Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023)
Publication: Breastfeeding Medicine
Volume 18, Issue Number 10
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments.
Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother–infant dyads.
Recommendations: 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.
Get full access to this article
View all available purchase options and get full access to this article.
References
1. Hernández-Aguilar M-T, Bartick M, Schreck P, et al. ABM clinical protocol #7: Model maternity policy supportive of breastfeeding. Breastfeed Med 2018;13(9):559–574;
2. Reece-Stremtan S, Campos M, Kokajko L. ABM clinical protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med 2017;12(9):500–506.
3. Sriraman NK, Melvin K, Meltzer-Brody S, et al. ABM clinical protocol #18: Use of antidepressants in breastfeeding mothers. Breastfeed Med 2015;10(6):290–299;
4. Reece-Stremtan S, Marinelli KA. ABM clinical protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeed Med 2015;10(3):135–141;
5. Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69(3):548–56.
6. Feldman-Winter L, Bartick M, Marinelli K, et al. Academy of breastfeeding medicine recommendations on changes to classification of levels of evidence for clinical protocols. Breastfeed Med 2021;16(3):185–188;
7. Verstegen RHJ, Ito S. Drugs in lactation. J Obstet Gynaecol Res 2019;45(3):522–531;
8. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther 2016;100(1):42–52;
9. Hale TW, Krutsch K. Hale's Medications & Mothers' Milk 2023: A Manual of Lactational Pharmacology. Springer Publishing Company: New York; 2022.
10. Cicero T, Ellis M, Surratt H, et al. The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry 2014;71(7):821–826.
11. Han B, Cotto J, Etz K, et al. Methamphetamine overdose deaths in the US by sex and race and ethnicity. JAMA Psychiatry 2021;78(5):564–567;
12. Keyes KM, Grant BF, Hasin DS. Evidence for a closing gender gap in alcohol use, abuse, and dependence in the United States population. Drug Alcohol Depend 2008;93(1–2):21–29;
13. Ito S. Opioids in breast milk: pharmacokinetic principles and clinical implications. J Clin Pharmacol 2018;58:S151–S163;
14. Degenhardt L, Charlson F, Ferrari A, et al. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry 2018;5(12):987–1012;
15. Substance Use and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Substance Use and Mental Health Services Administration; Rockville, MD, USA; 2023.
16. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet 2016;387(10017):475–490;
17. Welle-Strand GK, Skurtveit S, Jansson LM, et al. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr Oslo Nor 1992 2013;102(11):1060–1066;
18. Abdel-Latif ME, Pinner J, Clews S, et al. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006;117(6):e1163–e1169;
19. Chapman SLC, Wu L-T. Postpartum substance use and depressive symptoms: A review. Women Health 2013;53(5):479–503;
20. Rutherford H, Williams S, Moy S, et al. Disruption of maternal parenting circuitry by addictive process: Rewiring of reward and stress systems. Front Psychiatry 2011;2:37.
21. D'Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol 2013;56(1):202–211;
22. Lotzin A, Grundmann J, Hiller P, et al. Profiles of childhood trauma in women with substance use disorders and comorbid posttraumatic stress disorders. Front Psychiatry 2019;10:674;
23. Choi S, Rosenbloom D, Stein MD, et al. Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review. J Addict Med 2022;16(3):e185–e196;
24. Harris MTH, Laks J, Stahl N, et al. Gender dynamics in substance use and treatment: A women's focused approach. Med Clin North Am 2022;106(1):219–234;
25. Vythilingum B, Roos A, Faure SC, et al. Risk factors for substance use in pregnant women in South Africa. S Afr Med J 2012;102(11):851;
26. Stulac S, Bair-Merritt M, Wachman EM, et al. Children and families of the opioid epidemic: Under the radar. Curr Probl Pediatr Adolesc Health Care 2019;49(8):100637;
27. Marshall SK, Charles G, Hare J, et al. Sheway's services for substance using pregnant and parenting women: Evaluating the outcomes for infants. Can J Community Ment Health Rev Can Sante Ment Communaut 2005;24(1):19–34;
28. Ganetsky VS, Heil J, Yates B, et al. A low-threshold comprehensive shared medical appointment program for perinatal substance use in an underserved population. J Addict Med 2022;16(3):e203–e209;
29. Schiff DM, Partridge S, Gummadi NH, et al. Caring for families impacted by opioid use: A qualitative analysis of integrated program designs. Acad Pediatr 2022;22(1):125–136;
30. Guttmacher Institute. Substance Use During Pregnancy. Guttmacher Institute: New York, NY, USA; 2021.
31. Murphy AS. A survey of state fetal homicide laws and their potential applicability to pregnant women who harm their own fetuses. Ind LJ 2014;89:847.
32. Boyd S. Gendered drug policy: Motherisk and the regulation of mothering in Canada. Int J Drug Policy 2019;68:109–116;
33. Oni HT, Drake JA, Dietze P, et al. Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study. Women Birth J Aust Coll Midwives 2022;35(6):576–581;
34. Kozhimannil KB, Dowd WN, Ali MM, et al. Substance use disorder treatment admissions and state-level prenatal substance use policies: Evidence from a national treatment database. Addict Behav 2019;90:272–277;
35. Hui K, Angelotta C, Fisher CE. Criminalizing substance use in pregnancy: Misplaced priorities. Addict Abingdon Engl 2017;112(7):1123–1125.
