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Breastfeeding and Nicotine Replacement Therapy: What You Need to Know

Stopping smoking: breastfeeding and nicotine replacement therapy

We know that nicotine is harmful to your health, and that includes vaping. About 10-11% of breastfeeding mothers are vaping. However, as Dr. Lori Feldman-Winter pointed out when I interviewed her recently, mothers often overlook three fundamental facts. First, nicotine, as well as other chemicals, are delivered through vaping. Second, nicotine, delivered through either method, is a highly addictive substance, and nicotine passes through her milk. Finally, vaping does not help all smokers to kick the cigarette habit. (However, one recent study showed vaping, combined with other strategies, can be helpful.) If vaping isn’t working, what else could help? What should you know about breastfeeding and nicotine replacement therapy?

A related question is, how would the treatment affect a mother’s milk, or her baby? There are a number of ways breastfeeding mothers can kick the habit.  In this post, I’ll consider only nicotine replacement therapy, and I’ll address other strategies later.

What is nicotine replacement therapy?

Nicotine replacement therapy (NRT) does not mean that the nicotine is completely absent from the product. Rather, Nicotine replacement therapy delivers smaller, reduced amounts of nicotine, which therefore reduces the symptoms of withdrawal and satisfies cravings. NRT raises some important questions for breastfeeding mothers.

Is NRT safe or effective when breastfeeding?

All forms of NRT is compatible with breastfeeding. Interestingly, though, many or most pediatricians are uncertain about the safety of breastfeeding and nicotine replacement therapy.

Does NRT provide any advantage to the breastfeeding couplet?

In the general populous, NRT is an effective means by which to kick the smoking habit. A Cochrane review states that “All of the commercially available forms of nicotine replacement therapy are effective…They increase quit rates approximately 1.5 to 2 fold regardless of setting.” This tells us about the comparison of NRT to other forms of smoking cessation methods.

However, for the breastfeeding mother, there’s yet another question. She needs to compare the amount of nicotine she is currently taking in through cigarettes to the amount she would take in through NRT. In short, the amount of nicotine delivered through NTR must be less than the amount of nicotine that the mother is currently ingesting through cigarettes.

What does the breastfeeding mother need to be aware of?

Breastfeeding mothers who are using NRT should not be smoking cigarettes. Doing so exposes the mother and the infant to a higher level of nicotine than cigarette smoking only or only using NRT. 

The FDA has approved 5 forms of nicotine replacement therapy.

3 Types of over-the-counter NRT

Three types of NRT are available for purchase over-the-counter at a pharmacy or super center: patches, gum, and lozenges.


The patch gives a slow-release of nicotine through the skin. Ilett and colleagues showed that the dose of nicotine and cotinine in the 7-mg patch was 70% lower, compared to cigarette-smoking or using a 21-mg patch. Interestingly, though, the baby’s intake of milk was no different between the two.

Especially for heavy smokers, the patch may be helpful in combination with the gum or lozenges.


Like other forms of NRT, nicotine gum has been shown to be effective, either alone, or in combination with other NRTs. Nicotine gum is available in different strengths. In general, the more cigarettes the person smokes, the higher the strength of nicotine gum is needed.


Lozenges are available in 2 mg and 4 mg doses. The 4 mg is usually recommended only for heavy smokers.

The lozenge dissolves over 20-30 minutes; hence, it does not immediately reduce cravings. However, it’s good for anyone who doesn’t like chewing gum, and the lozenge offers some advantage over the gum for those who are worried about immediate weight gain. The amount of nicotine absorbed per lozenge appears to be somewhat higher than that delivered by gum.

Prescription NRT

Two additional methods of nicotine replacement therapy require a doctor’s prescription. These include inhalers and nasal sprays. Wadgave and Negesh give details and comparisons of these and other forms of NRT.


The term “inhaler” is a bit of a misnomer. The inhalers were designed to mimic the “hand-to-mouth” maneuver. However, most of the nicotine is delivered into the oral cavity and the stomach; only 4% is delivered to the lung. Inhalers have a mouthpiece and a plastic cartridge that contains nicotine. Each cartridge contains 10mg nicotine. These deliver immediate symptom relief.

Nasal sprays

A nozzle delivers 0.5 mg of nicotine per squirt; the user takes one squirt per nostril. The sprays rapidly deliver doses of nicotine. In comparison to other NRT forms, this is the quickest way for the nicotine to get into the blood, thereby quickly relieving the craving.

Finally, all smokers need to remember that while a specific type of NRT therapy works best for one person, it might not be the best for another person.

Have you used nicotine replacement therapy when breastfeeding to stop smoking or vaping? What method worked best for you? Tell me in the comments below!

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