Hookah, also known as shisha or water pipe, is a method of smoking flavored tobacco that involves passing the smoke through water before inhalation. Despite common beliefs that this process makes it safer, the tobacco and charcoal used in a typical hour-long session release a complex mixture of harmful chemicals. These substances are absorbed into the mother’s bloodstream, and they transfer directly into breast milk, posing measurable risks to the nursing infant.
Chemical Transfer from Hookah Smoke into Breast Milk
The constituents of hookah smoke, once inhaled, quickly enter the maternal circulation and readily pass into breast milk through passive diffusion. Nicotine is the primary concern because it is highly lipid-soluble and becomes concentrated in breast milk at levels higher than in the mother’s plasma. Following a smoking session, the nicotine concentration in breast milk typically peaks within 30 to 60 minutes after the mother stops smoking.
Beyond nicotine, the smoke introduces toxic agents, including carbon monoxide, heavy metals like cadmium and lead, and polycyclic aromatic hydrocarbons. These substances are products of tobacco combustion and the charcoal used to heat the shisha. Breast milk is used as a route for excreting these elements, meaning the infant receives a direct dose of these contaminants.
The time it takes for the nicotine level to decrease is characterized by its half-life, which in breast milk is roughly 1.5 to 2 hours. This means that for every two hours that pass after smoking, the concentration of nicotine in the milk is reduced by approximately half. However, regular use can lead to the accumulation of cotinine, a long-lived nicotine metabolite, which remains in the baby’s system for a significantly longer period.
Health Effects on the Nursing Infant
Exposure to these toxins through breast milk can lead to immediate changes in the infant’s behavior and pose risks to long-term health. Nicotine acts as a stimulant in the infant’s developing nervous system, resulting in symptoms like increased irritability, restlessness, and gastrointestinal discomfort. These neurological effects can also disrupt the infant’s sleep architecture, leading to shorter sleep cycles and a reduction in both active and quiet sleep periods.
The presence of carbon monoxide reduces the oxygen-carrying capacity of the mother’s blood, which can indirectly affect the infant’s oxygen supply. Exposure to hookah smoke is associated with an elevated risk of Sudden Infant Death Syndrome (SIDS) and an increased incidence of respiratory symptoms, such as frequent ear infections. Accumulation of heavy metals like cadmium and lead can interfere with the infant’s metabolism of essential micronutrients, potentially impacting early development.
Nicotine exposure also directly impacts the mother’s physiology related to milk production, which in turn affects the baby’s feeding and nutrition. Nicotine is known to inhibit the release of prolactin and oxytocin, hormones necessary for milk synthesis and the milk ejection reflex. This hormonal interference can lead to a reduced milk supply and is a factor associated with the early cessation of breastfeeding.
Addressing Misconceptions and Minimizing Exposure
A common belief is that the water in the hookah pipe acts as an effective filter, removing harmful substances from the smoke, but this is inaccurate. The water primarily serves to cool and humidify the smoke, making it feel less harsh and leading to deeper, longer inhalations that increase overall exposure. Hookah smoke delivers similar or greater levels of toxic chemicals than cigarette smoke, and the burning charcoal produces exceptionally high levels of carbon monoxide.
For mothers who choose to continue nursing, the most effective strategy for reducing infant exposure involves careful timing of smoking sessions. Since nicotine levels peak shortly after use, a mother should nurse the infant immediately before smoking, creating the longest possible interval until the next feeding. Waiting a minimum of two to three hours after smoking allows the nicotine concentration in the breast milk to significantly decline.
Minimizing the infant’s exposure to residual smoke is paramount to reducing overall risk. Chemicals from the smoke settle on clothes, hair, and skin, creating a source of third-hand smoke exposure. Practical measures include changing clothing, washing hands and face, and brushing teeth immediately after a session and before handling the infant.