Many women who are breastfeeding are wrongly advised to stop taking necessary medications or to discontinue nursing because of potential harmful effects on their infants, according to a new report published online today by the American Academy of Pediatrics.
Receiving mixed messages from physicians and other providers about safety can lead some mothers to unnecessarily wean their babies from breast milk, says AzAAP member Laurie Jones, MD, IBCLC. “This is an area where communication between a mother’s provider and baby’s provider is critical,” she adds.
Certain classes of drugs can be problematic according to the report, either because of accumulation in breast milk or due to their effects on the nursing infant or mother. The most common products of concern include pain medications, antidepressants, and drugs to treat substance/alcohol abuse or smoking cessation.
The AAP hopes that the report will reaffirm the recommendation that most medications and immunizations are safe during lactation. The AAP advises all physicians to obtain the most up-to-date information on drugs and lactation.
We asked Dr. Jones, an International Board Certified Lactation Consultant, in practice at St. Joseph’s Pediatric Clinic, to answer a few questions about what moms need to know about medications and breastfeeding.
RAK: What is the most common misconception about medications and breast feeding?
LJ: The most common misconception is that all medications have risk to the baby while breastfeeding. Many doctors and pharmacists do not know where to look for information about drug safety, and this report from the AAP is validation that a very small number of medications are contraindicated in breastfeeding mothers.
There is an assumption that a drug’s safety in pregnancy is the same as lactation. But we all know that the placenta is not the same organ as the breast! There are completely different rating scales for pregnancy and lactation.
Another great resource is the Infant Risk Hotline at Texas Tech University. Anyone can call during business hours and get information about medications and herbs in breast milk. Thomas W. Hale, RPh, PhD, pediatrics professor at Texas Tech, has literally written the book on medications in breast milk, and also pioneered an iPhone/Android App with a rating scale (L1 safest, L5 not safe) for medications. The book is published every two years, but the app is updated continually.
RAK: If a mom wants to breastfeed, but takes anti-depressants, is there a way that she can?
LJ: Absolutely! A mother can breastfeed while receiving treatment for depression and/or anxiety. Many mothers are prescribed these medications during pregnancy and much higher doses reach the baby during that time than through breast milk after birth.
A mother should never abruptly stop her medications. She should have a conversation with her OB-GYN to weigh the risks and benefits of treatment. Ideally, physicians should choose a medication that can be taken during both pregnancy and lactation. Switching medications could mean lapses in time where a mother might be without proper pharmacologic support at what is often a very vulnerable time: the post-partum period.
All antidepressants cross into breast milk in some proportion, but there are dozens of options and many with low levels of penetration into breast milk. The AAP statement does point out the limitations of current research on long-term effects of small exposure through breast milk; however there are known risks to not treating the mother and known risks of giving formula to infants.
I recommend mothers who take antidepressants during pregnancy take a look at LactMed and call the Infant Risk line to get the best information possible. Decide in conjunction with your OB-GYN or other provider the best course of action during lactation. The goal is to choose the medication that has the best safety and effectiveness for the mother and the lowest exposure to the infant.
RAK: What should an expectant mom ask her doctor if she is concerned?
LJ: A mother should ask a physician first about all available non-pharmacologic interventions for depression and anxiety including alternative and behavioral therapies.
The risk is different depending on age of the infant: an older baby receives much smaller dose per body weight than a newborn. The risk of sleepiness and poor feeding more prominent in certain drugs in newborn period but not in older infants.
Ideally, a medicine would be chosen for best outcomes in both pregnancy and lactation since the baby will receive much higher doses through placenta than the breast. Untreated depression can lead to premature births and poor maternal health — and puts baby at risk, also.
Breast milk is the ideal way for a mother to feed and grow her child, and a mother should be able to find a medication that supports her health and has minimal risk to the baby.