36. Chen C-Y, Wang I-A, Fang S-Y, et al. Inadequate prenatal care utilization among women with and without methadone-treated opioid use disorders in Taiwan. Int J Drug Policy 2019;67:1–8;
37. Slabbert I, Greene MC, Womersley JS, et al. Article commentary: Women and substance use disorders in low- and middle-income countries: A call for advancing research equity in prevention and treatment. Subst Abuse 2020;41(1):6–10;
38. Harp KLH, Bunting AM. The racialized nature of child welfare policies and the social control of black bodies. Soc Polit 2020;27(2):258–281;
39. Pflugeisen BM, Mou J, Drennan KJ, et al. Demographic discrepancies in prenatal urine drug screening in Washington State surrounding recreational marijuana legalization and accessibility. Matern Child Health J 2020;24(12):1505–1514;
40. Schiff DM, Nielsen T, Hoeppner BB, et al. Assessment of racial and ethnic disparities in the use of medication to treat opioid use disorder among pregnant women in Massachusetts. JAMA Netw Open 2020;3(5):e205734;
41. Perlman NC, Cantonwine DE, Smith NA. Racial differences in indications for obstetrical toxicology testing and relationship of indications to test results. Am J Obstet Gynecol MFM 2021;4(1):100453;
42. Cedar Project Partnership, Clarkson AF, Christian WM, et al. The Cedar Project: Negative health outcomes associated with involvement in the child welfare system among young Indigenous people who use injection and non-injection drugs in two Canadian cities. Can J Public Health Rev Can Sante Publique 2015;106(5):e265–e270;
43. Mitchell-Foster SM, Emon CE, Brouwer M, et al. Disconnected perspectives: Patient and care provider's experiences of substance use in pregnancy. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2021;155(2):170–178;
44. Burns L, Mattick RP, Lim K, et al. Methadone in pregnancy: Treatment retention and neonatal outcomes. Addict Abingdon Engl 2007;102(2):264–270;
45. Nidey N, Groh K, Agnoli A, et al. Breastfeeding initiation and continuation among women with substance and tobacco use during pregnancy: Findings from the pregnancy risk assessment monitoring system 2016–2018. Breastfeed Med Off J Acad Breastfeed Med 2022;17(6):544–549;
46. Stephen JM, Shrestha S, Jimenez EY, et al. Disparities in breastfeeding outcomes among women with opioid use disorder. Acta Paediatr Oslo Nor 1992 2020;109(5):1064–1066;
47. Rangmar J, Lilja M, Köhler M, et al. Children who face development risks due to maternal addiction during pregnancy require extra medical and psychosocial resources. Acta Paediatr 2019;108(1):101–105;
48. Arnaudo CL, Andraka-Christou B, Allgood K. Psychiatric co-morbidities in pregnant women with opioid use disorders: Prevalence, impact, and implications for treatment. Curr Addict Rep 2017;4(1):1–13;
49. Cottler LB, Nishith P, Compton WM. Gender differences in risk factors for trauma exposure and post-traumatic stress disorder among inner-city drug abusers in and out of treatment. Compr Psychiatry 2001;42(2):111–117;
50. Demirci JR, Bogen DL, Klionsky Y. Breastfeeding and methadone therapy: The maternal experience. Subst Abuse 2015;36(2):203–208;
51. Jansson LM, Velez ML, Butz AM. The effect of sexual abuse and prenatal substance use on successful breastfeeding. J Obstet Gynecol Neonatal Nurs 2017;46(3):480–484;
52. Yonke N, Jimenez EY, Leeman L, et al. Breastfeeding motivators and barriers in women receiving medications for opioid use disorder. Breastfeed Med 2020;15(1):17–23;
53. Howard MB, Wachman E, Levesque EM, et al. The joys and frustrations of breastfeeding and rooming-in among mothers with opioid use disorder: A qualitative study. Hosp Pediatr 2018;8(12):761–768;
54. Hicks J, Morse E, Wyant DK. Barriers and facilitators of breastfeeding reported by postpartum women in methadone maintenance therapy. Breastfeed Med 2018;13(4):259–265;
55. Cook KJ, Larson KL. Breastworks: Breastfeeding practices among women with substance use disorder. Appl Nurs Res ANR 2019;47:41–45;
56. Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: A review of the literature and current management guidelines. J Hum Lact 2004;20(1):62–71;
57. World Health Organization. Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. World Health Organization: Geneva; 2014.
