What do mothers think about concurrent breast-feeding and smoking?

According to newer policies of the American Academy of Pediatrics, smoking is not contraindicated with breast-feeding, yet smokers initiate and maintain breast-feeding less often than nonsmokers. We sought to describe maternal knowledge and attitudes regarding concurrent breast-feeding and smoking or nicotine replacement therapy (NRT) and to evaluate the association between maternal smoking and infant feeding practices.

Mothers bringing children <13 months old for an appointment completed a 24-item anonymous survey that addressed knowledge, attitudes, and practices about concurrent breast-feeding and smoking/NRT.

Among 204 survey completers, 63% were African American, 52% had never breast-fed, and 54% had never smoked. Regardless of smoking status, 19% were aware of the recommendation to smoke after breast-feeding; most did not know that nicotine gum (42%) or patch (40%) transfers less or about the same amount of nicotine into breast milk than smoking a pack per day. Most mothers (80%) believed that women should not smoke any cigarettes if breast-feeding; current smokers (25%) were more likely than former (10%) or never smokers (11%) to find it acceptable to smoke one or more cigarettes per day (P = .03). Only 2% found it acceptable to use NRT while breast-feeding. Among ever breast-feeders, 10% stopped breast-feeding because of smoking. Over half of recent or current smokers reported that smoking affected their infant feeding decision.

Mothers in this sample believe that women who smoke or take NRT should not breast-feed. Smoking status affected women's infant feeding practices. Correction of misinformation could increase breast-feeding rates.