Alcohol and Breastfeeding

Alcohol is a substance that easily crosses the placental barrier and, during the postpartum period, is transferred to breast milk in concentrations similar to those in the maternal bloodstream, reaching peak plasma–milk levels between 30 and 60 minutes after ingestion. During pregnancy, exposure to alcohol is linked to permanent malformations and long-term neurocognitive deficits. In the context of breastfeeding, high or frequent alcohol intake can reduce milk production and ejection, alter the infant’s sleep, and impair their growth and development.

During pregnancy, the American College of Obstetricians and Gynecologists (ACOG) has a categorical guideline: there is no safe amount of alcohol; total abstinence is recommended throughout all stages of pregnancy.

When it comes to breastfeeding, the guidelines vary in terms of permissiveness. In Brazil, the Brazilian Society of Pediatrics (SBP) adopts the precautionary principle and recommends zero alcohol consumption; however, an occasional drink is considered acceptable if the mother waits the necessary amount of time for the alcohol to be eliminated before nursing. The Ministry of Health supports this conservative stance: in addition to discouraging any frequent intake, it advises temporarily suspending breastfeeding if alcohol consumption is regular.

In the United States, both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) adopt a more controlled approach. They consider it safer to avoid alcohol but allow up to one standard drink per day (≈14 grams of alcohol — the U.S. standard), provided the mother waits at least two hours per drink before the next breastfeeding session. Consumption exceeding two drinks per day is discouraged, as it increases the risk of adverse effects on the baby.

For breastfeeding mothers who choose to drink alcohol, certain measures can reduce the risk of infant exposure: planning feedings or pumping before drinking; having pre-expressed milk available to cover the waiting period; strictly counting the number of drinks and respecting the minimum two-hour wait per drink; and ensuring that a sober caregiver handles tasks such as bathing, transportation, or bed-sharing while alcohol remains in effect.

In summary, pregnant women should maintain abstinence. Breastfeeding women, if following Brazilian guidelines, should avoid or strictly minimize alcohol consumption; if they choose to follow U.S. guidelines, they are limited to an occasional drink, with a minimum two-hour wait before breastfeeding. Any consumption beyond this threshold — especially binge drinking — requires temporary suspension of breastfeeding and consultation with a pediatrician to individualize care.

References:

Sociedade Brasileira de Pediatria. (2024). Guia prático de aleitamento materno. Guia prático de aleitamento materno (Atualização 2024). Rio de Janeiro, RJ: SBP.

American Academy of Pediatrics. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1), e2022057988. https://doi.org/10.1542/peds.2022-057988

American College of Obstetricians and Gynecologists. (n.d.). Tobacco, alcohol, drugs, and pregnancy. Recuperado em 1 de agosto de 2025, de https://www.acog.org/womens-health/faqs/tobacco-alcohol-drugs-and-pregnancy

Centers for Disease Control and Prevention. (2025, 26 fevereiro). Alcohol and breastfeeding. Recuperado de https://www.cdc.gov/breastfeeding-special-circumstances/hcp/vaccine-medication-drugs/alcohol.html

Ministério da Saúde. (2022). Amamentação e uso de medicamentos e outras substâncias (2ª ed.). Brasília, DF.