Breast milk is a biological fluid secreted by the mammary glands during the lactation period of women. Breastfeeding provides the optimum nutritional need of infants for their growth and development as it is an invaluable source of nutrition for infants.
The newborn infant has a weak immune system and needs support from the mother. The first milk from the mother’s breast contains colostrum, crucial for the baby as it contains immunoglobulins that protect from infection and minimize the risk of catching numerous systemic conditions later in life. Apart from various research on formula milk composition, no substitute is known that replaces the mother breast milk.
Every breastfeeding mother gets concerned when they require specific medication in their breastfeeding period. Almost all women worry about the possible impact of medicines on breast milk and the harmful effect on their newborns.
Can All Medicines Pass Into Breast Milk?
Most of the medicines in your blood can get transferred into your breast milk. However, the extent of drug transfer into breast milk varies for each drug. Usually, the levels of drugs transferred in breast milk are deficient, posing no real risk to most infants.
However, some medicines can become concentrated in breast milk. Hence, it is essential to consider all medications separately and take drugs only after consulting your doctor.
What Are the Determining Factors for Prescribing Medications to Breastfeeding Mothers?
The decision to prescribe medications for a breastfeeding mother depends on weighing the benefits of medication use for the mother against the potential risk of exposing the infant to the medicines. It is not predetermined that a safe drug during pregnancy is also safe during breastfeeding.
The transfer of medications into breast milk depends on the concentration gradient of the drugs. Therefore, the exposure of infants to drugs can be minimized by prescribing medications that are poorly absorbed orally by breastfeeding mothers.
Besides, the mothers can be instructed to avoid breastfeeding during the peak maternal serum drug concentration. Prescribing topical treatment wherever possible could limit the drug concentration in the mother's blood.
Also, the mothers having premature infants might require altered dosing to avoid drug toxicity in these infants.
According to the American Academy of Pediatrics (AAP) recommendation, all healthcare professionals should weigh the risks and benefits while prescribing drugs to breastfeeding mothers. The considerable factors are:
Drug needs of the mother.
Effects of the drug on milk production.
The concentration of the drug reaches the human breast milk.
Oral absorption proportion of the breastfeeding infant.
Potential side effects on the breastfeeding infant.
Age of the infant.
How Can We Minimize the Risk of Drug Exposure to Breastfeeding Infants?
The risk of breastfeeding infants can be minimized by reducing the drug exposure of the infant. This is because the drug's overall risk to a breastfed infant depends on the drug concentration in the infant's blood.
However, in situations where usage of medications is indicated for breastfeeding mothers, the infants need to be adequately monitored for any possible side effects like failure to thrive, irritability, or sedation. However, it is challenging to assess adverse reactions in newborns.
A mother can plan to breastfeed their baby immediately before taking medicine as the drug concentrations in milk are likely to be lowest at ending the dosing interval. It can help the mother to minimize infant exposure to the drug. However, milk concentrations of some drugs lag behind plasma concentrations.
Under unavoidable circumstances, if unsafe drugs for breastfeeding are being prescribed to the breastfeeding mother, the breast milk may be expressed and discarded until the treatment is finished. The mother should be advised to resume breastfeeding after the drug is eliminated from the maternal bloodstream.
Can a Drug Affect the Production of Milk From the Mammary Gland?
Some drugs can affect milk composition and secretion by affecting mammary gland development and the hormonal regulation of lactation. For example, dopamine agonists such as Cabergoline can affect the prolactin hormone, essential for human milk secretion. Cabergoline is sometimes used for stopping lactation therapeutically. On the other hand, dopamine antagonists such as Metoclopramide and most antipsychotics can increase prolactin hormone secretion in the mother's body.
SSRIs (selective serotonin reuptake inhibitors) and opioids are other drugs that have been associated with causing hyperprolactinemia.
Can the Age and Health of an Infant Influence Drug Reaction?
The age and health of your baby are the determining factors that decide the associated risk of drug exposure to the infant. Premature and newborn babies that are medically unstable pose the most significant health risk from exposure to drugs in breast milk.
The risk is lowest for healthy babies who are six months and older, as they have developed a defense mechanism to remove drugs through their bodies efficiently.
The milk secretion gradually reduces when they breastfeed their babies for more than one year after childbirth. Hence, the transfer of medications in breast milk is also reduced.
Do I Need to Consult My Healthcare Provider Before Taking Medicine While Breastfeeding?
It is essential to contact your healthcare professionals before you plan to take any medicine while breastfeeding. You also need to avoid taking unnecessary drugs like herbal medications, high-dose vitamins, and unusual supplements.
You should also consult your doctor regarding the drug's timing, as taking the medication immediately after breastfeeding might help reduce your baby's exposure to the drug. This is because the drug requires time to dissolve in the blood and reach breast milk secretion. However, the peak time of all the drugs varies.
What if My Baby Shows a Reaction to Drugs?
When you are in a situation where taking medicine cannot be avoided, you must keep a close watch on your baby to evaluate for any changes in general behavior like eating or sleeping habits, fussiness, or a rash. You need to consult your doctor immediately in case of any noticeable changes.
Like pregnancy, you need to be careful before taking any medication while breastfeeding your baby. If you are in a situation where the intake of medicine cannot be avoided, you must take the medication only after contacting your doctor. Your doctor will prescribe you the drug that has the lower level of passage in the breast milk so that it does not cause any ill-effects on your newborn baby. Your doctor will help you with appropriate planning for the timing of the drug and the breastfeeding schedule.