Knowledge, Representations, Attitudes, and Behaviors of Women Faced With Taking Medications While Breastfeeding

Alleviating anxiety while breastfeeding: evaluating buspirone transfer into human milk

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.

Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey

BACKGROUND

The World Health Organization recommends breastfeeding as the best method for infant feeding. Known risk factors for breastfeeding non-initiation and early cessation of breastfeeding are diverse and include low breastfeeding self-efficacy, poverty, smoking, obesity, and chronic illness. Although women with disabilities experience elevated rates of these risk factors, few studies have examined their breastfeeding outcomes. Our objective was to examine breastfeeding non-initiation and early cessation of breastfeeding in women with and without disabilities.

METHODS

We used data from the 2017-2018 Canadian Community Health Survey. Included were n = 4,817 women aged 15-55 years who had a birth in the last five years, of whom 26.6% had a disability, ascertained using the Washington Group Short Set on Functioning. Prevalence ratios (aPR) of breastfeeding non-initiation, and of early cessation of any and exclusive breastfeeding before 6 months, were calculated for women with versus without disabilities. We also examined disability by severity (moderate/severe and mild, separately) and number of action domains impacted (≥ 2 and 1, separately). The main multivariable models were adjusted for maternal age, marital status, level of education, annual household income level, and immigrant status.

RESULTS

There were no differences between women with and without disabilities in breastfeeding non-initiation (9.6% vs. 8.9%; aPR 0.88, 95% CI 0.63, 1.23). Women with disabilities were more likely to have early cessation of any (44.4% vs. 35.7%) and exclusive breastfeeding before 6 months (66.9% vs. 61.3%), with some attenuation in risk after adjustment for sociodemographic factors (aRR 1.15, 95% CI 0.99, 1.33 and aRR 1.07, 95% 0.98, 1.16, respectively). Disparities were larger for women with moderate/severe disabilities and disabilities in ≥ 2 domains, with differences attenuated by adjustment for socio-demographics.

CONCLUSIONS

Women with disabilities, and particularly those with moderate/severe and multiple disabilities, could benefit from tailored, accessible breastfeeding supports that attend to the social determinants of health.

The most common medications dispensed to lactating persons: An electronic health record-based approach

PURPOSE

Using a novel, electronic health record (EHR)-based approach, to estimate the prevalence of prescription medication use at 2, 4, and 6 months postpartum among lactating individuals.

METHODS

We utilized automated EHR data from a US health system that records infant feeding information at well-child visits. We linked mothers who received prenatal care to their infants born May 2018-June 2019, and we required infants to have ≥1 well-child visit between 31 and 90 days of life (i.e., 2-month well-child visit with a ±1 month window). Mothers were classified as lactating at the 2-month well-child visit if their infant received breast milk at the 2-month well-child visit. For subsequent well-child visits at 4 and 6 months, mothers were considered lactating if their infant was still receiving breast milk.

RESULTS

We identified 6013 mothers meeting inclusion criteria, and 4158 (69.2%) were classified as lactating at the 2-month well-child visit. Among those classified as lactating, the most common medication classes dispensed around the 2-month well-child visit were oral progestin contraceptives (19.1%), selective serotonin reuptake inhibitors (8.8%), first generation cephalosporins (4.3%), thyroid hormones (3.5%), nonsteroidal anti-inflammatory agents (3.4%), penicillinase-resistant penicillins (3.1%), topical corticosteroids (2.9%), and oral imidazole-related antifungals (2.0%). The most common medication classes were similar around the 4 and 6-month well-child visits although prevalence estimates were often lower.

CONCLUSIONS

Progestin-only contraceptives, antidepressants, and antibiotics were the most dispensed medications among lactating mothers. With routine collection of breastfeeding information, mother-infant linked EHR data may overcome limitations in previous studies of medication utilization during lactation. These data should be considered for studies of medication safety during lactation given the need for human safety data.

Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study

INTRODUCTION

Use of medications is a common concern for breastfeeding women, particularly when they are strongly needed or unavoidable to manage maternal chronic conditions. Yet the influence of medication usage patterns on breastfeeding duration in mothers with chronic conditions is unclear. The objective of this study was to examine whether postpartum medication practices were associated with shorter breastfeeding duration or earlier than planned breastfeeding cessation among mothers with chronic conditions.

MATERIAL AND METHODS

We analyzed 346 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study (Alberta, Canada) who initiated breastfeeding after birth. Data were collected through self-report questionnaires spanning late pregnancy to 6 months postpartum. Based on reported use of preexisting medications while breastfeeding, women were classified as continuing medications (reference group), discontinuing one or more medications, or those who did not use preexisting medications. Cox proportional hazards regression was used to analyze the association of medication practices and overall breastfeeding duration in weeks. Logistic regression was used to analyze the association of medication practices and earlier than planned breastfeeding cessation. Multivariable models adjusted for demographic and health-related factors.

RESULTS

Overall, 30.6% of women with chronic conditions stopped breastfeeding in the first 6 months, almost all of whom did so earlier than planned. In multivariable models, medication discontinuation was significantly associated with shorter breastfeeding duration (adjusted hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03-2.70) and earlier than planned breastfeeding cessation (adjusted odds ratio [OR] 1.85, 95% CI 1.01-3.42), whereas medication non-use was not associated with differences in breastfeeding outcomes.

CONCLUSIONS

Women with chronic conditions who discontinued preexisting medications while breastfeeding had significantly shorter breastfeeding duration and were less likely to meet their breastfeeding goals in the first 6 months postpartum compared to women who continued preexisting medications.

Medication Intake as a Factor for Non-Initiation and Cessation of Breastfeeding: A Prospective Cohort Study in Greece during the COVID-19 Pandemic

Pharmacological treatment may become a barrier for a mother’s breastfeeding goals. We aimed to investigate maternal medication intake as a factor for non-initiation and cessation of breastfeeding and the effect of professional counseling on maternal decision-making. Throughout 2020,847 women were recruited from five healthcare institutions. Information was gathered prospectively with an organized questionnaire through interview during hospitalization and through telephone at 1, 3 and 6 months postpartum. Results revealed that from the 57 cases of breastfeeding cessation due to medication intake, only 10.5%received evidence-based counseling from a physician. Unfortunately, 68.4% (n = 39/57) of the participants ceased breastfeeding due to erroneous professional advice. The compatibility of medicines with breastfeeding was examined according to the Lactmed and Hale classification systems, which showed discrepancy in 8 out of 114 medicines used, while 17.5% and 13.2% of the medicines, respectively, were not classified. Educational level, employment at six months postpartum, mode of delivery, previous breastfeeding experience, medication intake for chronic diseases, physician’s recommendation and smoking before pregnancy were factors significantly correlated with breastfeeding discontinuation due to medication intake. The COVID-19 restrictions protected women from ceasing breastfeeding due to medication intake. Maternal and lactation consultancy should be strictly related to evidence-based approaches.

Surgical Performance of En Bloc Total Capsulectomy Breast Implant Removal With Uninterrupted Breastfeeding

INTRODUCTION

A 28-year-old woman was able to maintain lactation for her 21-month-old child through the process of an En Bloc Total Capsulectomy Breast Implant Removal. This case study is important as it exemplifies collaborative care to achieve maintenance of lactation through a surgical procedure.

MAIN ISSUE

The participant was providing human milk to her 21-month-old child 4 times per day through breastfeeding and pumping and bottle feeding, and desired to continue lactation through explant surgery. The participant was experiencing Breast Implant Illness, yellowing of the skin and whites of the eyes, bottoming out of the right implant, severe capsular contracture of the right implant causing constant pain, limited mobility of the right arm and shoulder, and concern about an active recall on the brand implant she received.

