Breastfeeding and medications

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Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother, and the balance between maternal health and the safety of the breastfeeding infant. [1] [2] Medications, when administered to breastfeeding mothers, almost always are transferred to breast milk, albeit usually in small quantities. [3] The degree of impact on the nursing infant varies, with many medications posing minimal risk. Nonetheless, informed decision-making and professional guidance is needed.

Contents

The National Institutes of Health (NIH) maintains a database, which contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. [4]

Some medications and herbal supplements can be of concern. This can be because the drug can accumulate in breastmilk or have effects on the infant and the mother. Those medications of concern are those medications used to treat substance and alcohol addiction. Other medications of concern are those that are used in smoking cessation. Pain medications, such as opioids among others, and antidepressants need evaluation. [5]

Evaluating the potential for adverse effects

The determination of the safety of a medication can be evaluated by considering the following:

Lactation risk categories

Drugs can be categorised in one of five categories to determine how safe they are for breastfeeding: [6] [7] [8] [9]

L1 Compatible

"Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant." [6]

L2 Probably Compatible

"Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote." [6]

L3 Probably Compatible

"There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.)" [6]

L4 Possibly Hazardous

"There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective)." [6]

L5 Hazardous

"Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant." [6]

Over the counter medications

Over the counter medications are those medications that do not require a prescription to purchase in the US. Medications that require a prescription to purchase in the US may be available in other countries without a prescription. The following guidelines are recommended:

Other substances or chemicals have been evaluated regarding their safe use during pregnancy. Hair dye or solutions used for a 'permanent' do not pass to breastmilk. No adverse reports of using oral antihistamines and breastfeeding are found. Some of the older antihistamines used by a nursing mother can cause drowsiness in the infant. This may be a concern if the infant misses feedings by sleeping instead of nursing. [11]

Related Research Articles

<span class="mw-page-title-main">Infant formula</span> Manufactured food designed for feeding infants

Infant formula, also called baby formula, simply formula, baby milk or infant milk, is an ultra-processed food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid. The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk".

<span class="mw-page-title-main">Breast pump</span> Mechanical device used to extract milk from human breasts

A breast pump is a mechanical device that lactating women use to extract milk from their breasts. They may be manual devices powered by hand or foot movements or automatic devices powered by electricity.

<span class="mw-page-title-main">Breast milk</span> Milk produced by the mammary glands in the breast of a human female

Breast milk or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, such as through human milk’s own microbiome, whilst also contributing to healthy development of the immune system and gut microbiome.

A human milk bank is "a service which collects, screens, processes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant". As of November 2019, there are 28 milk banks in North America that are members of the Human Milk Banking Association of North America (HMBANA). They are usually housed in hospitals, although some are free standing. Members of HMBANA follow the annually revised "Guidelines for the Establishment and Operation of a Donor Human Milk Bank" which include protocols for soliciting donors and collecting, processing, and distributing the milk. In addition, some states have required standards for donor human milk banks. However, the Food and Drug Administration (FDA), states that "the FDA has not been involved in establishing these voluntary guidelines or state standards." Some of these protocols are described below.

<span class="mw-page-title-main">Erotic lactation</span> Sexual activity involving the stimulation of womans breast

Erotic lactation is sexual arousal by breastfeeding on a woman's breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.

Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. In some women it occurs only with the first let-down in a feeding, occasionally women may have multiple strong letdowns during a feeding. OALD can make breastfeeding difficult and can be the source of some breastfeeding complications. It may also be known as hyper milk-ejection. A woman may have OALD in addition to an oversupply of breastmilk. The physical or medical cause of an overactive let-down is still unknown. Whether mothers with OALD have a higher overall milk volume – or a strong reaction to the hormone oxytocin also remains to be seen.

<span class="mw-page-title-main">History and culture of breastfeeding</span>

The history and culture of breastfeeding traces changing social, medical and legal attitudes to breastfeeding, the act of feeding a child breast milk directly from breast to mouth. Breastfeeding may be performed by the infant's mother or by a surrogate, typically called a wet nurse.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. Non-essential drugs and medications should be avoided while pregnant. Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects. Even small amounts of alcohol, tobacco, and marijuana have not been proven to be safe when taken while pregnant. In some cases, for example, if the mother has epilepsy or diabetes, the risk of stopping a medication may be worse than risks associated with taking the medication while pregnant. The mother's healthcare professional will help make these decisions about the safest way to protect the health of both the mother and unborn child. In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.