58. American College of Obstetricians and Gynecologists Committee on Health Care for Undeserved Women. ACOG Committee opinion no. 343: Psychosocial risk factors: Perinatal screening and intervention. Obstet Gynecol 2006;108(2):469–477;
59. Wanar A, Saia K, Field TA. Delayed norfentanyl clearance during pregnancy. Obstet Gynecol 2020;136(5):905–907;
60. Sazegar P. Cannabis essentials: Tools for clinical practice. Am Fam Physician 2021;104(6):598–608.
61. Moeller KE, Kissack JC, Atayee RS, et al. Clinical interpretation of urine drug tests: What clinicians need to know about urine drug screens. Mayo Clin Proc 2017;92(5):774–796;
62. Harris M, Joseph K, Hoeppner B, et al. A retrospective cohort study examining the utility of perinatal urine toxicology testing to guide breastfeeding initiation. J Addict Med 2021;15(4):311–317;
63. Ordean A, Kim G. Cannabis use during lactation: Literature review and clinical recommendations. J Obstet Gynaecol Can 2020;42(10):1248–1253;
64. Wachman EM, Saia K, Humphreys R, et al. Revision of breastfeeding guidelines in the setting of maternal opioid use disorder: One institution's experience. J Hum Lact 2016;32(2):382–387;
65. Blandthorn J, James K, Bowman E, et al. Two case studies illustrating a shared decision-making approach to illicit methamphetamine use and breastfeeding. Breastfeed Med 2017;12(6):381–385;
66. Tsai LC, Doan TJ. Breastfeeding among mothers on opioid maintenance treatment: A literature review. J Hum Lact 2016;32(3):521–529;
67. Doerzbacher M, Chang YP. Supporting breastfeeding for women on opioid maintenance therapy: A systematic review. J Perinatol 2019;39(9):1159–1164;
68. Crook K, Brandon D. Prenatal breastfeeding education: Impact on infants with neonatal abstinence syndrome. Adv Neonatal Care 2017;17(4):299–305;
69. Schiff DM, Wachman EM, Philipp B, et al. Examination of hospital, maternal, and infant characteristics associated with breastfeeding initiation and continuation among opioid-exposed mother-infant dyads. Breastfeed Med 2018;13(4):266–274;
70. Shukla S, Hanna I, Cortez J, et al. Increasing usage of mother's own milk in neonates at risk of neonatal abstinence syndrome: MOM-NAS quality improvement initiative. J Perinatol 2021;41(11):2684–2689;
71. MacMillan KDL, Rendon CP, Verma K, et al. Association of rooming-in with outcomes for neonatal abstinence syndrome: A systematic review and meta-analysis. JAMA Pediatr 2018;172(4):345;
72. Moore ER, Anderson GC, Bergman N, et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2012;5:CD003519;
73. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder documented at delivery hospitalization—United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2018;67(31):845–849;
74. Ko JY, Patrick SW, Tong VT, et al. Incidence of neonatal abstinence syndrome—28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65(31):799–802;
75. Patrick SW, Barfield WD, Poindexter BB. Neonatal opioid withdrawal syndrome. Pediatrics 2020;146(5):e2020029074;
76. Turner SD, Gomes T, Camacho X, et al. Neonatal opioid withdrawal and antenatal opioid prescribing. CMAJ Open 2015;3(1):E55–E61;
77. Substance Abuse Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration: Rockville, MD; 2020.
78. Ciccarone D. Fentanyl in the US heroin supply: A rapidly changing risk environment. Int J Drug Policy 2017;46:107–111;
79. Lewis B, Hoffman LA, Nixon SJ. Sex differences in drug use among polysubstance users. Drug Alcohol Depend 2014;145:127–133;
80. Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry 2021;34(4):344–350.
81. DiGennaro C, Garcia G-GP, Stringfellow EJ, et al. Changes in characteristics of drug overdose death trends during the COVID-19 pandemic. Int J Drug Policy 2021;98:103392;
82. Frank RG, Pollack HA. Addressing the fentanyl threat to public health. N Engl J Med 2017;376(7):605–607;
83. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid–involved overdose deaths—27 states, 2013–2014. MMWR Morb Mortal Wkly Rep; 2016;65(33);837–843.
84. Laing MK, Tupper KW, Fairbairn N. Drug checking as a potential strategic overdose response in the fentanyl era. Int J Drug Policy 2018;62:59–66;
85. Bogen DL, Whalen BL. Breastmilk feeding for mothers and infants with opioid exposure: What is best? Semin Fetal Neonatal Med 2019;24(2):95–104;
86. Hendrickson RG, McKeown NJ. Is maternal opioid use hazardous to breast-fed infants? Clin Toxicol 2012;50(1):1–14.
87. Bruneau J, Ahamad K, Goyer M-È, et al. Management of opioid use disorders: A national clinical practice guideline. CMAJ 2018;190(9):E247–E257.
88. Krčevski Škvarč N, Morlion B, Vowles KE, et al. European clinical practice recommendations on opioids for chronic noncancer pain—Part 2: Special situations*. Eur J Pain U K 2021;25(5):969–985;
89. Drugs and Lactation Database (LactMed). Heroin. National Institutes of Health: Bethesda (MD); 2021.
90. Lee AI, McCarthy RJ, Toledo P, et al. Epidural labor analgesia-fentanyl dose and breastfeeding success: A randomized clinical trial. Anesthesiology 2017;127(4):614–624;
91. Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J 2008;29(5):678–682.
92. Yousefshahi F, Davari-Tanha F, Najafi A, et al. Effects of intrathecal opioids use in cesarean section on breastfeeding and newborns' weight gaining. J Fam Reprod Health 2016;10(4):176–183.
