Calls to a Major Teratogen Information Service Regarding Exposures During Breastfeeding

Hegedus, Elizabeth; Oakes, Diana J.; Hill, Majella; Ritchie, Helen E.; Kennedy, Debra

doi:10.1089/bfm.2019.0010

Cited by 3 publications

(8 citation statements)

References 30 publications

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“…Medications used to treat complaints from the nervous system or respiratory system constitute a major part of the questions in our data material, including several medications also available over-the-counter (OTC), in line with previous studies [24][25][26][27][28]. Despite OTC medications generally being recognized as safe and available without involvement from a physician, our results support previous findings indicating a need among women to ensure safety of use during pregnancy and breastfeeding [27,28].…”

Section: Frequently Asked About Medications Therapeutic Fields and Ta...supporting

confidence: 91%

“…The number of questions concerning use of medications during breastfeeding (42%) was somewhat higher in our material compared to what is reported from other TIS (34-39%) [24,27,28]. Norway has a well-established and strong culture for breastfeeding and are among the countries with both the highest rate and duration of breastfeeding [33][34][35].…”

Section: Questions About Breastfeedingcontrasting

confidence: 67%

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Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

Bakkebø

Heitmann

Vågsvoll

et al. 2022

BMC Pregnancy Childbirth

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Background Online information about safety of medications during pregnancy and breastfeeding is shown to be conflicting, resulting in anxiety and abstaining from use. The aim of this study was to characterize questions to SafeMotherMedicine, a web-based medicines information service for pregnant and breastfeeding women, to identify target areas that could guide subsequent development of medicines information directed at pregnant and breastfeeding women. Methods The SafeMotherMedicine database contains all questions received through the web-based service and their corresponding answers. A retrospective database analysis of questions received from January 2016 to September 2018 was performed, using descriptive statistics. Results A total of 11 618 questions were received including 5 985 questions (51.5%) concerning pregnancy, 4 878 questions (42.0%) concerning breastfeeding, and 755 questions (6.5%) concerning both conditions. The medications in question represented all therapeutic groups with paracetamol (7.0%), ibuprofen (4.1%), cetirizine (3.3%), desloratadine (3.2%) and meclizine (2.8%) being the top five. The 20 medications most frequently asked about for either pregnancy, breastfeeding or both pregnancy and breastfeeding, constituted half of all questions and were used to identify target areas. These included both symptomatic relief of common complaints, such as pain, nausea, and rhinitis, as well as treatment of chronic conditions such as allergy, psychiatric disorders, and asthma. Analysis of a subset of questions showed that most of these questions were asked before use of medications in a current pregnancy (49%) or during breastfeeding (72%). The questions concerned use of medications in all stages of pregnancy and breastfeeding. For 81.6% of the questions concerning pregnancy, and for 84.2% of the questions concerning breastfeeding, information of no or low risk for the foetus or the breastfed infant was provided by SafeMotherMedicine. Conclusions We found that target areas for medicines information directed at pregnant and breastfeeding women included both symptomatic relief of common complaints as well as treatment of chronic conditions. The questions concerned a wide range of medications and involved use in all stages of pregnancy and breastfeeding. Our findings indicate that developing medicines information addressing the identified target areas will meet the information need for a large proportion of this patient group.

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Section: Frequently Asked About Medications Therapeutic Fields and Ta...supporting

confidence: 91%

Section: Questions About Breastfeedingcontrasting

confidence: 67%

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

Bakkebø

Heitmann

Vågsvoll

et al. 2022

BMC Pregnancy Childbirth

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“…Breastfeeding mothers and health professionals often hold concerns about inadvertently exposing breastfed infants to xenobiotics through breastmilk. Although most drugs are considered safe and compatible with breastfeeding, cases of toxic drug exposure have been reported 1–5 . More importantly, there is often a lack of clear and conclusive information about the safety of medicines in lactation resulting in the unnecessary discontinuation of breastfeeding or suboptimal treatment of maternal medical conditions with less effective alternatives 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Although most drugs are considered safe and compatible with breastfeeding, cases of toxic drug exposure have been reported. 1 , 2 , 3 , 4 , 5 More importantly, there is often a lack of clear and conclusive information about the safety of medicines in lactation resulting in the unnecessary discontinuation of breastfeeding or suboptimal treatment of maternal medical conditions with less effective alternatives. 2 Drug properties and pharmacokinetic parameters such as drug lipophilicity, protein binding and p Ka are used to determine milk to plasma ratio (M: P), a measurement of ratios of the areas under the curves of milk and plasma drug concentrations.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 More importantly, there is often a lack of clear and conclusive information about the safety of medicines in lactation resulting in the unnecessary discontinuation of breastfeeding or suboptimal treatment of maternal medical conditions with less effective alternatives. 2 Drug properties and pharmacokinetic parameters such as drug lipophilicity, protein binding and p Ka are used to determine milk to plasma ratio (M: P), a measurement of ratios of the areas under the curves of milk and plasma drug concentrations. 6 As most drugs enter breastmilk via passive diffusion, M:P ratio provides a reliable indication of drug transferability into breastmilk.…”

