Alcohol and Tobacco use While Breastfeeding and Risk of Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder.
Louisa Gibson, Melanie Porter
PMID 33893938WHAT IT FOUND
Maternal alcohol or tobacco use while breastfeeding was not linked to higher ADHD or ASD risk in children aged 6-7 or 10-11.
This null finding does not prove safety, as other harms like reduced milk supply and sleep disruption remain known risks.
Key findings
01Alcohol and tobacco intake during breastfeeding showed no association with increased ADHD or ASD risk in either the actively breastfeeding group or the broader breastfed group at either age point.
02Prenatal exposure to alcohol and tobacco also showed no significant association with ADHD or ASD diagnoses in this specific cohort analysis.
03The study authors explicitly state that the lack of association with these specific diagnoses does not mean alcohol and tobacco are safe, citing known risks to milk production and infant sleep.
STILL TO COME
How it was doneWhat they found
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What it does not show
Diagnoses of ADHD and ASD were based on caregiver report rather than clinical assessment. Exposure to alcohol and tobacco was self-reported and measured only at study entry, which may not reflect long-term habits or timing relative to feeds. The study did not account for maternal ADHD or ASD status, which is a genetic and behavioural confounder. The analysis treated alcohol and tobacco use separately, so it could not detect additive or interactive effects if both were used together. Data was missing for some variables and imputed, with poorly educated parents being more likely to drop out.
The easy way to misread this
Do not interpret this null finding as evidence that alcohol or tobacco use is safe during breastfeeding. The study only looked at ADHD and ASD diagnoses, ignoring other established harms such as reduced milk supply, altered infant sleep, and potential impacts on cognitive development.