Automedicação em nutrizes e sua influência sobre a duração do aleitamento materno

Abstract

Objective: To investigate the practice of self-medication by nursing mothers, the main drugs used and the influence on the duration of breastfeeding.Methods: A longitudinal cohort study involving 246 women seen at the maternity unit of Hospital Manoel Gonçalves in Itaúna, state of Minas Gerais, Brazil. A monthly follow-up of mothers and newborns was performed for the first 12 months postpartum or until weaning. The effect of the practice of self-medication on the duration of breastfeeding was evaluated by multivariate analysis using Cox's regression model with time-dependent variables.Results: Self-medication was practiced by 52.4% of the nursing mothers. The most used pharmacological classes were: analgesics/antipyretics (54.5%), non-steroidal anti-inflammatories (15%), spasmolytics (6.2%), laxatives (3.5%), benzodiazepines (3%), nasal decongestants (1.4%), and antibiotics (0.9%). The most used drugs were dipyrone (31.5%) and paracetamol (17.9%). The practice of self-medication was associated with a higher probability of the use of drugs posing the risk of adverse effects for the infant or for lactation (p = 0.000). However, the practice of self-medication was not associated with weaning (p = 0.135). Conclusions:The high rates of self-medication among nursing mothers and the use of drugs posing risks of undesirable effects for the infant and for lactation reveal the need for better education on the risks of self-medication by nursing mothers. However, self-medication was not proven to be a risk factor for weaning.J Pediatr (Rio J). 2009;85(2):129-134: Breastfeeding, lactation, weaning, self-medication, pharmaceutical preparations.

Postpartum women’s use of medicines and breastfeeding practices: a systematic review

“…Finally, 25 full-text articles [ 31 – 55 ] (24 English and 1 Portuguese [ 42 ]) were assessed for eligibility for inclusion. Five further articles were excluded: one article based on impact of antidepressant use during pregnancy on breastfeeding [ 32 ]; two articles did not contain overall medicine use information [ 31 , 40 ]; one article [ 35 ] contained information about maternal use of self-medication only and was based on the same cohort used in another article [ 33 ] included in this review; and another one [ 54 ] was a letter to the editor. Two articles [ 45 , 46 ] using the same cohort were considered as a single study and two articles [ 41 , 44 ] from the same survey were also abstracted as one study.…”

Where are the data linking infant outcomes, breastfeeding and medicine exposure? A systematic scoping review

“…In cohorts and databases, prescription medicines, marijuana and pesticides adversely affected breastfeeding rates. Reasons for shortened breastfeeding duration included: patients’ concerns over prescription medicines [ 38 , 41 ], weak suckling [ 42 ] or adverse effects on the infant [ 43 , 44 ]. Decreased lactation following oestrogen and progesterone exposure led to early discontinuation of breastfeeding [ 38 , 45 ].…”

Lactantes em tratamento medicamentoso da rede pública de saúde

“…Em geral, os profissionais de saúde que atuam prescrevendo medicamentos para lactantes devem se basear na relação risco/benefício e conhecer as categorias de risco das drogas, que vão desde as mais seguras até as contraindicadas (12) . Porém, a carência de informações e a complexidade dos diversos fatores que determinam a escolha de um medicamento para uso durante a lactação reforçam a preocupação sobre a automedicação e a interrupção da amamentação por orientação dos profissionais de saúde (13)(14)(15) . A amamentação somente deverá ser interrompida se existirem evidências de que a droga usada pela lactante é nociva para o lactente, ou quando não houver informações a respeito e a droga não puder ser substituída por outra que seja compatível com a amamentação (3) .…”

“…Ressalta-se, entretanto, que as drogas prescritas eram de uso compatível com a amamentação (2) . Além disso, os prescritores escolheram medicamentos cujos efeitos são descritos na literatura, pouco excretados no leite materno e que não oferecem risco para saúde da criança, como já abordado em outro trabalho (14) . Para a confirmação da associação desses sintomas com os medicamentos prescritos, testes específicos faziam-se necessários.…”