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Falconi S, Okimi A, Wesley S, Sethi P, Datta P, Krutsch K. The concentration of maternal sacubitril/valsartan transferred into human milk is negligible. Front Public Health 2024; 12:1389513. [PMID: 38841677 PMCID: PMC11150817 DOI: 10.3389/fpubh.2024.1389513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Background Peripartum cardiomyopathy (PPCM) is a common cause of heart failure (HF) in the peripartum. Some medications are considered safe while breastfeeding. However, sacubitril/valsartan (Entresto), while efficacious, is not recommended in breastfeeding women due to concerns about adverse infant development, and no published data suggest otherwise. Objectives This study aimed to assess the transfer of sacubitril/valsartan into human milk and evaluate the infant's risk of drug exposure. Methods The InfantRisk Human Milk Biorepository released samples and corresponding health information from five breastfeeding maternal-infant dyads exposed to sacubitril/valsartan. Sacubitril, valsartan, and LBQ657 (sacubitril active metabolite) concentrations were determined using liquid chromatography-mass spectrometry (LC/MS/MS) from timed samples 0, 1, 2, 4, 6, 8, 10, and 12 h following medication administration at steady state conditions. Results Valsartan levels were below the detection limit of 0.19 ng/mL in all milk samples. Sacubitril was measurable in all milk samples of the five participants, peaking 1 h after drug administration at a mean concentration of 1.52 ng/mL for a total infant dose of 0.00049 mg/kg/12 h and a relative infant dose (RID) calculated at 0.01%. The maximum concentration of its active metabolite LBQ657 in the milk samples was observed 4 h after medication administration and declined over the remaining 12-h dosing interval, for an average concentration of 9.5 ng/mL. The total infant dose was 0.00071 mg/kg/12 h, and the RID was 0.22%. Two mothers reported continuing to breastfeed while taking sacubitril/valsartan; both mothers stated observing no negative effects in their breastfed infants. Conclusion The transfer of sacubitril/valsartan into human milk is minimal. These concentrations are unlikely to pose a significant risk to breastfeeding infants, with a combined calculated RID of <0.25%, which is far lower than the industry safety standards (RID <10%).
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Affiliation(s)
- Sirin Falconi
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Abiodun Okimi
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Shaun Wesley
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States
| | - Pooja Sethi
- Department of Cardiology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Palika Datta
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Kaytlin Krutsch
- Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, United States
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Eleftheriou G, Zandonella Callegher R, Butera R, De Santis M, Cavaliere AF, Vecchio S, Lanzi C, Davanzo R, Mangili G, Bondi E, Somaini L, Gallo M, Balestrieri M, Mannaioni G, Salvatori G, Albert U. Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:551. [PMID: 38791766 PMCID: PMC11121006 DOI: 10.3390/ijerph21050551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother's milk. METHODS A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved. RESULTS Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants' cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders. CONCLUSIONS The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.
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Affiliation(s)
- Georgios Eleftheriou
- Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy; (R.B.); (S.V.); (C.L.); (G.M.)
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Riccardo Zandonella Callegher
- Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy; (R.Z.C.); (E.B.); (U.A.)
- Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy
| | - Raffaella Butera
- Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy; (R.B.); (S.V.); (C.L.); (G.M.)
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco De Santis
- Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy; (M.D.S.); (A.F.C.)
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy; (M.D.S.); (A.F.C.)
- Department of Gynecology and Obstetrics, Fatebenefratelli Gemelli, Isola Tiberina, 00186 Rome, Italy
| | - Sarah Vecchio
- Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy; (R.B.); (S.V.); (C.L.); (G.M.)
- Addiction Centre, Ser.D, Local Health Unit, 28100 Novara, Italy
| | - Cecilia Lanzi
- Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy; (R.B.); (S.V.); (C.L.); (G.M.)
- Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Riccardo Davanzo
- Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy; (R.D.); (G.M.)
- Maternal and Child Health Institute IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- Task Force on Breastfeeding, Ministry of Health, 00144 Rome, Italy
| | - Giovanna Mangili
- Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy; (R.D.); (G.M.)
- Department of Neonatology, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Emi Bondi
- Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy; (R.Z.C.); (E.B.); (U.A.)
