Why does the need for medication become a barrier to breastfeeding? A narrative review

McClatchey, Alyson; Shield, Alison; Cheong, Lynn; Ferguson, Sally; Cooper, Gabrielle; Kyle, Greg

doi:10.1016/j.wombi.2017.12.004

Cited by 25 publications

(36 citation statements)

References 26 publications

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“…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]. It is expected that maternal milk should be free from any form of contamination and that mothers should avoid any risks, many times putting their children's needs before their own [25].…”

Section: Discussionmentioning

confidence: 99%

“…For women who are breastfeeding, weighing risks and benefits is complicated by the consideration of its effects on both mother and child [25]. In addition, since pregnant and breastfeeding women are usually excluded from drug trials, safety information is usually limited or non-existent [10,25,26]. Thus, health practitioners are expected to balance the need to treat the mother for a medical condition and at the same time support breastfeeding, providing accurate and up-to-date advice [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Another strength of this study is the use of two drug classifications according to their safety in lactation: a national classification system used in Brazil and a widely used international classification system. Current information about medicines safety during lactation is conflicting [9,10]. Some important differences between these two classifications were observed, specifically the hormonal contraceptives, pharmacological group widely used by women in reproductive age.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Many women use medicines during lactation, and health care providers face the challenge of determining which medications are compatible with breastfeeding. Although there is a large amount of literature on the availability of active components of medications in the breast milk, the quality of information about their safety during lactation varies and can be conflicting [9,10]; therefore, many women can be advised by health practitioners to stop breastfeeding unnecessarily or avoid treatment without evidence-based information [11,12]. For instance, there are several controversies regarding the safety of hormonal contraceptive medication use, which is widely used by women at this stage, during lactation.…”

Section: Introductionmentioning

confidence: 99%

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

Lutz

Bassani

Miranda

et al. 2020

IJERPH

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Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale’s lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale’s risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Lutz

Bassani

Miranda

et al. 2020

IJERPH

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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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Landscape review of global real‐world data sources for studying medication use in pregnancy and lactation that support regulatory decision making

Davis,

Yost,

Brauneis

et al. 2023

Pharmacoepidemiology and Drug

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PurposeMost pregnant people take at least one medication during gestation or while breastfeeding, however data are lacking on the safety of medication use in these populations. We conducted a landscape review of real‐world data sources specific to medication use in pregnancy and breastfeeding populations that have met, or have potential to meet, health authorities' requirements for post‐authorization safety studies.MethodsA 2‐phase approach identified data sources from literature, publicly available registers of non‐interventional post‐authorization studies of pregnant women, existing database inventories, and emerging data sources known to the authors.ResultsRequired key attributes were assessed according to current regulatory guidance, resulting in selection of 49 suitable data sources. All global regions were represented, with North America (37%) and Europe (33%) most common; 12% of the data sources included pregnancy information from low‐to middle‐income countries. Administrative healthcare claims (25%) and electronic healthcare records (21%) comprised the largest types of data sources. Across data sources, 53% were managed by national or regional governments, 27% by industry, and 20% by academic institutions. Maternal age, diagnoses, prenatal care, and reproductive history were available in most, whereas fewer included demographic data (e.g., race/ethnicity). Breastfeeding data were collected in 37% of the final data sources.ConclusionWe conducted a systematic approach to data source evaluation of pregnancy and breastfeeding to be used as a resource for investigators to consider when designing pregnancy‐related research studies to satisfy regulatory requirements.

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Why does the need for medication become a barrier to breastfeeding? A narrative review

Cited by 25 publications

References 26 publications

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

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

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

Landscape review of global real‐world data sources for studying medication use in pregnancy and lactation that support regulatory decision making

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