Breastfeeding in the Setting of Substance Use and Substance Use Disorder
Publication Date: October 17, 2023
Last Updated: November 14, 2023
General Recommendations
Those who have SUD or use substances during pregnancy or the postpartum period should engage in multidisciplinary prenatal and postpartum substance use care. (2, B)
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Individuals who discontinue nonprescribed substance use by the delivery hospitalization can be supported in breastfeeding initiation with appropriate follow-up. (2, B)
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Targeted perinatal dyadic lactation care such as prenatal education, inpatient and postpartum lactation support, and ongoing multidisciplinary SUD treatment can facilitate breastfeeding continuation. (2, B)
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Individual programs and institutions should establish breastfeeding guidelines to mitigate bias, facilitate consistency across providers, and empower individuals with SUD. (3, C)
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Setting of Nonprescribed Substance Use
Opioids
Breastfeeding should be avoided during the use of nonprescribed opioids. (2, B)
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Sedative hypnotics
Breastfeeding should be avoided during the use of nonprescribed sedative hypnotics. (3, C)
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Prescribed benzodiazepines
In breastfeeding mothers who stop nonprescribed use but remain on prescribed benzodiazepine tapers for the treatment of benzodiazepine use disorder, or for anxiety disorders, mothers may return to breastfeeding. (2, B)
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Stimulants
Breastfeeding should be avoided during the use of nonprescribed stimulants. (3, B)
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Alcohol
Breastfeeding should be avoided immediately after moderate-to-high alcohol consumption. Occasional intake of modest amounts of alcohol (two 150 mL glasses of wine or 1.5 pints of beer) during lactation and waiting for 2 hours per drink consumed to resume breastfeeding is likely safe. (1, A)
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Combustible tobacco and nicotine vaping
We recommend breastfeeding to be continued in those mothers who smoke or vape, given the documented benefits, but suggest they reduce their use as much as possible and avoid tobacco smoking and nicotine vaping product use around their infants. (1, A)
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We encourage cessation and/or reduction of cannabis use during breastfeeding. (2, B)
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For mothers who continue to use cannabis and wish to breastfeed, we recommend a shared decision-making process to discuss the risks and benefits of breastfeeding. Discussions may be guided by examining the route and type of cannabis product use, potency of product use, and frequency of use. (3, C)
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Setting of Substance Use Treatment
Methadone
Breastfeeding is compatible with methadone treatment, regardless of dose, and recommended in mothers taking methadone. During periods of titration, breastfeeding mothers should be counselled to monitor for infant sedation. (2, A)
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Buprenorphine sublingual
Breastfeeding is compatible with sublingual-buprenorphine formulations and is recommended in mothers taking sublingualbuprenorphine. (2, A)
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Buprenorphine injectable
Safety data for injectable extended-release buprenorphine formulations are lacking. Decisions around and treatment changes to support breastfeeding should be made in consultation with the patient and addiction provider given the risks associated with changes in OUD treatment. (3, C)
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Naltrexone
Breastfeeding is compatible with naltrexone and is recommended in mothers taking naltrexone. (3, B)
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Acamprosate
Breastfeeding appears compatible with acamprosate, but there is little evidence; thus, providers should pursue a risk–benefit discussion with patients to guide decision-making. (3, C)
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Disulfiram
Breastfeeding does not appear compatible with disulfiram given risk of infant exposure and risk of alcohol toxicity in the breastfeeding mother. Thus, other AUD treatments should be pursued over disulfiram in the setting of breastfeeding. (3, C)
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NRT
Breastfeeding is compatible with NRT and is recommended in mothers taking NRT. The type of NRT should be determined by the clinical needs of the breastfeeding mother. (2, B)
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Varenicline
Animal data suggest there may be some harms associated with varenicline exposure through breast milk, though clinical data are lacking. Providers should pursue a risk–benefit discussion with patients to guide decision-making based on the severity of tobacco use disorder and the clinical context. (3, C)
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Bupropion
Breastfeeding is compatible with bupropion, and bupropion is recommended in the setting of breastfeeding. (2, B)
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- NRT: Nicotine Replacement Therapy
- SUD: Substance Use Disorder
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Breastfeeding in the Setting of Substance Use and Substance Use Disorder
Authoring Organization
Academy of Breastfeeding Medicine
Publication Month/Year
October 17, 2023
Last Updated Month/Year
November 20, 2023
Country of Publication
US
Document Objectives
This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
Target Patient Population
Breastfeeding mothers with substance use disorders
Target Provider Population
Clinicians caring for breastfeeding mothers with substance use disorders, including OBGYNs, psychiatrists, addictions specialists and similar
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Addiction treatment specialist, nurse, nurse midwife, nurse practitioner, physician, physician assistant, social worker
Scope
Counseling, Management
Diseases/Conditions (MeSH)
D001942 - Breast Feeding, D019966 - Substance-Related Disorders
Keywords
Breastfeeding, Substance use disorders, substance use disorder, SUD in pregnancy
Source Citation
Miriam Harris, Davida M. Schiff, Kelley Saia, Serra Muftu, Katherine R. Standish, and Elisha M. Wachman. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeeding Medicine.Oct 2023.715-733.http://doi.org/10.1089/bfm.2023.29256.abm