- Department of Psychiatry, ASST Papa Giovanni XXIII, 24100 Bergamo, Italy
| | - Lorenzo Somaini
- Ser.D Biella, Drug Addiction Service, 13875 Biella, Italy;
- Italian Society of Addiction Diseases (S.I.Pa.D), Via Tagliamento 31, 00198 Rome, Italy
| | - Mariapina Gallo
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
- Italian Society for Drug Addiction (SITD), Via Roma 22, 12100 Cuneo, Italy
| | - Matteo Balestrieri
- Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Italian Society of Neuropsychopharmacology (SINPF), Via Cernaia 35, 00158 Rome, Italy
| | - Guido Mannaioni
- Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy; (R.B.); (S.V.); (C.L.); (G.M.)
- Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
- Italian Society of Pharmacology, Via Giovanni Pascoli, 3, 20129 Milan, Italy
| | - Guglielmo Salvatori
- Italian Society of Pediatrics, Via Gioberti 60, 00185 Rome, Italy;
- Department of Medical and Surgical Neonatology Ospedale Pediatrico Bambino Gesù, 00165 Rome, Italy
| | - Umberto Albert
- Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy; (R.Z.C.); (E.B.); (U.A.)
- UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy
- Italian Society of Neuropsychopharmacology (SINPF), Via Cernaia 35, 00158 Rome, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
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Krutsch K, Campbell L, Baker T, Datta P. Alleviating anxiety while breastfeeding: evaluating buspirone transfer into human milk. Arch Womens Ment Health 2024:10.1007/s00737-024-01445-1. [PMID: 38376615 DOI: 10.1007/s00737-024-01445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Buspirone, an anxiolytic with minimal risk of dependence or respiratory depression, lacks extensive published data on its transfer into human milk during lactation. The objective of this study was to 1) quantify the transfer of buspirone and its active metabolite 1-pyrimidinylpiperazine (1-PP) into human milk, allowing for an estimation of maternal drug exposure to the breastfed infant, and 2) report observations of the infants exposed to buspirone via breastmilk. METHODS Milk samples and health histories were collected from nine lactating mothers who donated milk samples to the InfantRisk Human Milk Biorepository while taking buspirone. The drug concentration-time profile of buspirone and 1-PP was determined using liquid chromatography-mass spectrometry. RESULTS Buspirone was below the detection level of 1.5 ng/mL in all milk samples with dosages ranging from 7.5 to 30 mg twice daily. However, low levels of active metabolite 1-PP were observed at 7.5 mg twice daily up to 30 mg twice daily. The relative infant dose (RID) calculated ranged from 0.21 to 2.17%, which is below the standard 10% threshold for infant safety. There were no reports of adverse effects in the exposed infants. CONCLUSION The levels of buspirone observed in all participants' milk samples were exceedingly low. The subsequently low relative infant dose (RID) in the range of 0.21% to 2.17% is below the 10% threshold for infant safety, suggesting that the transfer of maternal buspirone and its active metabolite (1-PP) into human milk is clinically insignificant and poses minimal risk to a breastfed infant.
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Affiliation(s)
- Kaytlin Krutsch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Levi Campbell
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
| | - Teresa Baker
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Palika Datta
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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Saito J, Yakuwa N, Hosokawa Y, Hamada H, Suzuki T, Sago H, Kaneko K, Yamatani A, Murashima A. Establishment of a measurement system to evaluate breast milk transfer of biological agents using dry filter paper: A multi-institutional study. Br J Clin Pharmacol 2024; 90:146-157. [PMID: 37548054 DOI: 10.1111/bcp.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
AIMS Information on breastfeeding and safety of biologics in infants is lacking due to difficulties in case collection. We evaluated methods for determining the concentration of biologics in breast milk using a dry filter method that can simplify the collection, storage and transport of breast milk. METHODS To generate dried filter paper (DFP) samples, approximately 30 μL of breast milk was placed onto a Whatman 903 card and punched out. After extraction, the supernatant was measured using an enzyme-linked immunosorbent assay. Three concentrations of each drug were prepared in liquid breast milk (LBM) and DFP samples to determine their stability up to 28 days after storage at 2-8°C or -20°C for LBM and 25 ± 5°C for DFP. LBM and DFP samples were also provided by nursing mothers using biologics during lactation, and drug concentrations in both samples were compared. The agreement between the two measurement methods was confirmed by Bland-Altman analysis. RESULTS Breast milk was provided by 12 mothers who used biologics (tocilizumab, abatacept, etanercept, golimumab, sarilumab and belimumab). The coefficients of variation for within-run and between-run precision for the six drugs were within 15% for both LBM and DFP, and accuracy was within 90%-110% of the quality controls. After 28 days, concentrations remained at more than 90%. The difference between the values obtained by each method was within the acceptable range of error (-12.1 to +16.6 ng/mL). CONCLUSIONS A method for determining the concentration of biologics using DFP is expected to help improve pharmacotherapy for lactating women.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Yakuwa
