If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.

  • Advise women who choose to curb their energy intake to pay special attention to eating a balanced, varied diet and to including foods rich in calcium, zinc, magnesium, vitamin B6, and folate. Encourage energy intake of at least 1,800 kcal/day. Calcium, multivitamin-mineral supplements, or both may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although fasts lasting less than 1 day have not been shown to decrease milk volume. Liquid diets and weight loss medications are not recommended. Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.

Maternal Substance Use and Abuse

The use of illicit drugs should be actively discouraged, and affected women (regardless of their mode of feeding) should be assisted to enter a rehabilitative program that makes provision for the infant. The use of certain legal substances by lactating women is also of concern, including the potential for alcohol abuse.

  • There is no scientific evidence that consumption of alcoholic beverages has a beneficial impact on any aspect of lactation performance. If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.

  • Actively discourage smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.

  • Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee. The equivalent of 1 to 2 cups of regular coffee daily is unlikely to have a deleterious effect on the nursling, although preliminary evidence suggests that maternal coffee intake may adversely influence the iron content of milk and the iron status of the infant.

Infant Growth and Nutrition

The subcommittee recommends that health care providers be informed



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