Drugs that affect the fetus and newborn infant via the placenta or breast milk

Ostrea, Enrique M.; Mantaring, Jacinto Blas V.; Silvestre, Maria Asuncion A.

doi:10.1016/j.pcl.2004.01.001

Cited by 47 publications

(16 citation statements)

References 269 publications

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“…11,12 Many antianxiety drugs, antidepressants, and mood stabilizers appear in low concentrations in human milk, with estimated relative infant doses less than 2% of weight-adjusted maternal dose and/or milk-plasma ratios less than 1. 13 However, the percentage of maternal doses that approach clinically significant levels (10% or more) have been reported for bupropion, 14 diazepam, 13 fluoxetine, 15 citalopram, 16 lithium, 17 lamotrigine, 18 and venlafaxine. 19 Data on drug excretion in human milk are not available for up to one-third of psychoactive therapies.…”

Section: Antidepressants Anxiolytics and Antipsychoticsmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

458

198

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Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (http://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see http://www.who.int/topics/breastfeeding/en/).

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Section: Antidepressants Anxiolytics and Antipsychoticsmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

458

198

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“…Many compounds that the mother consumes during pregnancy cross the placenta and enter the bloodstream of the fetus (Myllynen, Pasanen, & Pelkonen, 2005) . The total dose of the drug that reaches the fetus is dependent on the dose of the drug ingested by the mother, the manner in which the drug is excreted, and the metabolic rate and pathway of the drug (Ostrea, Mantaring, & Silvestre, 2004) . Several reviews detail the effects and risks associated with placental transfer of a wide range of licit and illicit drugs (Briggs, Freeman, & Yaffe, 1998 ;Garland, 1998 ;Ostrea et al, 2004) .…”

Section: Pharmacologymentioning

confidence: 99%

“…The total dose of the drug that reaches the fetus is dependent on the dose of the drug ingested by the mother, the manner in which the drug is excreted, and the metabolic rate and pathway of the drug (Ostrea, Mantaring, & Silvestre, 2004) . Several reviews detail the effects and risks associated with placental transfer of a wide range of licit and illicit drugs (Briggs, Freeman, & Yaffe, 1998 ;Garland, 1998 ;Ostrea et al, 2004) . Mothers can also expose infants to drugs through breast milk.…”

Section: Pharmacologymentioning

confidence: 99%

“…Mothers can also expose infants to drugs through breast milk. The total dose that reaches the infant depends on the dose the mother ingested, the duration of the drug regimen (occasional vs. consistent use), the route of administration (drugs that enter the mother's system parenterally are typically less concentrated in the breast milk than those administered orally), the pharmacokinetics of the drug (drugs with longer half-lives have greater potential to collect in significant amounts in milk), and the infant's ability to absorb, metabolize, and excrete the drug, with older infants being able to process most drugs more efficiently than premature or younger infants (Ostrea et al, 2004) .…”

Section: Pharmacologymentioning

confidence: 99%

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Adolescent Substance Abuse

Leukefeld¹

2009

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“…There is a wealth of evidence to show that some health behaviours and social problems can have a significant impact on the long‐term development of the baby when they occur during pregnancy. For example, it is well established that alcohol (Riley et al ., ) and some drugs (Ostrea et al ., ) can cross the placenta and be harmful for the foetus in terms of causing perinatal mortality (including miscarriage), stillbirth, premature delivery, low birthweight, impairment of normal foetal brain development, neonatal abstinence syndrome and foetal alcohol syndrome. Research has also highlighted the adverse effect of intimate partner violence during pregnancy, which can result in miscarriage, stillbirth, premature birth, low birthweight, foetal brain injury and bone fractures (Boy and Salihu, ; Guaderrama de Moseson, ; Pallitto et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Assessing Parental Capacity when there are Concerns about an Unborn Child: Pre‐Birth Assessment Guidance and Practice in England

et al. 2017

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Assessment where there are concerns that an unborn child is likely to suffer significant harm is one of the most difficult tasks that social workers undertake; the legal and ethical context makes the process of assessment and intervention during this period complex. This paper explores pre‐birth assessment guidance and practice in England. Local safeguarding guidance in 147 English localities was accessed and analysed, and interviews were conducted with 22 practitioners involved in pre‐birth assessments. The findings showed that while most local safeguarding guidance was more detailed and explicit than the national guidance, legal and ethical issues were rarely addressed. Interview data showed that, in general, guidance to support social work assessments during the pre‐birth period was insufficient, and that few practitioners used standardised tools to aid assessment. Some practitioners regarded pre‐birth assessments as less urgent than cases involving infants/older children, thereby increasing delays in decision‐making. It is concluded that existing guidance and practice with regard to pre‐birth assessment are inadequate. Copyright © 2017 John Wiley & Sons, Ltd. Key Practitioner Messages Existing guidance regarding pre‐birth assessment are inadequate with regards to providing practitioners with the necessary information about the assessment process or tools with which to undertake the assessment. Practitioners undertaking pre‐birth assessment should be provided with better training regarding the assessment process. There is a need for practitioners undertaking pre‐birth assessment to use standardised tools alongside professional judgement.

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Drugs that affect the fetus and newborn infant via the placenta or breast milk

Cited by 47 publications

References 269 publications

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Adolescent Substance Abuse

Assessing Parental Capacity when there are Concerns about an Unborn Child: Pre‐Birth Assessment Guidance and Practice in England

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