- Pregnancy and Drug Information Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiko Hosokawa
- Department of Obstetrics and Gynecology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomo Suzuki
- Division of Obstetrics, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Division of Obstetrics, National Center for Child Health and Development, Tokyo, Japan
| | - Kayoko Kaneko
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Reitan Riibe S, Heitmann K, Schjøtt J, Riedel B. Healthcare professionals' information need related to antiseizure medication use in breastfeeding patients with epilepsy. Retrospective analysis of enquiries to Norwegian medicines information and pharmacovigilance centers. Epilepsy Behav Rep 2023; 24:100629. [PMID: 37954010 PMCID: PMC10632412 DOI: 10.1016/j.ebr.2023.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023] Open
Abstract
Background Safety information of antiseizure medication (ASM) during breastfeeding is scarce and conflicting. We aimed to identify characteristic traits of safety concerns among healthcare professionals by reviewing enquiries to the Norwegian Regional Medicines Information and Pharmacovigilance Centres (RELIS). Method Enquiries related to breastfeeding, epilepsy, and ASM identified by their ATC-numbers were retrieved from the RELIS database of question-and-answer pairs (QAPs) by combining indexed and Boolean database searches and manual inspection. 112 QAPs were analyzed retrospectively using descriptive statistics. Results Hospital-employed physicians and nurses were puzzled by ambiguous or conflicting drug information advice and called for general information about the compatibility of an ASM with breastfeeding, mainly related to lamotrigine and levetiracetam. Other enquiries were related to co-medication with other drugs, mainly antidepressants. Half of the enquiries were posed after birth, 12 of these motivated by suspected adverse events in the infants. Conclusion Healthcare professionals with acknowledged high competence in the topic were uncertain about the prevailing safety information of ASM during breastfeeding. The fear to harm the infant may lead to the decision not to recommend breastfeeding. Future information strategies should aim to reach these professions, and support their information need on this topic.
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Affiliation(s)
- Sunniva Reitan Riibe
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Sandnessjøen Helgeland Hospital, Prestmarkveien 1, 8800 Sandnessjøen, Norway
| | - Kristine Heitmann
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, 5021 Bergen, Norway
| | - Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, 5021 Bergen, Norway
| | - Bettina Riedel
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
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Bohn K, Fernandez A, Stroever S, O’Neil D, Enderle J, Krutsch K. Mixing Meds and Milk: Evaluation of a Performance Gap Intervention for Provider Education in Breastfeeding and Maternal Medication Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6850. [PMID: 37835121 PMCID: PMC10572915 DOI: 10.3390/ijerph20196850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
The need for maternal medications is a known barrier to breastfeeding. Though most medications are compatible with lactation, healthcare providers use abundant caution, often viewing medications and breastfeeding as mutually exclusive. A dual intervention of an educational webinar and access to a mobile app for lactation pharmacology was used to enhance provider familiarity, confidence, and access to knowledge in medication use during breastfeeding. Surveys were administered before, one week after, and three months after the webinar to evaluate performance gap improvement. Usage data of the mobile app was collected over twelve months to monitor topic engagement. Results suggested the interventions temporarily increased provider confidence in maternal medication use during lactation; however, the increase was not sustained at three months. Even with one-time training and lactation-specific mobile app access, simply providing an informational resource is insufficient to support evidence-informed care for lactating patients. Longitudinal training on evidence-based medication safety is critical to care for the lactating dyad.