93. Fleet J-A, Jones M, Belan I. The influence of intrapartum opioid use on breastfeeding experience at 6 weeks postpartum: A secondary analysis. Midwifery 2017;50:106–109;
94. Wilson MJA, MacArthur C, Cooper GM, et al. Epidural analgesia and breastfeeding: A randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia 2010;65(2):145–153;
95. Raksakulkiat S, Punpuckdeekoon P. A comparison of meperidine and fentanyl for labor pain reduction in Phramongkutklao Hospital. J Med Assoc Thai 2019;102(2):197–202.
96. Choi J-W, Lee J, Jung SJ, et al. Use of sedative-hypnotics and mortality: A population-based retrospective cohort study. J Clin Sleep Med 2018;14(10):1669–1677;
97. Kaufmann CN, Spira AP, Alexander C, et al. Trends in prescribing of sedative-hypnotic medications in the United States: 1993–2010. Pharmacoepidemiol Drug Saf 2016;25(6):637–645;
98. Bais B, Molenaar NM, Bijma HH, et al. Prevalence of benzodiazepines and benzodiazepine-related drugs exposure before, during and after pregnancy: A systematic review and meta-analysis. J Affect Disord 2020;269:18–27;
99. Votaw VR, Geyer R, Rieselbach MM, et al. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019;200:95–114;
100. Tobias S, Shapiro AM, Grant CJ, et al. Drug checking identifies counterfeit alprazolam tablets. Drug Alcohol Depend 2021;218:108300.
101. McAuley A, Matheson C, Robertson JR. From the clinic to the street: The changing role of benzodiazepines in the Scottish overdose epidemic. Int J Drug Policy 2022;100:103512.
102. Tupper KW, McCrae K, Garber I, et al. Initial results of a drug checking pilot program to detect fentanyl adulteration in a Canadian setting. Drug Alcohol Depend 2018;190:242–245;
103. Laing MK, Ti L, Marmel A, et al. An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods. Int J Drug Policy 2021;93:103169.
104. Nishimura A, Furugen A, Umazume T, et al. Benzodiazepine concentrations in the breast milk and plasma of nursing mothers: Estimation of relative infant dose. Breastfeed Med 2021;16(5):424–431;
105. Payne JL. Psychopharmacology in pregnancy and breastfeeding. Med Clin North Am 2019;103(4):629–650.
106. Gilder ME, Tun NW, Carter A, et al. Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting. BMC Pregnancy Childbirth 2021;21(1):121.
107. Uguz F. A new safety scoring system for the use of psychotropic drugs during lactation. Am J Ther 2021;28(1):e118–e126.
108. Miller MA, Mehta N, Clark-Bilodeau C, et al. Sleep pharmacotherapy for common sleep disorders in pregnancy and lactation. Chest 2020;157(1):184–197.
109. Damkier P, Videbech P, Larsen ER. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand 2016;133(5):429–430.
110. Betcher HK, Wisner KL. Psychotropic treatment during pregnancy: Research synthesis and clinical care principles. J Womens Health 2020;29(3):310–318.
111. Kaplan YC, Demir O. Use of phenytoin, phenobarbital carbamazepine, levetiracetam lamotrigine and valproate in pregnancy and breastfeeding: Risk of major malformations, dose-dependency, monotherapy vs polytherapy, pharmacokinetics and clinical implications. Curr Neuropharmacol 2021;19(11):1805–1824.
112. Bollig KJ, Jackson DL. Seizures in pregnancy. Obstet Gynecol Clin North Am 2018;45(2):349–367.
113. Anderson PO. Antiepileptic drugs during breastfeeding. Breastfeed Med 2020;15(1):2–4.
114. Drugs and Lactation Database (LactMed). Gabapentin. National Library of Medicine: Bethesda, MD, USA; 2006.
115. Fujimura K, Mitsuhashi T, Takahashi T. Adverse effects of prenatal and early postnatal exposure to antiepileptic drugs: Validation from clinical and basic researches. Brain Dev 2017;39(8):635–643.
116. McAllister-Williams RH, Baldwin DS, Cantwell R, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017;31(5):519–552.
117. Thorsness KR, Watson C, LaRusso EM. Perinatal anxiety: Approach to diagnosis and management in the obstetric setting. Am J Obstet Gynecol 2018;219(4):326–345.
118. Kronenfeld N, Baran TZ, Berlin M, et al. Chronic use of psychotropic medications in breastfeeding women: Is it safe? PLoS One 2018;13(5):e0197196.