Lactation suppression refers to the act of suppressing lactation by medication or other non pharmaceutical means. The breasts may become painful when engorged with milk if breastfeeding is ceased abruptly, or if never started. This may occur if a woman never initiates breastfeeding, or if she is weaning from breastfeeding abruptly. Historically women who did not plan to breastfeed were given diethylstilbestrol and other medications after birth to suppress lactation. However, its use was discontinued, and there are no medications currently approved for lactation suppression in the US and the UK. Dopamine agonists are routinely prescribed to women following a stillbirth in the UK under the NHS.

<span class="mw-page-title-main">Human milk bank</span> Service that collects and dispenses human milk

A human milk bank, breast milk bank or lactarium is a service that collects, screens, processes, pasteurizes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant. The optimum nutrition for newborn infants is breast milk for at least the first 6 months of life. For women who are unable to breast feed or produce enough milk, pasteurized donor breast milk may be an effective approach to feeding. Breast milk supplied by a woman other than the baby's mother that is not pasteurized and informal breast milk sharing is associated with a risk of transmitting bacteria and viruses from the donor mother to the baby and is not considered a safe alternative. If pasteurized donor breast milk is not available, commercial formula is suggested as a second alternative.

<span class="mw-page-title-main">Breastfeeding promotion</span> Activities and policies to promote health through breastfeeding

Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.

<span class="mw-page-title-main">Extended breastfeeding</span> Defined as after age 12–24 months

In Western countries extended breastfeeding usually means breastfeeding after the age of 12 to 24 months, depending on the culture.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

Nipple confusion is the tendency of an infant to unsuccessfully adapt between breast-feeding and bottle-feeding. It can happen when the infant is put back onto breast-feeding. Nipple confusion can turn into nipple refusal in which the infant refuses both the bottle and breastfeeding.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

<span class="mw-page-title-main">Breastfeeding and mental health</span>

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority.

<span class="mw-page-title-main">Delayed onset of lactation</span>

Delayed onset of lactation (DOL) describes the absence of copious milk secretion (onset of lactation) within the first 72 hours following childbirth. It affects around 20–40% of lactating women, the prevalence differs among distinct populations.

<span class="mw-page-title-main">Establishment of breastfeeding</span>

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organisation(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

References

  1. 1 2 "The La Leche League InternationalI - Medications and Breastfeeding". La leche League International. Retrieved 2 August 2017.
  2. 1 2 Spencer, Jeanne P.; III, Luis S. Gonzalez; Barnhart, Donna (1 July 2001). "Medications in the Breast-Feeding Mother". American Family Physician. 64 (1): 119–26. PMID   11456429.
  3. "Breastfeeding" (PDF). Office on Women's Health, U.S. Department of Health and Human Services. 2014. Archived from the original (PDF) on 14 May 2017. Retrieved 20 July 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  4. Drugs and Lactation Database (LactMed). 2006.{{cite book}}: |website= ignored (help)PD-icon.svg This article incorporates text from this source, which is in the public domain .
  5. "Breastfeeding and Medication". American Association of Pediatrics. Archived from the original on 2 April 2019. Retrieved 4 August 2017.
  6. 1 2 3 4 5 6 Hale, Thomas Wright; Rowe, Hilary E. (2016-12-30). Medications and Mothers' Milk 2017 (17th ed.). New York: Springer Publishing Co Inc. ISBN   9780826128584. ASIN   0826128580.
  7. "Medications and Mothers Milk Online". www.medsmilk.com. Archived from the original on 2018-01-23. Retrieved 2018-03-24.
  8. "Lactation Drug Risk Categories". CMBC Medical Reference. Retrieved 2018-03-24.
  9. Riordan, Jan (2005). Breastfeeding and Human Lactation. Jones & Bartlett Learning. p. 138. ISBN   9780763745851.
  10. staff, familydoctor.org editorial (1 September 2005). "OTC Medicines and Pregnancy - familydoctor.org".
  11. "Drugs in Breastmilk -Is It Safe?". The Breasfeeding Network - Britains Nonprofit Breastfeeding Support Organization. Archived from the original on 7 January 2023. Retrieved 4 August 2017.