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Affiliation(s)
- Kaci Bohn
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Alejandra Fernandez
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Stephanie Stroever
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Dara O’Neil
- American Heart Association, Dallas, TX 75231, USA (J.E.)
| | - Joan Enderle
- American Heart Association, Dallas, TX 75231, USA (J.E.)
| | - Kaytlin Krutsch
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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Tigka M, Metallinou D, Pardali L, Lykeridou K. Shared decision-making about medication intake during lactation: A prospective longitudinal study in Greece. Eur J Midwifery 2022; 6:48. [PMID: 35974713 PMCID: PMC9340817 DOI: 10.18332/ejm/149830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/16/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The need for medication intake during lactation may affect women’s decision on breastfeeding initiation, duration or cessation. We investigated shared decision-making about medication intake (MI) during lactation by breastfeeding women. METHODS The study was conducted in five maternity hospitals in Greece (January–August 2020). A total of 283 mothers participated in the study. Data were obtained through a self-designed questionnaire. Mothers answered the questionnaire before discharge and were followed up by phone interviewing at one, three and six months postpartum. Information about breastfeeding status, reasons for cessation and MI during lactation were gathered. RESULTS In total, 30.7% of the mothers were receiving medication due to a pre-pregnancy chronic condition but only 23.7% maintained it during lactation; 48.4% of mothers stated that they would avoid MI during lactation as a personal attitude and 45.2% were satisfied with the information provided by healthcare professionals (HPs) concerning MI during lactation. But, 66.1% of the mothers indicated the necessity of further guidance. Mothers with higher education, Greek ethnicity and vaginal delivery participated significantly in the decision-making process concerning MI during lactation (p=0.001, p=0.001 and p=0.01, respectively). Mothers who shared decision-making, primarily consulted a pediatrician (p=0.02) and were more likely to maintain full and mixed breastfeeding for one month postpartum, rather than cease breastfeeding (p=0.005). Breastfeeding duration of all indicators was for a mean of 110 days (SD: 74.58). CONCLUSIONS Advancing HPs’ evidence-based knowledge, communication skills, confidence and competence in breastfeeding management will contribute favorably to breastfeeding indicators and maternal satisfaction regarding professional counseling.
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Affiliation(s)
- Maria Tigka
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
- Obstetric Emergency Department, General and Maternity Hospital ‘Helena Venizelou’, Athens, Greece
| | - Dimitra Metallinou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
- Neonatal Department, ‘Alexandra’ General Hospital, Athens, Greece
| | - Lemonia Pardali
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Katerina Lykeridou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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Janssens I, Van Hauwe M, Ceulemans M, Allegaert K. Development and Pilot Use of a Questionnaire to Assess the Knowledge of Midwives and Pediatric Nurses on Maternal Use of Analgesics during Lactation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111555. [PMID: 34770067 PMCID: PMC8583667 DOI: 10.3390/ijerph182111555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
There is a need to assess the knowledge of healthcare providers on the use of maternal analgesics during lactation; however, valid instruments are not yet available. This study aimed to develop and test a valid questionnaire on the knowledge of analgesics (acetaminophen, ibuprofen, aspirin, tramadol, codeine, oxycodone) during lactation, using a structured, stepwise approach. As a first step, literature was screened to generate a preliminary version consisting of a pool of item subgroups. This preliminary version was subsequently reviewed during two focus groups (midwives: n = 4; pediatric nurses: n = 6), followed by a two-round online Delphi with experts (n = 7) to confirm item and scale content validity. This resulted in an instrument consisting of 33 questions and 5 specific clinical case descriptions for both disciplines. Based on the assumption of an a priori difference in knowledge between midwives and pediatric nurses related to their curricula (known-groups validity), high construct validity was demonstrated in a pilot survey (midwives: n = 86; pediatric nurses: n = 73). We therefore conclude that a valid instrument to assess knowledge on lactation-related exposure to analgesics was generated, which could be further validated and used for research and educational purposes. As these pilot findings suggest suboptimal knowledge for both professions on this topic, adaptations to their curricula and postgraduate training might be warranted.
