Pharmacology in Breastfeeding

Question 1

list the benefits of breastfeeding for the baby

Answer 1

• Reduced risk of infections – GI infections, UTIs, otitis media, respiratory diseases, NEC (in preterm babies)
• Neurological development – studies show link between BF and increases scores in cognitive function
• Protection against later development of atopic diseases, eg. Eczema
• Lower incidence of insulin-dependent diabetes
• Lower incidence of Sudden Infant Death Syndrome (SIDS) – linked to neurological maturation

Question 2

list the benefits of breastfeeding for the mother

Answer 2

• Reduction in risk of pre-menopausal breast cancer, ovarian cancer and hip fractures
• Less uterus bleeding, quicker return to it’s normal size
• Prevents post-natal depression
• Exclusively breastfeeding can provide contraception (LAM) – lactational amenorrhoea method*
• Faster weight loss from pregnancy weight gain
• Saves money compared to formula

Question 3

list some drugs that should be avoided while breastfeeding

Answer 3

• cytotoxics
• immunosuppressants
• anti-convulsants (not all)
• drugs of abuse
• amiodarone
• lithium
• radio-iodine

Question 4

give an example of adrug that can suppress lactation

can maybe be used in the case of infant death

Answer 4

• cabergoline - inhibition of lactation

Question 5

give example of drugs that can enhance lactation

Answer 5

• metoclopramide: 10mg, 2-3 times daily
• also domperidone

Question 6

what are the principles of prescribing in breastfeeding?

Answer 6

• Avoid unnecessary drug use – always consider non-pharmaceutical options
• Always check up to date information resources
  If medicine is licensed and safe for use in paediatrics/neonates; then it is likely to be safe to be used during breastfeeding (amount in milk will be less than treatment doses used in baby)
• Try to choose drugs with pharmacokinetic properties which reduce infant exposure to drug eg, highly protein bound drugs
• Always weigh up the benefit of breastfeeding to mother and infant – should never discourage feeding unless in extreme circumstances e.g. cancer diagnosis, substance misuse, lithium