Despite evidence to the contrary, health care providers are still regularly getting questions and comments about prescription medication use being unsuitable for breastfeeding mothers.
“It’s a huge misperception,” said Dr. Jenny Thomas, breastfeeding coordinator of the Wisconsin Chapter of the American Academy of Pediatrics. “I’ve seen everything from patients who just had a single x-ray to mothers who were prescribed an antibiotic who were all told by clinicians or other well-meaning people to ‘pump and dump’ just to play it safe. It runs the gamut but the overwhelming majority of prescriptions are compatible with breastfeeding.”
Most medications pass through breast milk to a certain extent, including both prescription and over-the-counter pharmaceuticals. Not all are necessarily harmful to an infant, but given the size discrepancy between mother and child, it takes significantly less for a nursing infant to feel the pharmaceutical’s impact.
The American Academy of Pediatrics went so far as to release a report in August 2013, advising women that most medications are indeed safe for use while breastfeeding, but lactation consultants and other health professionals are still fielding questions tied to the persistent myth.
With an estimated 16 percent of all Native Americans living with diabetes,” Citizen Potawatomi Nation WIC lactation consultant Cheryl Richardson frequently fields questions about managing the disease while breastfeeding.
Not only is insulin safe to take while nursing, but according to a 2005 study published in the Journal of the American Medical Association, the metabolic burden placed on exclusively breastfeeding mothers was enough to help lower the necessary dosage to keep their blood sugar levels in check.
“When a mom breastfeeds and is enjoying that lower glucose level, once she gets to the point where she’s weaning, she needs to be aware that once she starts weaning, she has to be watching her glucose levels,” Richardson said. “They’ll probably go back up since she’s changing things up. If she starts dropping feedings or weaning, especially if she is insulin dependent, she’ll have to make changes.”
Other chronic conditions require a closer review of the potential treatments before making a decision. Nationwide, an estimated one in four women suffer from depression, schizophrenia, anxiety or some other form of mental illness, but not all anti-depressants are created equal when it comes to breastfeeding.
“A lot of moms dealing with it (depression) are on something beforehand,” Richardson said. “If you’re on anti-depressants during pregnancy, the baby got a larger dose in utero than via breastfeeding. There are safer meds than others, but you’ve got to check the medication information closely.”
At the end of the day, it is up to the mother to take the initiative and determine if and how her health needs can be safely managed while breastfeeding. To facilitate that research, the National Institutes of Health maintains LactMed, a regularly updated online database and mobile app of medications and their impact on breastfeeding, including a list of alternative compatible prescription drugs.
Regularly incompatible pharmaceuticals generally fall into three categories: chemotherapy drugs, medications that could be classified as controlled substances and nuclear medicines. However, depending on the child’s age and whether the mother is exclusively breastfeeding or supplementing, other medications might not jive with nursing.
“The rest are on a case-by-case basis,” Thomas said. “In general, if it’s safe to give to a baby or a small child, it’s generally compatible with breastfeeding.”
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