MANAGEMENT

The lactation management began 3 weeks prior to the procedure with the participant expressing enough milk prior to the surgery to allow for human milk feeding from a bottle during the 7-day recovery period as desired. The surgical team and IBCLC selected an appropriate bra for recovery to allow for both appropriate surgical site healing and ease of access for pumping. Exclusive pumping was utilized until surgical drains were removed, after which the participant was able to reintroduce breastfeeding.

CONCLUSION

En Bloc Total Capsulectomy Breast Implant Removal can be performed while an individual is lactating without complication, given the appropriate multidisciplinary support. A temporary reduction of ease and efficiency of milk removal is possible post-operatively, in this case resolving within 24 hr.

Adverse Drug Reactions in Breastfed Infants: A Cross-Sectional Study of Lactating Mothers

Background: Breastfeeding-related adverse drug reactions (ADRs) are thought to be uncommon as reported cases are globally low. The nonspecific nature of these reactions and a lack of awareness and difficulty in identification of ADRs by mothers and clinicians may result in these ADRs being underreported. Aims: This study hypothesized that breastfeeding-related infant ADRs are more frequent than reported. As a first-hand account of breastfeeding mothers, this study aimed to evaluate the impact of the perceived ADRs on the continuation of breastfeeding and maternal treatment. Methods: Women currently breastfeeding or having breastfed in the last 12 months were invited to complete an online survey. The survey comprised 42 questions in 5 sections to obtain data from breastfeeding mothers, including their use of medicines during lactation, perceptions of infant adverse reactions attributable to maternal medication use and its potential impact on breastfeeding. Results: This online survey was completed by 339 women, 42% of whom reported taking at least one medication during breastfeeding. ADRs were reported in 23 infants where a possible or probable causal relationship indicated by a Naranjo score of 1-8 was established in 16 (11.3%). Antibiotics (n = 12) and opioids (n = 2), including tramadol and oxycodone were identified as the most common adverse reaction-causing drugs. The average age of infants at the time of the perceived ADR was 25.6 days (95% confidence interval; 4-85 days; median age 17.5 days). Conclusion: Suspected ADR reporting in this study was significantly greater than those reported to the regulatory body, the Australian Therapeutics Goods Administration, which shows that common breastfeeding-related infant ADRs are underreported.

Shared decision-making about medication intake during lactation: A prospective longitudinal study in Greece

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.

Successful lactation after resuming methylphenidate in a woman with narcolepsy

BACKGROUND

New mothers with narcolepsy face difficult decisions about medications and breastfeeding in addition to the more typical challenges of becoming a parent. Scant data are available to guide these choices.

CASE

A 30-year-old G1P1 woman with narcolepsy with cataplexy fed her infant breastmilk for 7 months by exclusive pumping. She chose to discontinue her stimulants at delivery, and restarted methylphenidate when her infant was 13 weeks old. The woman tracked milk production on an app geared towards new parents. Average daily volume was 751±228 ml before and 822±177 ml after restarting methylphenidate. Her infant's growth was appropriate and did not decrease after resuming medications.

CONCLUSIONS

In this new mother with narcolepsy, resuming methylphenidate did not reduce breastmilk volumes or negatively impact her infant. Tracking apps and other technologies can increase patients' confidence and provide data to address gaps in medical knowledge.

Importance of family planning in patients with immune-mediated inflammatory diseases: A multidisciplinary approach

BACKGROUND AND OBJECTIVES

Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases.

METHODS

A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated.

RESULTS

Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers.

CONCLUSION

These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.

Development and Pilot Use of a Questionnaire to Assess the Knowledge of Midwives and Pediatric Nurses on Maternal Use of Analgesics during Lactation

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.

