When a Cocaine-Using Mother Wishes to Breastfeed

Is breastfeeding safe in patients with a history of cocaine use during pregnancy?

“…A consensus opinion from the Motherisk team at the University of Toronto in 2005 recommended breastfeeding only be discontinued in infants who test positive for cocaine. 1 The authors reasoned that although cocaine and its metabolites can be transmitted in breast milk, there was only one reported case study of alleged neonatal toxicity after breastfeeding in a mother who had used cocaine acutely, suggesting that the risk of significant toxicity with remote use was low. 2…”

“…A consensus opinion from the Motherisk team at the University of Toronto in 2005 recommended breastfeeding only be discontinued in infants who test positive for cocaine. 1 The authors reasoned that although cocaine and its metabolites can be transmitted in breast milk, there was only one reported case study of alleged neonatal toxicity after breastfeeding in a mother who had used cocaine acutely, suggesting that the risk of significant toxicity with remote use was low. 2 A similar recommendation was shared in a 2012 consensus opinion in Canadian Family Physician whose authors recommended that breastfeeding be delayed sufficiently after cocaine use to allow for drug elimination, which they defined as approximately 24 h, based on the apparent rapid elimination of cocaine by the mother.…”

Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome

“…28 Several published case reports describe seizures, tachycardia, and irritability in infants who have been exposed to cocaine through breast milk. [28][29][30] In addition to the multitude of risks to the health of the infant due to exposure to the illicit substance, there is also potential risk due to associated lifestyle choices. Intravenous drug use and risky lifestyles (e.g., prostitution, theft) put the infant at risk for HIV and other sexually transmitted infections.…”

“…The proportion of pregnant women in the United States who use cocaine is estimated at 10% . Several published case reports describe seizures, tachycardia, and irritability in infants who have been exposed to cocaine through breast milk . In addition to the multitude of risks to the health of the infant due to exposure to the illicit substance, there is also potential risk due to associated lifestyle choices.…”