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

Abstract

The objectives of this article are to systematically review i) the extent of medicine use in postpartum women, and ii) the impact of maternal medicine use (excluding contraceptives and galactogogues) on breastfeeding outcomes (initiation and/or duration). PubMed, Medline (Ovid), Scopus (Elsevier), Cinahl (EBSCO), PsycINFO (Ovid), Embase (Ovid) and Web of Science (ISI) databases were searched to find original studies on medicine use in women after the birth. Additional studies were identified by searching Google Scholar, Wiley Online Library, Springer Link, selected journals and from the reference list of retrieved articles. Observational studies with information about postpartum women’s use of any type of medicine either for chronic or acute illnesses with or without breastfeeding information were included. The majority of relevant studies suggest that more than 50 % of postpartum women (breastfeeding or not) required at least one medicine. Due to the lack of uniform medication use reporting system and differences in study designs, settings and samples, the proportion of medicine use by postpartum women varies widely, from 34 to 100 %. Regarding the impact of postpartum women’s medicine use on breastfeeding, a few studies suggest that women’s use of certain medicines (e.g. antiepileptics, propylthiouracil, antibiotics) during lactation can reduce initiation and/ or duration of breastfeeding. These studies are limited by small sample size, and with one exception, all were conducted in Canada more than a decade ago. Large scale studies are required to establish the relationship between maternal medicine use and breastfeeding, considering type of illness, period of use and total duration of medicine use.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-015-0053-6) contains supplementary material, which is available to authorized users.

Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study

“…Breastfeeding practices can be affected by several historical, socioeconomic, cultural and individual factors [24]. During the sensitive period after childbirth, many women face health problems requiring the use of medications [6]. Although the most commonly used medications are considered safe during lactation and the adverse effects due to the maternal use of medications in breastfed children are rare, their use can be perceived as a barrier for breastfeeding for many reasons, especially due to misinterpretation of risk and pressures faced by the breastfeeding woman [10].…”

“…Despite this, in our findings, there was no statistically significant difference in weaning rates between women who did not consume medications or consumed only breastfeeding-compatible medications and among women who took medicines that pose some risk to milk production or risks for the child, for both criteria. Nowadays, there are few studies evaluating the duration of breastfeeding regarding the use of medicines [6,10]. A study carried out in Brazil using American Academy of Pediatrics classification for medicines' compatibility with breastfeeding (2001) and Hale's criteria (2004) with a sample of 246 women showed that duration of breastfeeding was longer in women who did not use any medication or who used only medicines compatible with breastfeeding [27].…”

“…However, the use of medications by mothers may influence the success of breastfeeding. Most studies suggest that more than 50% of women in the postpartum period (breastfeeding or not) use at least one medication [6]. These women may either discontinue breastfeeding or not adhere to the prescribed medication they need due to concerns about indirectly exposing the baby to the drug through breast milk [7].…”

Contraindications to Breastfeeding - Current Issues at the Border Between Myth and Reality

“…Some studies show that women take more medications during breastfeeding compared to pregnancy. It is necessary to advise and fi nd alternative ways to prevent ending breastfeeding 14 .…”

Inclusion of pregnant and breastfeeding women in research – efforts and initiatives

“…Surveys in different countries show that 90–99% of women take at least one drug in the postpartum period , and up to 5% of them take medications to treat chronic conditions (e.g. epilepsy, thyroid disorders, diabetes, hypertension and psychiatric conditions) . Since initiating and maintaining breastfeeding is crucial in the immediate postpartum setting, it is important to ensure that sufficient information exists about the pharmacokinetics and safety profiles of medications taken by the mother.…”