A Scoping Review of Breastfeeding in Women with Chronic Diseases

Background: Approximately 10-20% of mothers have a chronic disease. Studies on breastfeeding in women with chronic disease span multiple disciplines, and these have not been collated to synthesize knowledge and identify gaps. The objective of this review was to summarize published literature on breastfeeding in women with chronic disease. Methods: We conducted a scoping review of original research and systematic reviews identified in Medline, EMBASE, and CINAHL (1990-2019) and by hand searching on women with chronic diseases reporting on at least one breastfeeding-related topic. Conference abstracts, case-studies, and studies on pregnancy-induced conditions or lactation pharmacology were excluded. Content analysis and narrative synthesis were used to analyze findings. Results: We identified 128 articles that were predominantly quantitative (80.5%), conducted in Europe or North America (65.6%), analyzed sample sizes of <200 (57.0%), and published from 2010 onward (68.8%). Diabetes (42.2%), multiple sclerosis (MS; 19.5%), and epilepsy (13.3%) were the most common diseases studied. Breastfeeding was a primary focus in approximately half (53.1%) of the articles, though definitions were infrequently reported (32.8%). The most-studied topics were breastfeeding duration/exclusivity (55.7%), reasons for feeding behavior (19.1%), and knowledge and attitudes about breastfeeding (18.3%). Less studied topics (<10% of articles each) included milk expression behaviors, breastfeeding difficulties, and feeding supports. Conclusions: Existing literature focuses primarily on diabetes or MS, and breastfeeding behaviors and outcomes. Further research examining a broader range of chronic diseases, with large sample sizes, and sufficient breastfeeding measurement detail can improve our understanding of breastfeeding disparities in this population.

Breastfeeding Challenges: ACOG Committee Opinion, Number 820

ABSTRACT

Breastfeeding is associated with a decrease in a woman's risk of breast cancer, ovarian cancer, diabetes mellitus, and hypertensive heart disease. Breastfeeding initiation rates in the United States are increasing, and many women are aware of the maternal and infant health benefits of breastfeeding. However, problems may arise that can keep women from achieving their breastfeeding goals, and only 25% of women in the United States are breastfeeding exclusively at 6 months. Many women experience early and undesired weaning because of persistent pain or nipple injury. A focused history and physical examination are essential to help obstetrician-gynecologists and other obstetric care professionals distinguish the specific cause of their patients' pain and determine appropriate treatment. Studies have shown that pain with breastfeeding may be associated with postpartum depression; therefore, postpartum depression screening is an important part of the medical history when caring for these patients. Some women choose not to initiate breastfeeding, stop breastfeeding sooner than intended, or are unable to complete treatment with prescribed medications because they may have concerns regarding medication use during lactation. Health care professionals prescribing medications during lactation should base their counseling on accurate, current information from resources such as the National Center for Biotechnology Information's Drugs and Lactation database (known as LactMed). Causes of early weaning also may be attributed to societal factors, such as limited access to paid maternity leave and barriers to breastfeeding in the workplace. Obstetrician-gynecologists and other obstetric care professionals are uniquely positioned to support women in these situations.

Importance of family planning in patients with immune-mediated inflammatory diseases: a multidisciplinary approach

BACKGROUND AND OBJECTIVES

Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases.

METHODS

A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated.

RESULTS

Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers.

CONCLUSION

These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.

Adherence with prescription drugs in pregnant and breastfeeding women consulting with the Israel Poison Information Center Teratology Service

INTRODUCTION

During pregnancy and breastfeeding, many women require prescription medications. Concerns about drug effects on the fetus or breastfed infant may lead to decreased adherence. Our objective was to evaluate the adherence of pregnant and breastfeeding Israeli women to prescription drugs, the information they received regarding drug safety, and the women's awareness and pattern of the use of Teratogen Information Services (TIS) in Israel.

METHODS

We conducted a prospective observational cohort study among pregnant and breastfeeding women who had contacted the Israel Poison Information Center (IPIC) to consult about prescription medications. In a follow-up telephone call, we assessed adherence (defined as medication initiation by the time of the follow-up call) and the patients' recollection of the safety information given by the prescribing physician. In an additional cohort of post-partum women, we assessed their awareness about TIS in Israel.

