (about 12 ounces) of a variety of lower-mercury fish per week.Those that are commonly available include salmon, shrimp, Pollock, tuna (light canned), tilapia, catfish, and cod.
- Avoid the four highest-mercury fish. Tilefish, shark, swordfish, and king mackerel are not recommended in any quantities for breastfeeding women. (They are also not recommended for pregnant women or young children.)
- Limit white (albacore) tuna to no more than 6 ounces per week. Other canned tuna isn’t limited.
- Do your research before eating local fish. Check for fish advisories issued by the appropriate authority, usually the local wildlife or health department. If you can’t find any information, limit your intake of locally caught fish to 6 ounces a week.
- Eat fish as part of a well-balanced diet that meets your caloric needs. Information for breastfeeding mothers is available on the Choose My Platewebsite.
- Include low-mercury fish when you add complementary foods to your breastfed child’s diet. For children ages 2 to 6 years, this would be about 2–3 small servings (totaling 3–5 ounces) per week.
- Watch for signs of allergic reaction when introducing fish. Fish, especially shellfish, is a potential allergen, so watch for symptoms (hives, rash or flushed skin, tingling mouth, swelling of the lips or tongue, difficulty breathing, sweating, vomiting, diarrhea, food aversion, coughing, or loss of consciousness) when introducing fish to young children.
Studies have shown that high levels of mercury can damage the nervous system, kidneys, and liver of unborn children, infants, and young children, so some concern is warranted. However, seafood contains protein and omega-3 fatty acids that are important for overall health and neurological development. Stay informed but rest assured that the benefits of these vital nutrients outweigh the risks of consuming limited amounts of low-mercury fish.
The more milk your baby takes (or you remove through milk expression), the more milk you make. Some mothers with ample milk may “think” their supply is low when in fact it is not. So before you take steps to improve your milk supply, talk with you health care provider to make sure it is indeed low.
Many mothers assume that they are “losing” their milk because their let-down reflex is less noticeable and their breasts seem softer than they did in the first weeks after their baby’s birth. It’s easy to confuse “soft breasts” with “empty breasts.” Soft breasts are a natural progression of your body’s adjustment to your baby’s feeding patterns, and indicate that your body is making just the right amount of milk at just the right time.
While improper positioning, poor latch, or inadequate suckling can lead to low milk supply, a sudden increase in the number of feedings can simply signal a “growth spurt.” Fortunately, more frequent feedings together with a good latch will usually ensure an ample supply of milk.
Breast massage and skin-to-skin contact are effective low-tech strategies for increasing a mother’s milk supply. (See more on skin-to-skin contact here and breast massage here.) There are several common foods that have traditionally been recognized as beneficial for breastfeeding mothers who fear that they are losing their milk. However, there are few studies to support the lactogenic (milk-inducing) properties of various foods or products.
That said, the following foods may help (or at least not hurt) a mother’s milk supply:
- Oats. Some mothers claim a beneficial effect from a bowl of oatmeal or from oatmeal cookies, which often contain not only oatmeal but brewer’s yeast, another traditional galactagogue.
- Vegetables. Hilary Jacobson, author of Mother Food: A Breastfeeding Diet Guide with Lactogenic Foods and Herbs, sees a lot of potential in the produce aisle. Fennel and fennel seed may boost a mother’s supply, according to Jacobson, as well as reddish vegetables like beets, carrots, and yams which are rich in beta-carotene and other vitamins and minerals. Dark green, leafy vegetables like collard greens, kale, and beet leaves may also be helpful. Why these foods boost supply is unclear, but Jacobson points to nutrients like iron and calcium as possible causes.
- Barley. Mariah Carey may be the most famous person to drink a beer to boost milk supply, but she is certainly not the only one to do so. Barley, an ingredient in beer, may trigger the release of prolactin—a hormone that stimulates milk production. While there is no evidence to show that beer actually increases a mother’s milk supply, mothers who opt to drink a beer to increase their supply should choose a non-alcoholic beer. Alcohol passes readily into breast milk, and even small amounts of alcohol can negatively affect milk production and milk release. Hilary Jacobson recommends barley in its other forms: grains or porridge, beverages (often marketed as a coffee-alternative), or homemade “barley water.”
Perhaps the best thing mothers can do, nutritionally, to maintain a good milk supply is to eat a well-balanced diet that includes a variety of healthy foods each day and enough liquids (water and unsweetened fruit juice) to satisfy their thirst. If you have particular concerns about your nutritional needs, talk with your health care provider or a registered dietitian.