Safety during breastfeeding: drugs, foods, environmental chemicals, and maternal infections

Maternal food-avoidance diets and dietary supplements during breastfeeding

AIMS

To identify maternal food-avoidance diets and dietary supplement use during breastfeeding, and to explore factors associated with food avoidance diets.

DESIGN

A prospective mother-child birth cohort study.

METHODS

Electronic questionnaires were answered by 1,462 breastfeeding mothers 6 months postpartum in the Preventing Atopic Dermatitis and Allergies in Children (PreventADALL) study from 2014-2016. Demographic and antenatal factors were analysed for associations with food avoidance diets in 1,368 women by multiple logistic regression.

RESULTS

Overall, 289 breastfeeding women (19.8%) avoided at least one food item in their diet, most commonly cow's milk in 99 women (6.8%). Foods were most often avoided due to conditions in the child, maternal factors or lifestyle choice. The odds for food avoidance diets were 2.1 (95% CI: 1.3, 3.4) for food allergy (presumed or diagnosed) and 19.4 (5.4, 70.1) for celiac disease in the mother. Dietary supplements were reported by nearly 80%, most commonly cod liver oil.

Pharmacologic Management of Common Ailments in Women Who Are Breastfeeding

According to the Centers for Disease Control and Prevention, the rate of breastfeeding in the United States has increased 34% between 2005 and 2015. Women who breastfeed can require treatment of various common illnesses. When caring for women who are breastfeeding, health care providers may unnecessarily discourage them from breastfeeding during treatment. Choosing the appropriate medications for these individuals is critical to ensure the woman is effectively treated, infant exposure to medication is minimized, and the breastfeeding relationship is preserved. This article provides an overview of essential principles for prescribing medications for women who are lactating. Recommendations for the management of common illnesses seen in the outpatient setting are suggested and resources that can help guide therapeutic decision making are offered.

Update of the Scientific Opinion on opium alkaloids in poppy seeds

Poppy seeds are obtained from the opium poppy (Papaver somniferum L.). They are used as food and to produce edible oil. The opium poppy plant contains narcotic alkaloids such as morphine and codeine. Poppy seeds do not contain the opium alkaloids, but can become contaminated with alkaloids as a result of pest damage and during harvesting. The European Commission asked EFSA to provide an update of the Scientific Opinion on opium alkaloids in poppy seeds. The assessment is based on data on morphine, codeine, thebaine, oripavine, noscapine and papaverine in poppy seed samples. The CONTAM Panel confirms the acute reference dose (ARfD) of 10 μg morphine/kg body weight (bw) and concluded that the concentration of codeine in the poppy seed samples should be taken into account by converting codeine to morphine equivalents, using a factor of 0.2. The ARfD is therefore a group ARfD for morphine and codeine, expressed in morphine equivalents. Mean and high levels of dietary exposure to morphine equivalents from poppy seeds considered to have high levels of opium alkaloids (i.e. poppy seeds from varieties primarily grown for pharmaceutical use) exceed the ARfD in most age groups. For poppy seeds considered to have relatively low concentrations of opium alkaloids (i.e. primarily varieties for food use), some exceedance of the ARfD is also seen at high levels of dietary exposure in most surveys. For noscapine and papaverine, the available data do not allow making a hazard characterisation. However, comparison of the dietary exposure to the recommended therapeutical doses does not suggest a health concern for these alkaloids. For thebaine and oripavine, no risk characterisation was done due to insufficient data. However, for thebaine, limited evidence indicates a higher acute lethality than for morphine and the estimated exposure could present a health risk.

Efficient extraction method using magnetic carbon nanotubes to analyze cocaine and benzoylecgonine in breast milk by GC/MS

Aim: The increasing use of cocaine (COC) during breastfeeding has led to growing concern about exposure of infants. Therefore, to study this exposure, a new method to analyze COC and benzoylecgonine in breast milk was developed. Methodology: A new extraction method was used for the first time to analyze COC and its major metabolite, benzoylecgonine, in breast milk using magnetic carbon nanotubes partially doped with nitrogen. Results: The calibration curves were linear in the range 5.0–180.0 ng ml-1. The limit of quantification was 5.0 ng ml-1. Coefficients of variation were between 3.2 and 13.9%. Recovery was between 89.6 and 99.2%. Conclusion: The proposed method is simple, efficient and suitable to determine analytes in breast milk.