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Affiliation(s)
- Ine Janssens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, 3000 Leuven, Belgium; (I.J.); (M.V.H.)
| | - Margot Van Hauwe
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, 3000 Leuven, Belgium; (I.J.); (M.V.H.)
| | - Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
| | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
- Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC Rotterdam, Wytemaweg Hospital Pharmacy, 3075 CE Rotterdam, The Netherlands
- Correspondence: ; Tel.: +32-(16)-342020
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9
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Butler MS, Young SL, Tuthill EL. Perinatal depressive symptoms and breastfeeding behaviors: A systematic literature review and biosocial research agenda. J Affect Disord 2021; 283:441-471. [PMID: 33272686 PMCID: PMC7954873 DOI: 10.1016/j.jad.2020.11.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic. METHODS A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings. RESULTS Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations. LIMITATIONS Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed. CONCLUSIONS Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.
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Affiliation(s)
| | - Sera L Young
- Department of Anthropology, Northwestern University; Institute for Policy Research, Northwestern University
| | - Emily L Tuthill
- Department of Community Health Systems, University of California, San Francisco
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Louis-Jacques AF, Wilson R, Dean K, Hernandez I, Spatz D, Običan S. Improving Drug Exposure Knowledge During Lactation: Quality Improvement Initiative in Low-Income Women. Breastfeed Med 2020; 15:140-146. [PMID: 31928350 DOI: 10.1089/bfm.2019.0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: To improve maternal knowledge on medication and substance usage during lactation through prenatal breastfeeding education and assess breastfeeding rates at 2-4 and 6-8 weeks postpartum. Study Design: This quality improvement initiative occurred between August 2016 and October 2017. Pregnant women without contraindications to breastfeeding receiving prenatal care at one of four prenatal sites in Florida were eligible. Enrolled women participated in a 1-hour interactive session consisting of basic breastfeeding education and medication or substance use during lactation. Demographic information, medical history, and pre/post breastfeeding knowledge scores were obtained. Regression analysis was utilized to evaluate the influence of medication usage on breastfeeding rates at 2-4 and 6-8 weeks postpartum. Results: The majority of participants (N = 121; median age = 26) were Hispanic (64%), unmarried (70%), and unemployed (60%). Approximately 25% were on medications other than supplements. Of those, one-third reported concerns regarding medication usage and infant safety during lactation. Knowledge regarding postpartum medications or substances and their breastfeeding compatibility increased significantly postintervention; however, women who were using medications at 2-4 and 6-8 weeks postpartum were 4 times as likely to mix feed or formula feed as compared with mothers not taking medications (adjusted odds ratio [OR] at 2-4 weeks = 3.693 confidence interval [95% CI]: 1.398-9.757) and adjusted OR at 6-8 weeks = 4.208 (95% CI: 1.009-17.548). Conclusions: This prenatal breastfeeding education targeting low-income women improved knowledge on medication usage and lactation. However, despite increasing breastfeeding knowledge, medication use appears to influence infant feeding behaviors at 2-4 and 6-8 weeks postpartum.
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Affiliation(s)
- Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida.,University of South Florida College of Nursing, Tampa, Florida
| | - Roneé Wilson
- Chiles Center for Healthy Mothers and Babies, University of South Florida College of Public Health, Tampa, Florida
| | - Kathryn Dean
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | | | - Diane Spatz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sarah Običan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
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11
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Transporters in the Mammary Gland-Contribution to Presence of Nutrients and Drugs into Milk. Nutrients 2019; 11:nu11102372. [PMID: 31590349 PMCID: PMC6836069 DOI: 10.3390/nu11102372] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023] Open
Abstract
A large number of nutrients and bioactive ingredients found in milk play an important role in the nourishment of breast-fed infants and dairy consumers. Some of these ingredients include physiologically relevant compounds such as vitamins, peptides, neuroactive compounds and hormones. Conversely, milk may contain substances-drugs, pesticides, carcinogens, environmental pollutants-which have undesirable effects on health. The transfer of these compounds into milk is unavoidably linked to the function of transport proteins. Expression of transporters belonging to the ATP-binding cassette (ABC-) and Solute Carrier (SLC-) superfamilies varies with the lactation stages of the mammary gland. In particular, Organic Anion Transporting Polypeptides 1A2 (OATP1A2) and 2B1 (OATP2B1), Organic Cation Transporter 1 (OCT1), Novel Organic Cation Transporter 1 (OCTN1), Concentrative Nucleoside Transporters 1, 2 and 3 (CNT1, CNT2 and CNT3), Peptide Transporter 2 (PEPT2), Sodium-dependent Vitamin C Transporter 2 (SVCT2), Multidrug Resistance-associated Protein 5 (ABCC5) and Breast Cancer Resistance Protein (ABCG2) are highly induced during lactation. This review will focus on these transporters overexpressed during lactation and their role in the transfer of products into the milk, including both beneficial and harmful compounds. Furthermore, additional factors, such as regulation, polymorphisms or drug-drug interactions will be described.