Section: Introductionmentioning

confidence: 99%

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Are active efflux transporters contributing to infant drug exposure via breastmilk? A longitudinal study

Ahmadzai

Tee

Crowe

2022

Basic Clin Pharma Tox

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Although most drugs are considered safe and compatible with breastfeeding, cases of toxic drug exposure have been reported. Active efflux transporters have been implicated as a mechanism in the transfer of drugs from mother to baby via breastmilk. Using breastmilk as a source of human mammary epithelial cells, this novel longitudinal study investigated the expression of four active transporters, namely, MDR1, MRP1, MRP2 and BCRP in the lactating human breast. BCRP gene was found to be strongly overexpressed with levels peaking at 5 months postpartum, potentially indicating a time where a breastfed infant may be at risk of inadvertent exposure to BCRP substrates. Serum albumin, a major component of human breastmilk was increasingly downregulated as lactation progresses. Xanthine oxidase/dehydrogenase, an enzyme in breastmilk attributed to a reduced risk of gastroenteritis caused by Escherichia coli and Salmonella enteritides, was downregulated. Lysozyme and fatty acid synthase are progressively upregulated. This study also shows that breastmilk-derived epithelial cells, when propagated in culture, exhibit characteristics significantly different to those derived directly from breastmilk. This serves to warn that in vitro studies are not a true representation of in vivo processes in the lactating breast; hence, application of in vitro data should be conducted with caution.

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The most common medications dispensed to lactating persons: An electronic health record‐based approach

Palmsten

Vazquez‐Benitez

Bandoli

et al. 2023

Pharmacoepidemiology and Drug

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PurposeUsing a novel, electronic health record (EHR)‐based approach, to estimate the prevalence of prescription medication use at 2, 4, and 6 months postpartum among lactating individuals.MethodsWe utilized automated EHR data from a US health system that records infant feeding information at well‐child visits. We linked mothers who received prenatal care to their infants born May 2018–June 2019, and we required infants to have ≥1 well‐child visit between 31 and 90 days of life (i.e., 2‐month well‐child visit with a ±1 month window). Mothers were classified as lactating at the 2‐month well‐child visit if their infant received breast milk at the 2‐month well‐child visit. For subsequent well‐child visits at 4 and 6 months, mothers were considered lactating if their infant was still receiving breast milk.ResultsWe identified 6013 mothers meeting inclusion criteria, and 4158 (69.2%) were classified as lactating at the 2‐month well‐child visit. Among those classified as lactating, the most common medication classes dispensed around the 2‐month well‐child visit were oral progestin contraceptives (19.1%), selective serotonin reuptake inhibitors (8.8%), first generation cephalosporins (4.3%), thyroid hormones (3.5%), nonsteroidal anti‐inflammatory agents (3.4%), penicillinase‐resistant penicillins (3.1%), topical corticosteroids (2.9%), and oral imidazole‐related antifungals (2.0%). The most common medication classes were similar around the 4 and 6‐month well‐child visits although prevalence estimates were often lower.ConclusionsProgestin‐only contraceptives, antidepressants, and antibiotics were the most dispensed medications among lactating mothers. With routine collection of breastfeeding information, mother‐infant linked EHR data may overcome limitations in previous studies of medication utilization during lactation. These data should be considered for studies of medication safety during lactation given the need for human safety data.

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Calls to a Major Teratogen Information Service Regarding Exposures During Breastfeeding

Cited by 3 publications

References 30 publications

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

Are active efflux transporters contributing to infant drug exposure via breastmilk? A longitudinal study

The most common medications dispensed to lactating persons: An electronic health record‐based approach

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