119. Madgula RM, Groshkova T, Mayet S. Illicit drug use in pregnancy: Effects and management. Expert Rev Obstet Gynecol 2011;6(2):179–192;
120. Camacho X, Zoega H, Gomes T, et al. The association between psychostimulant use in pregnancy and adverse maternal and neonatal outcomes: Results from a distributed analysis in two similar jurisdictions. Int J Epidemiol 2023;52(1):190–202;
121. Admon LK, Bart G, Kozhimannil KB, et al. Amphetamine- and opioid-affected births: Incidence, outcomes, and costs, United States, 2004–2015. Am J Public Health 2019;109(1):148–154;
122. Bailey DN. Cocaine and cocaethylene binding to human milk. Am J Clin Pathol 1998;110(4):491–494;
123. Winecker RE, Goldberger BA, Tebbett IR, et al. Detection of Cocaine and Its Metabolites in Breast. 2001.
124. Marchei E, Escuder D, Pallas CR, et al. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal 2011;55(2):309–316;
125. Resende dos Santos R, Jose Nunes Paisa M, Cesar Veloso J, et al. Efficient extraction method using magnetic carbon nanotubes to analyze cocaine and benzoylecgonine in breast milk by GC/MS. Bioanalysis 2017;9(21):1655–1666;
126. Silveira G de O, Belitsky ÍT, Loddi S, et al. Development of a method for the determination of cocaine, cocaethylene and norcocaine in human breast milk using liquid phase microextraction and gas chromatography-mass spectrometry. Forensic Sci Int 2016;265:22–28;
127. Chomchai C, Chomchai S, Kitsommart R. Transfer of methamphetamine (MA) into breast milk and urine of postpartum women who smoked MA tablets during pregnancy: Implications for initiation of breastfeeding. J Hum Lact 2016;32(2):333–339;
128. Bartu A, Dusci LJ, Ilett KF. Transfer of methylamphetamine and amphetamine into breast milk following recreational use of methylamphetamine. Br J Clin Pharmacol 2009;67(4):455–459;
129. Chasnoff I, Lewis D, Squires L. Cocaine intoxication in a breast-fed infant. Pediatrics 1987;80:836–838.
130. Park JN, Rashidi E, Foti K, et al. Fentanyl and fentanyl analogs in the illicit stimulant supply: Results from U.S. drug seizure data, 2011–2016. Drug Alcohol Depend 2021;218(June 2020):108416;
131. Steiner E, Villen T, Hallberg M, et al. Amphetamine secretion in breast milk. Eur J Clin Pharmacol 1984;27:123–124.
132. Öhman I, Wikner BN, Beck O, et al. Narcolepsy treated with racemic amphetamine during pregnancy and breastfeeding. J Hum Lact 2015;31(3):374–376;
133. Ilett KF, Hackett LP, Kristensen JH, et al. Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. Br J Clin Pharmacol 2007;63(3):371–375;
134. Kristianssona B, Ghanib NA, Eriksson M, et al. Use of Khat in lactating women: A pliot study on breast-milk secretion. J Ethnopharmacol 1987;21:85–90;
135. Smid MC, Meta TD, Gordon AJ. Stimulant use in pregnancy. Clin Obstet Gynecol 2019;62(1):168–184.
136. de la Torre R, Farré M, Roset PN, et al. Human pharmacology of MDMA: Pharmacokinetics, metabolism, and disposition. Ther Drug Monit 2004;26(2):137–144;
137. Mello NK, Mendelson JH. Cocaine's effects on neuroendocrine systems: Clinical and preclinical studies. Pharmacol Biochem Behav 1997;57(3):571–599;
138. Patkar AA, Hill KP, Sterling RC, et al. Serum prolactin and response to treatment among cocaine-dependent individuals. Addict Biol 2002;7(1):45–53;
139. DeLeo V, Cella SG, Camanni F, et al. Prolactin lowering effect of amphetamine in normoprolactinemic subjects and in physiological and pathological hyperprolactinemia. Horm Metab Res 1983;15(9):439–443;
140. Petraglia F, de Leo V, Sardelli S, et al. Prolactin changes after administration of agonist and antagonist dopaminergic drugs in puerperal women. Gynecol Obstet Invest 1987;23(2):103–109;
141. Chaney N, Franke J, Wadlington WB. Cocaine convulsions in a breast-feeding baby. J Pediatr 1988;112(1):134–135;
142. Mihretu A, Teferra S, Fekadu A. What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia. Subst Abuse Treat Prev Policy 2017;12(1):1–12;
143. Ariagno R, Karch S, Middleberg R, et al. Methamphetamine ingestion by a breast-feeding mother and her infant's death: People v Henderson. JAMA 1995;274(3):215–215;
144. Kenneally M, Byard RW. Increasing methamphetamine detection in cases of early childhood fatalities. J Forensic Sci 2020;65(4):1376–1378;
145. Tse R, Kesha K, Morrow P, et al. Commentary on: Kenneally M, Byard RW. Increasing methamphetamine detection in cases of early childhood fatalities. J Forensic Sci 2020;65(4):1384–1384;
146. Bohm MK, Liu Y, Esser MB, et al. Binge drinking among adults, by select characteristics and state—United States, 2018. MMWR Morb Mortal Wkly Rep 2021;70(41):1441–1446;