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12
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Haase B, Brennan E, Wagner CL. Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade? J Hum Lact 2019; 35:441-452. [PMID: 31206324 DOI: 10.1177/0890334419851805] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. RESEARCH AIM To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC's role. METHODS The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008-2019. Qualitative and quantitative studies were reviewed. RESULTS Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC's role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. CONCLUSION In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.
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Affiliation(s)
- Barbara Haase
- 1 Medical University Of South Carolina, Department of Women's and Children's Services, Charleston, SC 29425, USA
| | - Emily Brennan
- 2 Medical University of South Carolina (MUSC) Library, Charleston, SC, USA
| | - Carol L Wagner
- 3 Medical University of South Carolina, Department of Pediatrics, Charleston, SC, USA
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13
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Spiesser-Robelet L, Maurice A, Gagnayre R. Understanding Breastfeeding Women's Behaviors Toward Medication: Healthcare Professionals' Viewpoint. J Hum Lact 2019; 35:137-153. [PMID: 29727253 DOI: 10.1177/0890334418771294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Taking medication during breastfeeding is often a major concern for mothers. Knowledge, representations, and attitudes condition a mother's behavior in this situation. Healthcare professionals, whose medication advice for breastfeeding women is often described in scientific literature as inappropriate, play a major role in counseling mothers. Healthcare professionals' perceptions of mothers' behaviors regarding medication use during breastfeeding may influence mothers' behaviors. RESEARCH AIM: The aim of this study was to identify healthcare professionals' perceptions of breastfeeding women's knowledge, representations, and attitudes and behaviors about medication use. METHOD: A cross-sectional, prospective qualitative design was used. Semistructured interviews were conducted with a broad array of healthcare professionals ( N = 20) in different practice settings in the Angers area (France). Thematic analysis of the interview transcripts was carried out using the planned behavior theory of Ajzen. RESULTS: Seventy themes concerning medication use while breastfeeding were identified and then combined into 8 categories. Healthcare professionals perceived that maternal behaviors regarding medication were mostly focused on the child's safety and were linked to poor knowledge and negative representations, attitudes, and feelings toward medication. Healthcare professionals also perceived significant negative influences from the mother's friends and family in regard to breastfeeding. Relationships between healthcare professionals and women were problematic when it came to drug use during breastfeeding. CONCLUSION: Taking into account healthcare professionals' perceptions of maternal behavior will help improve education for these professionals. Indeed, knowing precisely what difficulties are met by healthcare professionals when they encounter medication use during breastfeeding can help educators improve training for these professionals.
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Affiliation(s)
- Laurence Spiesser-Robelet
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Paris 13 University Sorbonne, Paris Cité, Bobigny, France.,2 Service Pharmacie, CHU d'Angers, Angers, France
| | - Aurélie Maurice
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Paris 13 University Sorbonne, Paris Cité, Bobigny, France
| | - Rémi Gagnayre
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Paris 13 University Sorbonne, Paris Cité, Bobigny, France
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14
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Ramos MM, Sebastian RA, Sebesta E, McConnell AE, McKinney CR. Missed Opportunities in the Outpatient Pediatric Setting to Support Breastfeeding: Results From a Mixed-Methods Study. J Pediatr Health Care 2019; 33:64-71. [PMID: 30217618 DOI: 10.1016/j.pedhc.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Outpatient pediatric providers play a crucial role in the promotion of breastfeeding. We conducted a mixed methods study to measure provider knowledge, attitudes, and current practices around breastfeeding counseling. METHOD In New Mexico in 2016 and 2017, we conducted a knowledge, attitudes, and practice survey of outpatient pediatric providers (i.e., nurse practitioners, physicians, and physician assistants) and conducted focus groups with outpatient pediatric providers. RESULTS Seventy-seven providers responded to the survey, and 17 participated in three focus groups. Fewer than half of providers surveyed reported asking how long mothers plan to breastfeed at initial well-baby examinations. One quarter of participants (28.2%) erroneously reported that hepatitis C was an absolute contraindication to breastfeeding. Just half of respondents had received continuing education within the past 3 years about managing common breastfeeding problems. DISCUSSION We identified missed opportunities for outpatient pediatric providers to support breastfeeding and a need for continuing provider education.
