Breastfeeding in the Setting of Substance Use and Substance Use Disorder

Document Overview

Document Title

Breastfeeding in the Setting of Substance Use and Substance Use Disorder

Authoring Society

Academy of Breastfeeding Medicine

Document Publication Date

Oct 16, 2023

Page Last Reviewed/Updated

May 5, 2026

Document Type

Guideline

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/ABM%20Clinical%20Protocol%2021%20SUD_English.pdf

Source Citation

Miriam Harris, Davida M. Schiff, Kelley Saia, Serra Muftu, Katherine R. Standish, and Elisha M. Wachman. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeeding Medicine.Oct 2023.715-733.http://doi.org/10.1089/bfm.2023.29256.abm

Supplemental Implementation Resources

• Quick-Reference Guide

Document Scope, Criteria, and Use Cases

Document Objectives

This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.

Scope

Counseling, Management

Keywords

Breastfeeding, SUD in pregnancy, Substance use disorders, substance use disorder

Target Patient Population

Breastfeeding mothers with substance use disorders

Target Provider Population

Clinicians caring for breastfeeding mothers with substance use disorders, including OBGYNs, psychiatrists, addictions specialists and similar

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Addiction Treatment Specialist, Nurse, Nurse Midwife, Nurse Practitioner, Physician, Physician Assistant, Social Worker

Recommendation Development Processes & Methodology

Number of Source Documents

240

Includes peer/external review process?

Yes

Includes public comment process?

No

Methodologist involvement?

Yes

Patient involvement?

No

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

Yes

Grades quality of strength of recommendation?

Yes

Discloses funding source?

Yes

Discloses conflicts of interest?

No

Includes benefits/harms analysis with recommendations?

No