Drug use during breastfeeding. A survey from the Netherlands

Abstract

Objective: To survey drug use by breastfeeding women, and to compare this with nonbreastfeeding women. In addition, we were interested whether drug use was of influence on the decision to give breastfeeding, and the other way around. Design and setting: During a 6-week period in 2002, a questionnaire was handed out to all women with a child not older than 6 months, who visited a Well-Baby Clinic in the province of Friesland, the Netherlands, eventually resulting in 549 returned questionnaires (response 43%). Results: In all, 82.1% of the participants breastfed their baby at least at any time during the first 6 months after birth. More than half (65.9%) of all breastfeeding women had used drugs; however, they used drugs less frequently than nonbreastfeeding women (79.6%). The pattern of drug use differed: oral contraceptives, iron preparations, drugs for peptic ulcer, and several psychotropic drugs were more frequently used by nonbreastfeeding women, while vitamins were more frequently used by breastfeeding women. Drugs play an important role in women's decision to start or continue breastfeeding: women frequently hesitated to use drugs during breastfeeding, stopped either breastfeeding or drug use to avoid combining the two, took a measure to minimise exposure to the child, did not use any drug because of breastfeeding, or did not breastfeed because of drug use. Conclusions: Drugs are frequently though reluctantly used during breastfeeding, and play an important role in the decision to start and stop breastfeeding. Information how to deal with drugs seems therefore indispensable in efforts to promote breastfeeding.

Antiepileptic drugs and breastfeeding

“…In fact, breast milk should not be considered as a “presumed guilty”, because, after a complete scrutiny, only very few AEDs resulted contraindicated during breastfeeding [24,72,73]. …”

“…First of all, we did not conduct a systematic review of the published literature, but we offered a synopsis of the two most updated and authoritative clinical sources on the lactation risk (namely: Hale and Toxnet). Secondly, the existing reports on the lactation risks of medications in general [73], and particularly of AEDs [44] , are usually anecdotal or based on case series and therefore of poor methodological quality. However, we should remember that any recorded side-effect, while biologically and pharmacologically plausible in the nursing infant, is rarely attributable with certainty to a particular drug taken by her/his mother [74].…”

Changing Societal and Lifestyle Factors and Breastfeeding Patterns Over Time

“…17 Furthermore, the impact of medical issues related to breastfeeding including lactation issues, counterindicative medications, and mastitis were not assessed. [18][19][20] It is likely these factors meaningfully contributed to early cessation rates. However, we observed similar patterns of association for individual risk factors in sensitivity analyses restricted to mothers successfully breastfeeding (>6 times/day) at 6 weeks postdelivery (data not shown).…”

Aleitamento materno e uso de medicamentos durante a lactação

“…Estudos mostram que, em alguns países, a prevalência de lactantes que utilizam medicamentos durante o período de aleitamento materno pode chegar a 90%, considerando-se tanto as prescrições médicas quanto a auto-medicação, sendo, portanto, um fato que deve ser conhecido e considerado no momento das orientações para implantação e manutenção do aleitamento materno entre as puérperas (9)(10)(11)(12) . Observa-se que os suplementos com ferro e as vitaminas foram os medicamentos mais utilizados e, em algumas ocasiões, além do efeito suplementar primário, podem também eventualmente apresentar, como efeito placebo, estimulo à amamentação, conforme relatado por algumas mães que referiram o motivo da utilização do medicamento.…”