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Affiliation(s)
- Mary M Ramos
- Mary M. Ramos, Assistant Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM..
| | - Rachel A Sebastian
- Rachel A. Sebastian, Medical Sociologist, Child Policy Research Consulting, LLC, Fort Wright, KY
| | - Emilie Sebesta
- Emilie Sebesta, Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Adrienne E McConnell
- Adrienne E. McConnell, Health Education Consultant, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Courtney R McKinney
- Courtney R. McKinney, Program Manager, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
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15
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Zucker I. Psychoactive drug exposure during breastfeeding: a critical need for preclinical behavioral testing. Psychopharmacology (Berl) 2018; 235:1335-1346. [PMID: 29549392 DOI: 10.1007/s00213-018-4873-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
Breastfeeding women are excluded from clinical trials of psychoactive drugs because of ethical concerns. Animal testing, which often is predictive of adverse effects in humans, represents the only avenue available for assessing drug safety for human offspring exposed to drugs during lactation. I determined whether behavioral outcomes for children exposed during breastfeeding to antidepressants, anxiolytics, antipsychotics, anti-seizure medications, analgesics, sedatives, and marijuana can be predicted by rodent studies of offspring exposed to drugs during lactation. Animal data were available for only 10 of 80 CNS-active drugs canvassed. Behavioral deficits in adolescence or adulthood in rats and mice after various drug exposures during lactation included reductions in sexual behavior, increased anxiety, hyperactivity, and impaired learning and memory. Whether similar adverse effects will emerge in adulthood in children exposed to drugs during breastfeeding is unknown. Rodent research has the potential to forecast impairments in breastfed children long before information emerges from post-marketing reports and should be prioritized during preclinical drug evaluation by the FDA for new drugs and for drugs currently prescribed off-label for lactating women.
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Affiliation(s)
- Irving Zucker
- Departments of Psychology and Integrative Biology, University of California, Berkeley, CA, 94720, USA. .,Psychology Department, University of California, Berkeley, CA, 94720, USA.
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16
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Jahnsen JA, Widnes SF, Schjøtt J. Analysis of questions about use of drugs in breastfeeding to Norwegian drug information centres. Int Breastfeed J 2018; 13:1. [PMID: 29339968 PMCID: PMC5759832 DOI: 10.1186/s13006-017-0143-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/18/2017] [Indexed: 01/16/2023] Open
Abstract
Background Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice. Methods A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with “BREASTFEEDING” in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used. Results In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician. Conclusions This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug. Electronic supplementary material The online version of this article (10.1186/s13006-017-0143-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Anker Jahnsen
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
| | - Sofia Frost Widnes
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
| | - Jan Schjøtt
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.,Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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17
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Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
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Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
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18
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Colaceci S, Giusti A, Chapin EM, Bettinelli ME, De Angelis A, Zambri F, Vellone E, Alvaro R, De Mei B. E-learning to Improve Healthcare Professionals' Attitudes and Practices on Breastfeeding. Breastfeed Med 2017; 12:629-636. [PMID: 28926281 DOI: 10.1089/bfm.2017.0060] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Breastfeeding training has a crucial role in increasing healthcare professionals' attitudes and in improving professional support for breastfeeding. The collaboration between the Italian National Institute of Health, UNICEF, and the Local Health Authority of Milan has led to the development of an online course on lactation and infant feeding practices. AIM To assess if the course was effective in improving healthcare professionals' attitudes and practices (APs). METHODS We conducted a prestudy-poststudy, comparing users' APs before (T0) and after (T1) the course through a 20-item questionnaire. Changes in APs were analyzed using paired t-test. Lower mean differences indicated more positive attitudes and more frequent professional practices favoring breastfeeding. Statistical analysis was carried out using SPSS version 15.0. RESULTS The course had 26,009 registrants and was successfully completed by 91.3% of users. The dropout rate was 8.7%. The final cohort was composed of 15,004 participants. The course improved attitudes, while minor changes were observed on practices (p < 0.05). Mean total attitude scores were 2.4 at T0 and 1.9 at T1, while mean total practice scores were 2.2 and 2.1, respectively. The main effects regarded the use of medications during breastfeeding (3.02 ± 1.29 at T0 and 1.88 ± 1.08 at T1) and the self-reported compliance with the International Code of Marketing of Breast Milk Substitutes (2.29 ± 1.24 at T0, 2.03 ± 1.21 at T1). CONCLUSION The noninteractive, high-coverage e-learning approach seems to be a useful tool for improving awareness and positive attitudes toward breastfeeding among healthcare professionals.