RESULTS

We included 59 pregnant women (62 prescriptions), 75 breastfeeding women (80 prescriptions), and 49 postpartum women. About two-thirds of all prescriptions were for antimicrobial drugs. By the time of the follow-up call, most participants (89% of pregnant and 89% of breastfeeding women) had initiated medications. Eight (11%) breastfeeding women stopped breastfeeding their babies while using the medication. Patients reported receiving explicit and unequivocal information concerning medication safety by the prescriber for 50% and 55% of prescriptions to pregnant and breastfeeding women, respectively. 70% of postpartum women interviewed in the maternity ward were not aware of TIS in Israel.

DISCUSSION AND CONCLUSIONS

We observed high adherence rate to prescription medication therapy among pregnant and breastfeeding women in our cohort. Only about half of the women reported receiving comprehensive drug safety information by the prescriber. Raising awareness of the importance of medication safety counseling among both physicians and patients may contribute to the quality of medical care of pregnant and breastfeeding women in Israel.

Enabling Breastfeeding to Support Lifelong Health for Mother and Child

The health benefits of breastfeeding are well documented, and more than 80% of US women initiate breastfeeding; however, mothers in the United States face substantial challenges in meeting their personal breastfeeding goals, with approximately 60% weaning earlier than they had intended. In addition, there are significant racial/ethnic inequities in infant-feeding behaviors, and these inequities are a major public health concern. Enabling women to meet their breastfeeding goals is a public health priority. Infant feeding should be addressed as a modifiable health behavior, rather than a lifestyle choice.

Maternal chronic disease and breastfeeding outcomes: a Canadian population-based study

Background: The prevalence of chronic disease in pregnant women has consistently risen over the past two decades. Substantial evidence demonstrates that maternal chronic disease is associated with adverse medical outcomes like preterm birth, but less research has characterized postpartum outcomes such as infant feeding practices. It is recommended that infants be exclusively breastfed from birth to 6 months given the numerous health benefits it provides.Objective: To determine the association between maternal chronic disease and breastfeeding outcomes.Methods: We analyzed cross-sectional self-report data from the 2015/2016 Canadian Community Health Survey, restricted to women who gave birth within 2 years of data collection (n = 2100, rounded). The exposure was professionally diagnosed chronic physical disease (e.g. diabetes, arthritis, heart disease). The outcomes were breastfeeding non-initiation and early cessation of breastfeeding before 6 months. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Estimates were bootstrapped and weighted to represent the national population.Results: Overall, 11.9% (95% CI 9.8-14.1) of women reported chronic disease, and were more likely to be single, be Canadian born, have low education, and be overweight/obese than women without chronic disease. The mean maternal age was approximately 30 years in both groups. Women with chronic disease had similar odds of breastfeeding non-initiation (AOR 0.96, 95% CI 0.54-1.71) and early cessation of any breastfeeding (AOR 1.40, 95% CI 0.82-2.40), but over twice the odds of early cessation of exclusive breastfeeding (AOR 2.48, 95% CI 1.49-4.12) compared to unaffected women.Conclusion: Mothers with chronic disease initiate and continue some form of breastfeeding to six months as often as their unaffected peers. However, they have substantially higher odds of ceasing exclusive breastfeeding before the recommended 6 months. Findings suggest a need to investigate the reasons for this disparity to ensure that appropriate breastfeeding support is available for women with chronic disease and their children.

Improving Drug Exposure Knowledge During Lactation: Quality Improvement Initiative in Low-Income Women

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.

