Are e-cigarettes safe for breastfeeding moms?

 Ask Anne…

Question: I started smoking when I was in high school, and smoked 10-15 cigarettes a day until I found out I was pregnant and I quit cold turkey. Now my baby is 6  months old and exclusively breastfed.

Over the past few months, I have gradually started smoking again. My husband still smokes, and it’s hard not to have a hit of his cigarette or even smoke one or two a day.

We don’t smoke in the house, and both plan to quit soon, but in the meantime, I’m thinking about switching to vaping. Are e-cigarettes safe for nursing moms?

Answer: Let me start out by saying that I know from personal experience how wicked hard it is to beat nicotine addiction.

I was born in 1955 and grew up in the heart of tobacco country. I started smoking as a teenager, got hooked, and didn’t kick the habit until my kids were grown. When my my first baby was born in the ’70s, everyone knew that smoking during pregnancy was a bad idea, but we didn’t know exactly how bad. We didn’t know about the harmful effects of second hand smoke, and when we smoked in the house, we worried more about kids getting burned or eating a cigarette butt than we did about them breathing in the smoke. Because of the warnings about the negative effects of nicotine on the fetus, most women at least tried to quit or cut back when they found out they were expecting.

Like me, many of them relapsed and started smoking again after their babies were born.

Fast forward a few decades and we have a new normal, where everyone knows how awful and addictive and dangerous cigarettes are, and it’s common knowledge that babies shouldn’t be exposed to cigarette smoke, ever. Cigarettes are just bad, end of story. If you care about your baby at all, you’ll put that pack down and never go back.

Except it’s not that simple. Nicotine is a highly addictive substance, and anyone who says giving it up is easy is either lying, or they never got hooked and then tried to quit. My six kids are all grown now, and  although all of them are healthy, I will carry guilt forever about the fact that they grew up in households with heavy smokers. I did the best I could do with the information available at the time, and that’s all any mom can do.

Here are some facts about nicotine that moms need to know:

• Nicotine transfers into breast milk in small amounts. It has a stimulant effect, and in large amounts, it can cause sleep disruptions in breastfed babies. It can also lower prolactin levels and cause a decrease in milk supply, and in some cases, may cause stomach upset. However, there is no evidence that babies exposed to nicotine during pregnancy or lactation have long term effects like increased rates of lung disease or cancer.
• Like most maternal medications, the higher the dose of the drug, the more transfers into the milk, and the more significant the side effects.
• It’s not only the nicotine that causes problems. It’s also the many toxins and chemicals that appear in tobacco smoke.
•  The greatest danger for infants is from the smoke they inhale, rather than the small amount they receive in breast milk. No one should smoke around a baby, ever. It’s known that exposure tobacco smoke is a risk factor for SIDS, and there is no safe threshold for smoke exposure.

What we do know for sure is that the benefits of breastfeeding far outweigh the risk of exposure to nicotine. Due to this fact, both the AAP and the CDC recognize that breast milk is the best food for babies, even when the mother smokes.

When it comes to breastfeeding, are e-cigarettes safer than regular cigarettes? Almost definitely. Are they a completely safe alternative to cigarettes? Probably not.

Here’s what you should know about e-cigarettes:

• E-cigarettes are an alternate nicotine delivery system, just like gum and patches. Because e-cigs are relatively new, they aren’t regulated by the FDA, so there isn’t any way to know exactly what’s in them, or how much nicotine is being inhaled with each puff. However, there are animal studies that indicate the presence of toxins in the vapor, so vaping is prohibited in public places just like cigarette smoking is.
• By far the biggest concern about tobacco use is the effects of the smoke inhaled by the baby, and since e-cigarettes don’t burn, they give off a tiny fraction of the dangerous chemicals produced from tobacco smoke. They also eliminate the risk of the baby getting burned from ashes or lighters.
• The liquid used in e-cigarettes comes in flavors like ‘bubble gum’ and ‘cotton candy’, which can be appealing to little ones. Cases of emergency room visits due to accidental poisoning due to ingestion are on the rise, and as little as a teaspoon of nicotine liquid can be fatal.

• Important Update: As of September, 2019, hundreds of acute respiratory illnesses have been reported in mostly healthy young people who use e-cigarettes and other vaping devices. There have been 450 possible cases reported in 33 states so far, and six people have died, raising concerns about the safety and regulation of e-cigarettes.

  No single device, ingredient or additive has been identified. The majority of patients say they vaped products containing THC (the ingredient in marijuana that produces the high). Most of the cases have been associated with with black market marijuana (THC) vaping cartridges bought on the street.and not .traditional, nicotine-containing electronic cigarettes.

  These lung illnesses aren’t caused by germs, but are due to exposure to high levels of chemicals in the vape liquid. Investigators are looking into the role of vitamin E acetate, used as a thickener, particularly in black market vape cartridges. Vitamin E is safe to take orally or use topically, but when inhaled into the lungs, the oily vitamin E droplets can trigger pneumonia.

  The FDA warns the public that “Consumers can help protect themselves by avoiding tetrahydrocannabinol (THC)-containing vapor products.”

So, here’s the bottom line:

• Nicotine is bad for everyone, all the time. Exposing your baby to tobacco, before or after birth, should be avoided.
• If you’re nursing your baby, don’t stop nursing. Quit smoking if you can, and reduce exposure to nicotine as much as possible.
• Studies to date indicate that since only small amounts of nicotine are excreted into breast milk, nursing mothers can safely use nicotine replacement therapy.
•  If you use tobacco in any form, keep it away from your baby. Eating cigarette butts, or chewing nicotine gum, or swallowing chocolate flavored e-liquid, can poison your little one.
• The most important thing to remember is that the benefits of breastfeeding outweigh the risks of smoking.
• Don’t wean your baby because of your nicotine addiction. Use nicotine replacement therapy (patches or gum) to quit or cut back.
• If you have to smoke, e-cigarettes are probably less harmful than regular cigarettes.
• Avoid vaping marijuana cartridges purchased on the street because they are extremely dangerous.
• Seek medical care promptly if you experience any symptoms of respiratory distress such as coughing, chest pain, shortness of breath, fatigue, or vomiting
• Don’t smoke around your baby. Not cigarettes, or weed, or vape pens. Just don’t do it.

And if you’re still struggling with your nicotine addiction, don’t beat yourself up. Continue to nurse your baby and provide him with the many benefits of breastfeeding while minimizing his exposure as much as possible.

Anne Smith, IBCLC
Breastfeeding Basics

References:
1. Safety of Electronic Cigarette Use During Breastfeeding, Journal of Medical Internet Research, Vol. 21 #8, August 2019

2. American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, Pediatrics Vol. 129 No. 3 March 1, 2012

2.  Dr. Thomas Hale, Medications and Mother’s Milk, 15th Edition, 2012

3.  CDC. Current Cigarette Smoking Among Adults-United States 2005-2013. 2014; 63(47):1108-1112.4 3.

4. Schripp T, Markewitz D, Udhe E, Salthammer T. Does e-cigarette consumption cause passive vaping? 2013; 23:25-31

5. Czogola J, Goniewicz M, Fidelus B, Zielinsa-Danch W, Travers M, Sobczak A. Secondhand exposure to vapors from electronic cigarettes. 2013

6. What we know so far about the US vaping illness outbreak
Carla k. johnson, AP medical writer, Sep 10, 2019

7. FDA Warns Consumers To Protect Themselves By Avoiding Tetrahydrocannabinol (THC)-Containing Vaping Products, MJ News Network, September 9, 2019