Literature review for - Flourish Paediatrics

ALCOHOL, CAFFEINE AND BREASTFEEDING OUTCOMES
What nutritional factors are important in optimizing breastfeeding outcomes?
Evidence statement
Grade
Component Rating Notes
Consumption of alcohol by lactating women in the range of
0.3-0.8g/ kg body weight is associated with increased risk
of adverse infant outcomes.
B
Evidence Base Good 2 Systematic reviews; 1 (P) had 24 studies, with 14 in
humans (6 level III-1, 2 level III-2, 2 level II, 4 level IV, 10
level V (all animal) and 1 (N)) the number was not reported
but had 33 references cited.
Consistency Excellent Decreased lactational performance with increasing alcohol
consumption.
Clinical impact Good Maternal alcohol doses associated with adverse infant
outcomes (development, feeding, sleeping) varied from
0.3g/kg to 0.8g/kg. Lactational performance reduced from
maternal intakes of 0.5-1g/kg body weight.
Generalisability Good Human studies can be contextualised to lactating Australian
women and their infants.
Applicability
Satisfactory Only human data has been considered, but there is limited
data in humans compared to the studies done in animal,
mostly rats.
The studies included in the body of evidence statement are shown in Table 26.1.
There were two systematic reviews that examined alcohol and breastfeeding outcomes. The positive
quality review by Giglia & Binns 2006 is a comprehensive review of both human and animal studies
and covers the literature on the effect of alcohol on breastfeeding physiology, lactogenesis and milk
“let down”, in detail. It addresses three questions in particular; the effect of alcohol on lactogenesis;
the effect of maternal blood alcohol on breastmilk and infant blood alcohol and the effect of
breastmilk alcohol on the infant. Evidence tables are provided to summarise studies for; 1) The
effect of alcohol on the mother (1 review, 2 level II, 4 level III-1, 1 level III-2, 2 level IV studies); 2)
The effect of alcohol on the infant (5 level III-1, 1 level III-2, 1 level IV). The authors also synthesise
advice for lactating women based on their evidence synthesis. This was that breastfeeding women
should:-
1. Not consume alcohol in the first month of the infant life
2. After that, limit alcohol to 1-2 standard drink per day, consumed after breastfeeding
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