Lactational state modifies alcohol pharmacokinetics in women

Abstract

Background: Given the physiological adaptations of the digestive system during lactation, the present study tested the hypothesis that lactation alters alcohol pharmacokinetics.

Methods: Lactating women who were exclusively breastfeeding a 2- to 5-month-old infant and 2 control groups of nonlactating women were studied. The first control group consisted of women who were exclusively formula-feeding similarly aged infants, whereas the other consisted of women who had never given birth. A within-subjects design study was conducted such that women drank a 0.4 g/kg dose of alcohol following a 12-hour overnight fast during one test session (fasted condition) or 60 minutes after consuming a standard breakfast during the other (fed condition). Blood alcohol concentration (BAC) levels and mood states were obtained at fixed intervals before and after alcohol consumption.

Results: Under both conditions, the resultant BAC levels at each time point were significantly lower and the area under the blood alcohol time curve were significantly smaller in lactating women when compared with the 2 groups of nonlactating women. That such changes were due to lactation per se and not due to recent parturient events was suggested by the finding that alcohol pharmacokinetics of nonlactating mothers, who were tested at a similar time postpartum, were no different from women who had never given birth. Despite lower BAC levels in lactating mothers, there were no significant differences among the 3 groups of women in the stimulant effects of alcohol. However, lactating women did differ in the sedative effects of alcohol when compared with nulliparous but not formula-feeding mothers. That is, both groups of parous women felt sedated for shorter periods of time when compared with nulliparous women.

Conclusions: The systemic availability of alcohol was diminished during lactation. However, the reduced availability of alcohol in lactating women did not result in corresponding changes in the subjective effects of alcohol.

Fig. 1

Schedule of events. Each subject arrived at the Center at 8:30 am following a 12-hour overnight fast. Capillary blood glucose was measured to ensure that the women had fasted and a pregnancy test was administered to confirm they were not pregnant. For those who were lactating, the women emptied their breasts via an electronic breast pump. At 9:00 am, women consumed a standard breakfast during one test day (fed condition) or remained fasted during the other (fasted condition). One hour later (hereafter referred to as time 0), subjects drank a 0.4 g/kg alcoholic beverage. The symbol X denotes determination of blood alcohol concentrations (BAC) and completion of Addiction Research Center Inventory (ARCI) and Biphasic Alcohol Effect Scales (BAES) questionnaires to evaluate various mood states.

Fig. 2

Blood alcohol concentrations (BACs) (g/L) for lactating (N=20; top panel, ●), formula feeding (N=9; middle panel, ○), and nulliparous (N=15; bottom panel, ▲) women after drinking a dose of 0.4 g/kg body weight. Each line represents an individual subject. Panels on the left depict data obtained during the fed condition and panels on the right depict data obtained during the fasted condition.

Fig. 3

Subjective effects of alcohol consumption in lactating (●), formula feeding (○), and nulliparous (▲) women. Panels on the left depict data obtained from the Biphasic Alcohol Effect Scales (Sedation scale on the top panel; Stimulation scale on the bottom panel) and those on the right depict data obtained from the Addiction Research Center Inventory (ARCI) scales (Drunkenness on the ARCI-Dr scale on the top panel, and stimulant-like effects on the ARCI-A on the bottom panel). Values represent mean ± SEM. Data collapsed across fed and fasted conditions. *Values within the test session that are significantly different from their respective baseline values (p<0.05).