Protocol for a scoping review of the international guidance on the consumption of alcohol during breastfeeding

Introduction: The long-term detrimental health impacts of alcohol consumption are long understood, with alcohol use one of the leading global causes of disability-adjusted life-years (DALYs) in 25–49-year-olds (Vos et al 2019). Alcohol is a casual factor in over 200 medical conditions such as diseases of the liver, cancers of the breast, bowel, mouth, throat and oesophagus, and liver), Major Adverse Cardiovascular Events (MACE) (stroke, myocardial infarction or vascular death) depression and anxiety, and alcohol use disorders (Rehm et al 2012; Nyberg et al 2022; Jani et al 2021). Perinatal alcohol consumption, defined as the time between conception and up to one-year postpartum (Wadephul et al 2020), can result in adverse pregnancy outcomes, and numerous maternal and infant health complications (Mamluk et al 2017; May et al 2016). The effects of alcohol consumption if a mother is breast feeding is less established, reflecting the lack of clear and consistent guidance for both health professionals and breastfeeding mothers. Objectives: To identify and review available strategies, policies, guidelines, and policy statements that have been developed addressing the consumption of alcohol during breastfeeding. To identify the target audience, key recommendations and empirical evidence used to form the identified strategies, policies, guidelines, and policy statements the consumption of alcohol during breastfeeding. To understand why strategies, policies, guidelines, and policy statement may vary, and to identify the gaps of knowledge in relation to addressing the consumption of alcohol during breastfeeding. Methods: This scoping review will employ the approach described by Arksey and O’Malley (2005) and will be conducted in accordance with recommendations for scoping reviews from the Joanna Briggs Institute (JBI) (Peters et al 2020). The Preferred Reporting Items for Systematic Reviews extension for Meta-Analyses-Scoping Review Extension (PRISMA-ScR) will be used as a framework for reporting the review (Peters et al 2015; Peters et al 2020; Tricco et al 2018). Google Advance search will be used to source international and national guidelines including links to governmental websites and third sector organisations (charities, local peer support groups and national organisations). Eligibility criteria will follow, Population, Concept, Context (PCC) developed in line with the scoping reviews objectives and the framework designed by Peters et al (2020) and will include guidance or recommendations for health professional or breast- feeders on the consumption of alcohol during breastfeeding. Key information will be recorded, coded, analysed and summarised using a narrative synthesis to produce an evidence-base for the current guidance in relation to alcohol consumption during breastfeeding