Two Case Studies Illustrating a Shared Decision-Making Approach to Illicit Methamphetamine Use and Breastfeeding

Abstract

Crystal methamphetamine (MA) is a potent psycho-stimulant that is increasingly used worldwide. It is highly addictive, is often made in clandestine laboratories, and can cause serious health issues in adults. Health professionals caring for women in the perinatal period must counsel women about the health risks to infants if they are exposed to MA in breast milk. Most guidelines recommend that women who have current or recent MA use do not breastfeed. This article explores approaches to breastfeeding advice in the context of MA use. Women who have made lifestyle changes, engaged well with services in the antenatal period, and are committed to drug counseling services after discharge from hospital may be supported to breastfeed if they are assessed as safe to do so. The importance of assessing each woman individually when developing infant feeding plans throughout the perinatal period is advocated.

The risk-risk trade-offs: Understanding factors that influence women’s decision to use substances to boost breast milk supply

“…We argue that breastfeeding support should begin with an assessment of whether milk supply is real or perceived and then ensure other measures are exhausted before considering galactagogue interventions [41]. To ensure women are exhausting non-galactagogue strategies, approaches with professionals may benefit from adopting an individually tailored, shared approach as it is considered a more bidirectional and holistic approach to decision-making [42, see also [43][44][45][46]. A shared decision-making approach would enable women to engage with practices to support breastfeeding and/or boost supply which are attuned to the complexity of their situations and individual values.…”

Parental ADHD in pregnancy and the postpartum period – A systematic review

“…A number of case reports with breastfeeding mothers showing a medical (ADHD, narcolepsy) or nonmedical use of amphetamines (amphetamine, dextroamphetamine, methamphetamine) suggest that all these drugs are generally highly transferred into breast milk (Ariagno, Karch, Middleberg, Stephens, & Valdès-Dapena, 1995;Bartu, Dusci, & Ilett, 2009;Blandthorn, James, Bowman, Bonomo, & Amir, 2017;Chomchai, Chomchai, & Kitsommart, 2015;Ilett, Hackett, Kristensen, & Kohan, 2007;Öhman, Wikner, Beck, & Sarman, 2015;Steiner, Villén, Hallberg, & Rane, 1984). However, medical treatment with racemic amphetamine (for narcolepsy) or dextroamphetamine (for ADHD) showed low RID of 2% and 5.7%, respectively (Ilett et al, 2007;Öhman et al, 2015).…”