this is my presentation for GPs & lactation specialists, house officers at Benha University hospitals also presented to all those candidates for the Benha lactation diploma students at Benha University this includes: smoke content effect of smoking on fetus& new born effect of smoking on breast feeding how to decrease smoking during breast feeding interpregnancy stoppage of breast feeding marijuana stoppage during breast feeding CDC (centers for disease prevention and control) recommendations ACOG recommendations NHS recommendations benefits of breast feeding for new born benefits of breast feeding for mothers

1. Smoking and breast feeding
By
Dr. Ahmed Mohamed Nasef
Assistant lecturer in obstetrics & gynecology
Benha University

2. There are more than 7,000 chemicals in
tobacco smoke, including hundreds of
chemicals that are toxic and about 70 that
can cause cancer

3. Nicotine and other harmful chemicals are found in
cigarettes, cigars, pipe tobacco, and chewing
tobacco

4. Electronic smoking
E-cigarette aerosol can contain harmful and potentially harmful
chemicals including nicotine and other toxicants, flavorings, and
solvents

5. CDC recommendations

6. Using tobacco or e-cigarettes while
breastfeeding can allow harmful chemicals to
pass from the mother to the infant through
breast milk or secondhand smoke exposure

7. Mothers who use tobacco or e-cigarettes
should be encouraged to quit; regardless,
breastfeeding provides numerous health
benefits and breast milk remains the
recommended food for an infant

8. What effects can tobacco or e-cigarette exposure have on infants?
Regardless of feeding method (breastfeeding or infant formula), maternal smoking is
a risk factor for
sudden infant death syndrome (SIDS)
lower respiratory illnesses (such as bronchitis and pneumonia)
ear infections
impaired lung function in infants and children
the chemicals found in tobacco, including nicotine, can be passed from a
breastfeeding mother who uses tobacco to her infant through breast milk
Smoking also decreases maternal milk supply, likely through the effect of nicotine,
which lowers serum prolactin levels.
E-cigarettes, and other vaping devices, are battery-powered devices that typically
deliver nicotine, flavorings, and other additives through an inhaled aerosol. Little is
known about the effects of e-cigarette use by the mother on the infant’s health

9. Can mothers who use tobacco or e-cigarettes
breastfeed their infant?
Yes. Mothers who use tobacco or e-cigarettes should be
encouraged to quit; regardless, breastfeeding provides
numerous health benefits and breast milk remains the
recommended food for an infant

10. To minimize exposure to the infant, mothers
and others who smoke should:
Don't smoke near the infant
Smoke outside
Have smoke-free rules for the car and home
Change clothes and wash hands after
smoking and prior to handling the infant

11. Secondhand smoke
Also called passive smoking
Smoke from burning tobacco products, like
cigarettes, cigars or pipes
Secondhand smoke also is smoke that has
been exhaled, or breathed out, by the person
smoking

12. Who is Harmed by Secondhand Smoke?
Anyone who is exposed to it, even for a short
time
Secondhand smoke can cause health
problems in children and adults, and can even
be deadly
Since 1964, about 2,500,000 people who do
not smoke have died from health problems
caused by secondhand smoke exposure

13. Effects of second hand smoking on breast fed infant
Babies who breathe secondhand smoke are more likely to die unexpectedly from
sudden infant death syndrome (SIDS), also called crib death, than babies who are not
exposed to smoke from burning tobacco products
Babies exposed to secondhand smoke in the womb or after birth are born and grow
up with weaker lungs than babies that are not exposed to secondhand smoke
Babies and children who breathe secondhand smoke are sick more often with
bronchitis, pneumonia, and ear infections than those that are not exposed to
secondhand smoke
For children with asthma, breathing secondhand smoke can trigger an asthma attack

14. ACOG recommendations

15. Tobacco use is a modifiable risk factor for a
host of adverse pregnancy outcomes and
longer-term health outcomes

16. The American College of Obstetricians and
Gynecologists and the American Academy of
Pediatrics recognize pregnancy and lactation
as two ideal times to promote tobacco and
smoking cessation as there are many motives

17. Tobacco Cessation
Non pregnant adult smokers should be offered smoking cessation
support through
Behavioral intervention (lifestyle measures, sports practice, Yoga…)
U.S. Food and Drug Administration-approved pharmacotherapy
(NRT)

18. In the interpregnancy period
All women should be routinely asked about
their use of alcohol and drugs, including
prescription opioids, marijuana, and other
medications used for nonmedical reasons and
referred as indicated
Substance use disorder and relapse
prevention programs also should be made
available

19. For lactating women
Nicotine replacement therapy (NRT) is compatible
with breastfeeding because the amounts of
nicotine transferred with breast milk are generally
the same or lower using replacement therapy
compared with smoking
Health care providers should reassess tobacco use
(smoked, chewed, electronic nicotine delivery
systems, vaped) at the postpartum visit and
continue to provide, or refer to, assistance with
ongoing efforts at cessation

20. ACOG, American academy of pediatrics& NHS
recommendations

21. Mothers who smoke tobacco (though they
should be encouraged to quit)

22. NHS recommendations

23. By stopping smoking before or as soon as pregnancy, this can aid
passing pregnancy safely and having a healthier baby
Stopping smoking soon after delivery will still help protect
infants against:
Sudden infant death syndrome
Breathing problems
Ear disease and deafness
Behavioral problems

24. If its hard for the woman to quit smoking, it's important not to stop
breastfeeding, Breastfeeding will still protect your baby from infections
and provide nutrients they can't get from formula milk
If woman or her partner can't stop smoking, still have a solution by
making home completely smoke free will help protect baby's health.
They may need to ask friends and family not to smoke near baby, too
It's important not to share a bed with baby (co-sleep). This is known to
reduce the risk of SIDS

26. Nicotine replacement therapy (NRT) and breastfeeding
Licensed NRT products are safe to use while breastfeeding. They
increase chances of quitting smoking
it is present in a wide range of forms, including patches, gum, lozenges,
nasal spray and inhalators.

27. Marijuana use during breast feeding
According to ACOG
Effects of Marijuana Use on Lactation
• There are insufficient data to evaluate the effects of marijuana use on
infants during lactation and breastfeeding
• and in the absence of such data, marijuana use is discouraged
• Breastfeeding women should be informed that the potential risks of
exposure to marijuana metabolites are unknown and should be
encouraged to discontinue marijuana use.

28. Breast feeding benefits
for infant
Infants who are breastfed have reduced risks of:
Asthma
Obesity
Type 1 diabetes
Severe lower respiratory disease
Acute otitis media (ear infections)
Sudden infant death syndrome (SIDS)
Gastrointestinal infections (diarrhea/vomiting)
Necrotizing enterocolitis (NEC) for preterm infants

29. Benefits for mother
Breastfeeding can help lower a mother’s risk
of:
High blood pressure
Type 2 diabetes
Ovarian cancer
Breast cancer