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Affiliation(s)
- Sofia Colaceci
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata , Rome, Italy .,2 National Centre for Diseases Prevention and Health Promotion, National Institute of Health , Rome, Italy
| | - Angela Giusti
- 2 National Centre for Diseases Prevention and Health Promotion, National Institute of Health , Rome, Italy .,3 Italian National Committee for UNICEF , Rome, Italy
| | | | - Maria Enrica Bettinelli
- 3 Italian National Committee for UNICEF , Rome, Italy .,4 Mother and Child Health Unit , ATS Città Metropolitana di Milano, Milan, Italy
| | - Alessia De Angelis
- 5 National Institute for Infectious Diseases 'Lazzaro Spallanzani', Rome, Italy
| | - Francesca Zambri
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata , Rome, Italy
| | - Ercole Vellone
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata , Rome, Italy
| | - Rosaria Alvaro
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata , Rome, Italy
| | - Barbara De Mei
- 2 National Centre for Diseases Prevention and Health Promotion, National Institute of Health , Rome, Italy
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19
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Bioanalytical challenge: A review of environmental and pharmaceuticals contaminants in human milk. J Pharm Biomed Anal 2016; 130:318-325. [PMID: 27372148 DOI: 10.1016/j.jpba.2016.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/08/2016] [Indexed: 12/31/2022]
Abstract
An overview of bioanalytical methods for the determination of environmental and pharmaceutical contaminants in human milk is presented. The exposure of children to these contaminants through lactation has been widely investigated. The human milk contains diverse proteins, lipids, and carbohydrates and the concentration of these components is drastically altered during the lactation period providing a high degree of an analytical challenge. Sample collection and pretreatment are still considered the Achilles' heel. This review presents liquid chromatographic methods developed in the last 10 years for this complex matrix with focuses in the extraction and quantification steps. Green sample preparation protocols have been emphasized.
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20
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Affiliation(s)
- Kathleen A Marinelli
- Connecticut Human Milk Research Center, Connecticut Children's Medical Center, Hartford, CT, USA University of CT School of Medicine, Farmington, CT, USA
| | - Sara L Gill
- The University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, TX, USA
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21
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Davanzo R, Romagnoli C, Corsello G. Position Statement on Breastfeeding from the Italian Pediatric Societies. Ital J Pediatr 2015; 41:80. [PMID: 26498033 PMCID: PMC4619394 DOI: 10.1186/s13052-015-0191-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/16/2015] [Indexed: 02/07/2023] Open
Abstract
The 2015 Position Statement on Breastfeeding of The Italian Pediatric Societies (SIP, SIN, SICupp, SIGENP) recognizes breastfeeding as an healthy behaviour with many short and long term benefits for both mother and infant.While protecting, promoting and supporting breastfeeding, neonatologists and pediatricians need specific knowledge, skills and a positive attitude toward breastfeeding. In Maternity Hospitals and in Neonatal Units, appropriate organizative interventions should be applied in order to facilitate the beginning of breastfeeding and the use of mother's/human milk.The Italian Pediatric Societies indicate the desiderable goal of around 6 months exclusive breastfeeding if the infant grows properly according to WHO Growth Charts. In principle, complementary feeding should not be anticipated before 6 months as a nutritional strategy pretending to prevent allergy and/or celiac disease. Eventually, long term breastfeeding should be supported meeting mother's desire.
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Affiliation(s)
- Riccardo Davanzo
- Division of Neonatology, Maternal and Child Health Institute-IRCCS "Burlo Garofolo" Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.
| | - Costantino Romagnoli
- Department of Pediatrics, Division of Neonatology, Catholic University S H, Rome, Italy.
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy.
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