147. Bakhireva LN, Shrestha S, Garrison L, et al. Prevalence of alcohol use in pregnant women with substance use disorder. Drug Alcohol Depend 2018;187:305–310;
148. Denny CH, Acero CS, Terplan M, et al. Trends in alcohol use among pregnant women in the U.S., 2011–2018. Am J Prev Med 2020;59(5):768–769;
149. Mårdby A-C, Lupattelli A, Hensing G, et al. Consumption of alcohol during pregnancy—A multinational European study. Women Birth 2017;30(4):e207–e213;
150. Oei JL. Alcohol use in pregnancy and its impact on the mother and child. Addiction 2020;115(11):2148–2163;
151. Wilson J, Tay RY, McCormack C, et al. Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Drug Alcohol Rev 2017;36(5):667–676;
152. Gibson L, Porter M. Drinking or smoking while breastfeeding and later academic outcomes in children. Nutrients 2020;12(3):829;
153. Dumas A, Toutain S, Simmat-Durand L. Alcohol use during pregnancy or breastfeeding: A national survey in France. J Womens Health 2017;26(7):798–805;
154. Graves L, Carson G, Poole N, et al. Guideline no. 405: Screening and counselling for alcohol consumption during pregnancy. J Obstet Gynaecol Can 2020;42(9):1158.e1–1173.e1; doi: 10.1016/J.JOGC.2020.03.002
155. Haastrup MB, Pottegård A, Damkier P. Alcohol and breastfeeding. Basic Clin Pharmacol Toxicol 2014;114(2):168–173;
156. Ho E, Collantes A, Kapur BM, et al. Alcohol and breast feeding: Calculation of time to zero level in milk. Biol Neonate 2001;80(3):219–222;
157. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973;115(6):817–821;
158. Dejong K, Olyaei A, Lo JO. Alcohol use in pregnancy. Clin Obstet Gynecol 2019;62(1):142–142;
159. Mennella JA. Regulation of milk intake after exposure to alcohol in mothers' milk. Alcohol Clin Exp Res 2001;25(4):590–593;
160. Sachs HC. The transfer of drugs and therapeutics into human breast milk: An update on selected topics. Pediatrics 2013;132(3):e796–e809;
161. Gibson L, Porter M. Drinking or smoking while breastfeeding and later cognition in children. Pediatrics 2018;142(2):e20174266;
162. Eidelman AI. Smoking, vaping, while breastfeeding in the era of COVID-19. Breastfeed Med 2021;16(10):765;
163. Singh PK, Singh L, Wehrmeister FC, et al. Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries. eClinicalMedicine 2022;53:101660;
164. Myr R. Promoting, protecting, and supporting breastfeeding in a community with a high rate of tobacco use. J Hum Lact 2004;20(4):415–416;
165. Carswell AL, Ward KD, Vander Weg MW, et al. Prospective associations of breastfeeding and smoking cessation among low-income pregnant women. Matern Child Nutr 2018;14(4):e12622;
166. Dorea JG. Maternal smoking and infant feeding: Breastfeeding is better and safer. Matern Child Health J 2007;11(3):287–291;
167. Calvaresi V, Escuder D, Minutillo A, et al. Transfer of nicotine, cotinine and caffeine into breast milk in a smoker mother consuming caffeinated drinks. J Anal Toxicol 2016;40(6):473–477;
168. Dahlström A, Ebersjö C, Lundell B. Nicotine exposure in breastfed infants. Acta Paediatr Oslo Nor 1992 2004;93(6):810–816.
169. Napierala M, Mazela J, Merritt TA, et al. Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review. Environ Res 2016;151:321–338;
170. Nordenstam F, Lundell B, Edstedt Bonamy A-K, et al. Snus users had high levels of nicotine, cotinine and 3-hydroxycotinine in their breastmilk, and the clearance was slower than in smoking mothers. Acta Paediatr Oslo Nor 1992 2019;108(7):1250–1255;
171. Vio F, Salazar G, Infante C. Smoking during pregnancy and lactation and its effects on breast-milk volume. Am J Clin Nutr 1991;54(6):1011–1016;
172. Adgent MA. Environmental tobacco smoke and sudden infant death syndrome: A review. Birth Defects Res B Dev Reprod Toxicol 2006;77(1):69–85;
173. Fleming P, Blair PS. Sudden infant death syndrome and parental smoking. Early Hum Dev 2007;83(11):721–725;
174. Chang C, Vivekanandarajah A, Waters KA, et al. Cell death in the lateral geniculate nucleus, and its possible relationship with nicotinic receptors and sudden infant death syndrome (SIDS). Mol Neurobiol 2023;60(7):4120–4131;
175. Miranda RA, Gaspar de Moura E, Lisboa PC. Tobacco smoking during breastfeeding increases the risk of developing metabolic syndrome in adulthood: Lessons from experimental models. Food Chem Toxicol 2020;144:111623;
176. Batstra L, Neeleman J, Hadders-Algra M. Can breast feeding modify the adverse effects of smoking during pregnancy on the child's cognitive development? J Epidemiol Community Health 2003;57(6):403–404;
177. Nafstad P, Jaakkola J, Hagen J, et al. Breastfeeding, maternal smoking and lower respiratory tract infections. Eur Respir J 1996;9(12):2623–2629;
178. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess 2007;(153):1–186.
