World Breastfeeding Week is celebrated every year from 1 to 7 August to encourage breastfeeding and improve the health of babies around the world. This year’s World Breastfeeding Week slogan is “Empower Parents, Enable Breastfeeding”. As this year’s world breastfeeding week wraps up, it is pertinent to reflect the theme, including safe use of drugs during breastfeeding.
Breast milk is the best form of nutrition for young infants. It provides all the energy and nutrients required for the first 6 months of life. Today, more than 60% of women choose to breastfeed their infants. Of these women, 90% to 95% receive a medication during the first postpartum week, most commonly for pain control after delivery.
Breastfeeding mothers frequently require treatment with prescription medicines or may self-medicate with over-the-counter preparations, nutritional supplements or herbal medicines. It is therefore vital for health professionals to understand the principles of safe use of medications during lactation in order to provide appropriate advice, and to minimize risks from drug effects in the nursing infant. It comes as no surprise that one of the goals of drug dosing in lactating women is minimal infant exposure to the drug. It is desirable to adjust the dosing and nursing schedules so that a drug dose is administered at the time of or immediately after the infant’s feeding. medications should be dosed before the infant’s longest sleep.
WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is 6 months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to 2 years or beyond.
Benefits of breastfeeding
- Breastfeeding promotes better health for mothers and children alike. Increasing breastfeeding to near-universal levels could save more than 800,000 lives every year, the majority being children under 6 months
- Breastfeeding decreases the risk of mothers developing breast cancer, ovarian cancer, type 2 diabetes, and heart disease. It is estimated that increased breastfeeding could avert 20 000 maternal deaths each year due to breast cancer.
- Breastfeeding also strengthens the mother–infant bond.
Some drugs, such as epinephrine, heparin, and insulin, do not pass into breast milk and are thus safe to take. Others, that are considered safe, include most non-prescription (over-the-counter) drugs. Exceptions are antihistamines (commonly contained in cough and cold remedies, allergy drugs, motion sickness drugs, and sleep aids) and, if taken in large amounts for a long time, aspirin and other salicylates. Acetaminophen and ibuprofen, taken in usual doses, appear to be safe.
Most drugs pass into breast milk but usually in tiny amounts. However, even in tiny amounts, some drugs can harm the baby. Some drugs pass into breast milk, but the baby usually absorbs so little of them that they do not affect the baby. Examples are the antibiotics gentamicin, kanamycin, streptomycin, and tetracycline.
Drugs that are applied to the skin, eyes, or nose or that are inhaled are usually safe.
Most antihypertensive drugs do not cause significant problems in breastfed babies.
Caffeine and theophylline do not harm breastfed babies but may make them irritable. The baby’s heart and breathing rates may increase.
Women who smoke should not breastfeed. Smoking (nicotine) reduces milk production and interferes with normal weight gain in the baby.
Chronic or heavy consumers of alcohol should not breastfeed. High intakes of alcohol decrease milk let down and disrupt nursing until maternal levels decrease. Heavy maternal use may cause infant sedation, fluid retention and hormone imbalances in breastfed infants.
Antidepressants and antipsychotics appear to pass into the breast milk; however, no serious adverse effects have been reported.
Anticholinergic compounds may result in adverse CNS effects in the infant and may reduce milk volume in the mother
Bromocriptine suppresses lactation and large doses of diuretics may do likewise. Metronidazole gives milk an unpleasant taste
Some drugs to be avoided during breastfeeding:
- Combined oral contraceptives
- Cytotoxics (anticancer drugs)
- Stimulant laxatives
- Thiazide Diuretics
- Vitamin A/retinoid analogues (e.g. etretinate)