The reproductive states of pregnancy and lactation constitute one of the greatest metabolic challenges experienced by women (217, 218). Overall, the increased plasma volume and lower ratio of lean muscle to adipose tissue during pregnancy and lactation can result in changes in the volume of drug distribution for drugs, including alcohol. Pregnancy and lactation are anabolic states that are orchestrated via hormonal and metabolic changes that redirect nutrients to specialized maternal tissues characteristic of reproduction, such as the placenta and mammary glands and, in turn, the developing fetus or infant, respectively (219). Lactation is the result of highly synchronized endocrine and neuroendocrine processes that begin during late pregnancy to prepare both the body and brain for motherhood (220).