179. Bahji A, Stephenson C. International perspectives on the implications of cannabis legalization: A systematic review & thematic analysis. Int J Environ Res Public Health 2019;16(17):3095;
180. Corsi DJ, Hsu H, Weiss D, et al. Trends and correlates of cannabis use in pregnancy: A population-based study in Ontario, Canada from 2012 to 2017. Can J Public Health 2019;110(1):76–84;
181. Towobola A, Towobola B, Nair B, et al. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: Narrative review. BJPsych Bull 2021;1–10;
182. Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol 2018;84(11):2477–2482;
183. Moss MJ, Bushlin I, Kazmierczak S, et al. Cannabis use and measurement of cannabinoids in plasma and breast milk of breastfeeding mothers. Pediatr Res 2021;90(4):861–868;
184. Wymore EM, Palmer C, Wang GS, et al. Persistence of δ-9-tetrahydrocannabinol in human breast milk. JAMA Pediatr 2021;175(6):632–634;
185. Joseph P, Vettraino IM. Cannabis in pregnancy and lactation—A review. Mo Med 2020;117(5):400–405.
186. Baker T, Datta P, Rewers-Felkins K, et al. Transfer of inhaled cannabis into human breast milk. Obstet Gynecol 2018;131(5):783–788;
187. Bertrand KA, Hanan NJ, Honerkamp-Smith G, et al. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics 2018;142(3):e20181076;
188. Badowski S, Smith G. Cannabis use during pregnancy and postpartum. Can Fam Physician Med Fam Can 2020;66(2):98–103.
189. Crume TL, Juhl AL, Brooks-Russell A, et al. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: The association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr 2018;197:90–96;
190. Murphy LL, Muñoz RM, Adrian BA, et al. Function of cannabinoid receptors in the neuroendocrine regulation of hormone secretion. Neurobiol Dis 1998;5(6 Pt B):432–446;
191. Ranganathan M, Braley G, Pittman B, et al. The effects of cannabinoids on serum cortisol and prolactin in humans. Psychopharmacology (Berl) 2009;203(4):737–744;
192. Olusi SO. Hyperprolactinaemia in patients with suspected cannabis-induced gynaecomastia. Lancet Lond Engl 1980;1(8162):255;
193. Harmon J, Aliapoulios MA. Gynecomastia in marihuana users. N Engl J Med 1972;287(18):936;
194. Josan C, Shiplo S, Fusch G, et al. Cannabis use during lactation may alter the composition of human breast milk. Pediatr Res 2023;93(7):1959–1968;
195. Martin GI. Marijuana: The effects on pregnancy, the fetus, and the newborn. J Perinatol 2020;40(10):1470–1476;
196. Zucker I. Psychoactive drug exposure during breastfeeding: A critical need for preclinical behavioral testing. Psychopharmacology (Berl) 2018;235(5):1335–1346;
197. Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990;12(2):161–168;
198. Adis Medical W. When treating pregnant women with opioid use disorder, the benefits of using opioid maintenance treatment outweigh the risks. Drugs Ther Perspect 2016;32(5):186–190;
199. Ambasta A, Malebranche M. Opioid use disorder in pregnancy. CMAJ 2019;191(38):E1057;
200. Wojnar-Horton RE, Kristensen JH, Yapp P, et al. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997;44(6):543–547;
201. Drugs and Lactation Database (LactMed). Methadone. National Library of Medicine: Bethesda, MD, USA; 2006.
202. Anderson PO. Opioid use disorder during breastfeeding. Breastfeed Med 2023;18(6):410–412;
203. Jansson LM, Choo R, Velez ML, et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008;121(1):106–114;
204. Klaman SL, Isaacs K, Leopold A, et al. Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: Literature review to support national guidance. J Addict Med 2017;11(3):178–190;
205. Ilett KF, Hackett LP, Gower S, et al. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med 2012;7:269–274;
206. Jansson LM, Spencer N, McConnell K, et al. Maternal buprenorphine maintenance and lactation. J Hum Lact 2016;32(4):675–681;
207. O'Connor AB, Collett A, Alto WA, et al. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy. J Midwifery Womens Health 2013;58(4):383–388;
208. Gower S, Bartu A, Ilett KF, et al. The wellbeing of infants exposed to buprenorphine via breast milk at 4 weeks of age. J Hum Lact 2014;30(2):217–223;
209. Johnson RE, Jones HE, Jasinski DR, et al. Buprenorphine treatment of pregnant opioid–dependent women: Maternal and neonatal outcomes. Drug Alcohol Depend 2001;63(1):97–103;
210. Marquet P, Chevrel J, Lavignasse P, et al. Buprenorphine withdrawal syndrome in a newborn. Clin Pharmacol Ther 1997;62(5):569–571;
211. Wong J, Saver B, Scanlan JM, et al. Does maternal buprenorphine dose affect severity or incidence of neonatal abstinence syndrome? J Addict Med 2018;12(6):435–441;
212. Brown HL. Opioid management in pregnancy and postpartum. Obstet Gynecol Clin North Am 2020;47(3):421–427;
213. Chan CF, Page-Sharp M, Kristensen JH, et al. Transfer of naltrexone and its metabolite 6,beta-naltrexol into human milk. J Hum Lact 2004;20(3):322–326;
214. Haber PS, Riordan BC, Winter DT, et al. New Australian guidelines for the treatment of alcohol problems: An overview of recommendations. Med J Aust 2021;215 Suppl(S7):S3–S32;
215. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry 2018;175(1):86–90;
216. Williams JF, Smith VC, Committee on Substance Abuse T, et al. Fetal alcohol spectrum disorders. Pediatrics 2015;136(5):e1395–e1406;
217. Rigotti NA, Kruse GR, Livingstone-Banks J, et al. Treatment of tobacco smoking: A review. JAMA 2022;327(6):566–577;
218. Baker TB, Piper ME, Stein JH, et al. Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks: A randomized clinical trial. JAMA 2016;315(4):371–379;
219. Maritz GS. Are nicotine replacement therapy, varenicline or bupropion options for pregnant mothers to quit smoking? Effects on the respiratory system of the offspring. Ther Adv Respir Dis 2009;3(4):193–210;
220. Anderson PO. Breastfeeding with smoking cessation products. Breastfeed Med 2021;16(10):766–768;
221. Pfizer Labs. Chantix (Varenicline) [Package Insert]. 2008. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021928s008lbl.pdf [Last accessed: December 5, 2022].
