Tobacco, the enemy of breastfeeding

Tobacco kills. We know this, among other things, because it is on the packs. We know that “9 out of 10 lung cancers are caused by tobacco”, that “smoking causes heart attacks” and also that “smoking can kill the child you are carrying”. But what the packs don’t warn us about is that smoking during pregnancy also reduces the duration of breastfeeding.

Breastfeeding has multiple benefits, the most immediate being those related to the health of the baby. But, in addition, it has positive effects on intellectual development and the prevention of chronic diseases in adulthood.

Due to this, the babies of smoking mothers are exposed to a double risk: that of the effects of tobacco during the development of the fetus and, later, that associated with shorter lactations.

The importance of tobacco in the initiation of lactation

Given the strong association between smoking in pregnancy and decreased breastfeeding rates, we decided to investigate this phenomenon further. In a study involving 401 women who intended to breastfeed, information was collected from pregnancy to the baby’s first year of life. This is what we find in relation to tobacco during pregnancy:

  • Women who smoked during pregnancy lactated less than those who did not smoke. The most notable difference between the two groups was observed in the first week and the first month after birth, but after a year this difference had disappeared.

  • Women who smoked at the time they became pregnant and who quit smoking during pregnancy enjoyed longer lactation periods, much longer than those who never smoked.

  • In addition, women who smoked during pregnancy used teats and pacifiers more frequently in the first week of the baby’s life, and also introduced formula milk earlier.

This last point is important since, for breastfeeding to start, it is essential that the baby suck and stimulate the nipple repeatedly as soon as it is born. Continued sucking causes the secretion of two hormones: prolactin, which stimulates milk production, and oxytocin, which allows it to come out. Hence, the tendency to introduce formula milk early and to use pacifiers in the first days after birth can be an obstacle to breastfeeding.

Added to this is the fact that nicotine and other tobacco components could directly affect this process due to their possible influence on the hormones that direct lactogenesis.

How to promote lactation in smoking mothers

The collected data suggest that smoking during pregnancy influences breastfeeding in quite complex ways. Physiological factors could affect the establishment of breastfeeding, but psychosocial factors such as motivation, and customs and practices related to upbringing should also be considered.

What is clear is that quitting smoking during pregnancy carries different nuances than quitting in other contexts. For this reason, in order for strategies to promote breastfeeding in smoking women to be successful, it is essential to take into account the specific circumstances that surround each woman at this stage.

An important aspect to consider would be the limited availability of drugs authorized to stop smoking during pregnancy. The strong motivational component related to the health of the baby would also be present, which could be key to the success of smoking cessation.

On the other hand, when it is not possible to quit smoking, it is necessary to correctly address the doubts that often arise about smoking during breastfeeding, without also forgetting psychological aspects such as anxiety and guilt that these women may suffer.

Finally, based on the conclusions of this study, from our research group we propose the following specific interventions in relation to tobacco and breastfeeding:

There is no doubt that the effort to improve health from birth, and into adulthood, involves increasing breastfeeding rates. For this, it is necessary to attend to the complex relationship that exists between tobacco and lactation.

The UPV/EHU has financed the expenses associated with the open access publication of the article in the journal ‘Journal of Neonatal Nursing’ in which the results that appear in this text have been presented.

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