Maternal work and exclusive breastfeeding practice: a community based cross-sectional study in Efutu Municipal, Ghana

BACKGROUND

Maternal work has been identified as one of the factors that affect exclusive breastfeeding in the first six months of life. In Ghana, mothers engaged in the formal sector of employment are unable to exclusively breastfeed after maternity leave because facilities at their work places and conditions of work do not support exclusive breastfeeding. Even though maternal work and exclusive breastfeeding does not seem well matched, not all maternal work are incompatible with the practice of exclusive breastfeeding. This study seeks to identify the features of maternal work associated with exclusive breastfeeding in Effutu Municipal in the Central Region of Ghana. To achieve the above aim, I discuss the different types of maternal work, their characteristics, and how the work may influence exclusive breastfeeding.

METHODS

The study is a community based cross-sectional study involving 225 mother-infant pairs attending community based Child Welfare Clinics in Effutu Municipal, Ghana. Data were collected through face-to-face structured interviews and focus group discussions over a period of five months in 2015. Data on breastfeeding is based on the breastfeeding practice in the 24 h preceding the survey. Chi-square test is used to identify strength of association between the features of maternal work and exclusive breastfeeding practice.

RESULTS

The exclusive breastfeeding rate among mothers with infants between the ages of 0 - 5 months is 72%. The mean and median number of breastfeeds per day is 11 ± 2.7 and 13.5 respectively. A significant difference in exclusive breastfeeding was established between mothers in the formal (16%) and informal (84%) sectors of employment (p = 0.020). The study also established a significant difference in breastfeeding frequency between mothers in the formal (9%) and informal (91%) sectors of employment (p = 0.001). There was also a significant difference in breastfeeding frequency among respondents that go to work with their infant (64%) and those who do not go to work with their infant (36%) (p = 0.000).

CONCLUSION

Interventions to promote exclusive breastfeeding should include the use of existing family structures, supportive cultural beliefs, and practices and promotion of an infant-friendly work environment.

Advising Mothers on the Use of Medications during Breastfeeding: A Need for a Positive Attitude

The use of medications by the nursing mother is a common reason for interrupting breastfeeding. Few drugs have been demonstrated to be absolutely contraindicated during breastfeeding. Excessive caution may lead health professionals to unnecessarily advise to interrupt breastfeeding, without assessing the latest evidence or considering the risk-benefit ratio of taking a medication versus terminating breastfeeding. To foster an appropriate approach toward the use of medications in breastfeeding women, the Italian Society of Perinatal Medicine created the following policy statement.

Antibiotics and Breastfeeding

During the breastfeeding period, bacterial infections can occur in the nursing mother, requiring the use of antibiotics. A lack of accurate information may lead health care professionals and mothers to suspend breastfeeding, which may be unnecessary. This article provides information on the main antibiotics that are appropriate for clinical use and the interference of these antibiotics with the infant to support medical decisions regarding the discontinuation of breastfeeding. We aim to provide information on the pharmacokinetic factors that interfere with the passage of antibiotics into breast milk and the toxicological implications of absorption by the infant. Publications related to the 20 most frequently employed antibiotics and their transfer into breast milk were evaluated. The results demonstrate that most antibiotics in clinical use are considered suitable during breastfeeding; however, the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant.

Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy

OBJECTIVES

Breastfeeding is a well-recognised investment in the health of the mother-infant dyad. Nevertheless, many professionals still advise breastfeeding mothers to temporarily discontinue breastfeeding after contrast media imaging. Therefore, we performed this review to provide health professionals with basic knowledge and skills for appropriate use of contrast media.

METHODS

A joint working group of the Italian Society of Radiology (SIRM), Italian Society of Paediatrics (SIP), Italian Society of Neonatology (SIN) and Task Force on Breastfeeding, Ministry of Health, Italy prepared a review of the relevant medical literature on the safety profile of contrast media for the nursing infant/child.

RESULTS

Breastfeeding is safe for the nursing infant of any post-conceptional age after administration of the majority of radiological contrast media to the mother; only gadolinium-based agents considered at high risk of nephrogenic systemic fibrosis (gadopentetate dimeglumine, gadodiamide, gadoversetamide) should be avoided in the breastfeeding woman as a precaution; there is no need to temporarily discontinue breastfeeding or to express and discard breast milk following the administration of contrast media assessed as compatible with breastfeeding.

CONCLUSIONS

Breastfeeding women should receive unambiguous professional advice and clear encouragement to continue breastfeeding after imaging with the compatible contrast media.

KEY POINTS

• Breastfeeding is a well-known investment in the health of the mother-infant dyad. • Breastfeeding is safe after administration of contrast media to the mother. • There is no need to temporarily discontinue breastfeeding following administration of contrast media.