Calls to a Major Teratogen Information Service Regarding Exposures During Breastfeeding

Background: MotherSafe is a free telephone-based counseling service for Australian consumers and health care providers concerned about drug exposures during pregnancy and breastfeeding. Calls relating to breastfeeding are relatively common and a source of significant distress to the breastfeeding mother, particularly if there is a lack of clarity regarding possible adverse effects of drug exposure on the infant. This study seeks to identify the medication exposures of concern for breastfeeding mothers and the information available to address these concerns. Aims: To review calls to MotherSafe about breastfeeding drug exposures during the 19-year period from 2000 to 2018 and to highlight drugs of concern and counseling issues. Materials and Methods: A retrospective descriptive assessment of a prospectively collected Access database was undertaken. Phone counseling records identified the medication (and other) exposures of concern regarding breastfeeding. The information about medication exposures via breastfeeding provided in consumer and product information (PI) was also reviewed. Results: Of a total of 315,158 calls received at MotherSafe between 2000 and 2018, 116,876 (37.1%) were regarding drug exposure via breastfeeding; 30% of these calls related to nonsteroidal anti-inflammatory drugs, antihistamines, antidepressants, simple analgesics, and antibiotics, and 5% were regarding an exposure specifically contraindicated when breastfeeding. Conclusions: Queries about medication exposures via breastfeeding represent a significant proportion of all the counseling calls to MotherSafe. This study demonstrates the inconsistent and often misleading information about breastfeeding exposures found in consumer and PI sheets and online and highlights the important role of Teratogen Information Services like MotherSafe in providing evidence-based information to both consumers and health care providers.

Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges

For the past several years, the implementation of pharmacogenetic (PGx) testing has become widespread in several centers and clinical practice settings. PGx testing may be ordered at the point-of-care when treatment is needed or in advance of treatment for future use. The potential benefits of PGx testing are not limited to adult patients, as children are increasingly using medications more often and at earlier ages. This review provides some background on the use of PGx testing in children as well as mothers (prenatally and post-natally) and discusses the challenges, benefits, and the ethical, legal, and social implications of providing PGx testing to children.

Aim and Design of pREGnant, the Dutch Pregnancy Drug Register

Information on the safety of medication use during pregnancy and breastfeeding is scarce, yet use of medication among pregnant and breastfeeding women is widespread. The pREGnant, the Dutch Pregnancy Drug Register, was set up to obtain insight into medication use among pregnant and breastfeeding women and potential effects on maternal and fetal/infant health. The systematically documented, good quality data on medication use during pregnancy and lactation in pREGnant will be used in signal detection, epidemiologic studies and counseling of healthcare providers and patients. The register has a prospective cohort design. The population is derived from pregnant women throughout the Netherlands. Data collection started in April 2014 and enrollment of women is continuous and is characterized by a relative high proportion of women born in the Netherlands with a high education compared with the general Dutch pregnant population. Data on current pregnancy, obstetric history, maternal lifestyle, health and medication use, delivery, and infant health are collected through web-based questionnaires completed by the participating women (three times during pregnancy and three times during the infant’s first year of life). If permission is given, the self-reported data can be complemented with information retrieved from Perined, the perinatal registry of the Netherlands, and from obstetric and medical records, and/or pharmacy records. Here, we provide detailed information on the design of the pREGnant, the Dutch Pregnancy Drug Register, as well as descriptive information on characteristics of the participants so far. Currently, steps are being taken to implement the register on a large scale in the Netherlands.

Understanding Breastfeeding Women's Behaviors Toward Medication: Healthcare Professionals' Viewpoint

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.

[Which medications are safe while breastfeeding? : A synopsis for the anesthetist, obstetrician and pediatrician]

Pharmacokinetic data on drug administration during lactation are often inconsistent or missing. For legal reasons medicinal drug product information generally advises to interrupt breastfeeding for 24 h after medication intake. However this is not standard of care in clinical practice as the mother should be instructed to initiate breastfeeding as soon as possible after giving birth. At the same time the medication exposure over the breast milk for the newborn should be minimized. Aim of this article is to summarize pharmacokinetic data and to give important clinical information on medications frequently administered during the lactation period. As a general rule a mother can start breastfeeding following anesthesia as soon as she is able to get her baby latched on her breast.

Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary

This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.