222. Howes S, Hartmann-Boyce J, Livingstone-Banks J, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2020;4:CD000031;
223. Haas JS, Kaplan CP, Barenboim D, et al. Bupropion in breast milk: An exposure assessment for potential treatment to prevent post-partum tobacco use. Tob Control 2004;13(1):52–56;
224. Allen S, Thomas J, Harrison K, et al. Bupropion for postpartum smoking relapse: A remote protocol for a two-arm, double-blind, placebo-controlled randomized clinical trial. Contemp Clin Trials 2021;105:106352;
225. Hartmann-Boyce J, McRobbie H, Lindson N, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2020;10:CD010216;
226. Chan GCK, Stjepanović D, Lim C, et al. A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation. Addict Behav 2021;119:106912;
227. Cleary E, McKiever M, Gonzales-Brown V, et al. Multidisciplinary Oud group prenatal care decreases NICU admissions and duration of treatment for NAS. Obstet Gynecol 2020;135:163S.
228. Byerley BM, Haas DM. A systematic overview of the literature regarding group prenatal care for high-risk pregnant women. BMC Pregnancy Childbirth 2017;17(1):329;
229. Francis J, Mildon A, Stewart S, et al. Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: A prospective cohort study. Int J Equity Health 2021;20(1):71;
230. Rhodes EC, Damio G, LaPlant HW, et al. Promoting equity in breastfeeding through peer counseling: The US Breastfeeding Heritage and Pride program. Int J Equity Health 2021;20(1):128;
231. Ahluwalia IB, Tessaro I, Grummer-Strawn LM, et al. Georgia's breastfeeding promotion program for low-income women. Pediatrics 2000;105(6):E85;
232. Huhn AS, Hobelmann JG, Oyler GA, et al. Protracted renal clearance of fentanyl in persons with opioid use disorder. Drug Alcohol Depend 2020;214:108147;
233. Shearer D, Young S, Fairbairn N, et al. Challenges with buprenorphine inductions in the context of the fentanyl overdose crisis: A case series. Drug Alcohol Rev 2022;41(2):444–448;
234. Wallman C, Baessler C, Hoffman JM. Marijuana, breastfeeding, and the use of human milk: Position statement #3071. Adv Neonatal Care 2021;21(3):176–177;
235. Ryan SA, Ammerman SD, O'Connor ME, et al. Marijuana use during pregnancy and breastfeeding: Implications for neonatal and childhood outcomes. Pediatrics 2018;142(3):e20181889;
236. American College of Obstetricians and Gynecologists Committee on Health Care for Undeserved Women. Committee opinion no. 722: Marijuana use during pregnancy and lactation. Obstet Gynecol 2017;130(4):e205–e209;
237. Lexicomp. Lexicomp: Evidence-Based Drug Treatment Information. n.d.
238. Jufer RA, Wstadik A, Walsh SL, et al. Elimination of cocaine and metabolites in plasma, saliva, and urine following repeated oral administration to human volunteers. J Anal Toxicol 2000;24(7):467–477;
239. Harris DS, Boxenbaum H, Everhart ET, et al. The bioavailability of intranasal and smoked methamphetamine. Clin Pharmacol Ther 2003;74(5):475–486;
240. Toennes SW, Harder S, Schramm M, et al. Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves. Br J Clin Pharmacol 2003;56(1):125–130;
ABM protocols expire 5 years from the date of publication. Content of this protocol is up to date at the time of publication. Evidence-based revisions are made within 5 years or sooner if there are significant changes in the evidence
Information & Authors
Information
Published In
Copyright
Copyright 2023, Mary Ann Liebert, Inc., publishers.
History
Published online: 17 October 2023
Published in print: October 2023
Topics
Authors
Authors' Contributions
The authors have all contributed to the conception and drafting of this document.
Disclosure Statement
No competing financial interests exist.
Funding Information
E.M.W. is supported by National Institutes of Health (NIH) R01 HD96798, NIH UG1DA013743, the Public Health Informatics Institute MATLINK Grant, and the March of Dimes (6-FY22–0009), D.M.S. by the National Institute on Drug Abuse (K23DA048169). The funding sources are not directly related to this work.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.