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Fomina YY, Byrne JJ, Spong CY. Evaluating strength of recommendations for commonly administered medications in lactating women. J Matern Fetal Neonatal Med 2023; 36:2163626. [PMID: 36597824 DOI: 10.1080/14767058.2022.2163626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To characterize the data on medications for lactating people in the LactMed database and evaluate the strength of the data for the most commonly administered medications in lactating women. METHODS A retrospective analysis of all medications in the LactMed database in 12/2020 was performed. Each medication was classified into one of three categories: absent data, minimal-moderate data, strong data pertaining to safety in lactation. No data was defined as no available research studies associated with the medication. Minimal-moderate data was defined as absent research studies in one or more of the four LactMed categories: maternal drug levels, infant drug levels, effects on infants, effects on lactation, or if data was limited to a case report or observational study. Strong data was classified as availability of research studies in all four LactMed categories with data derived from pharmacokinetic/pharmacodynamic, cohort, case control, or randomized control studies. Additionally, the most commonly used medications in lactating women as defined by prior literature were analyzed for strength of data. RESULTS 1408 medications were evaluated: 714 (51%) had no associated data, 664 (47%) had minimal-moderate data, and 30 (2%) had strong data. Maternal drug level category had the highest proportion of rigorous supportive data while the effect on lactation category had the least supportive data. Of the most common mediations used in lactating women, sex hormones (contraception) and the nervous system medication classes had the most robust supportive data while respiratory, blood forming organs, and galactogogues had the weakest supportive data. CONCLUSION There is significant variability and dearth in the quality of data guiding recommendations for use of medications in lactation providing numerous opportunities for research.
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Affiliation(s)
- Yevgenia Y Fomina
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health, Dallas, TX, USA
| | - John J Byrne
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health, Dallas, TX, USA
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health, Dallas, TX, USA
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Yeung CHT, Houle SKD, Anderson PO, Best BM, Dubinsky S, Edginton AN. Addressing maternal medication use during breastfeeding using clinical resources and a novel physiologically based pharmacokinetic model-derived metric: A qualitative study. Front Pediatr 2023; 11:1147566. [PMID: 37077336 PMCID: PMC10106747 DOI: 10.3389/fped.2023.1147566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
Introduction Breastfeeding has major benefits to the maternal-infant dyad and yet healthcare providers have expressed uncertainty about advocating breastfeeding when mothers are taking medications. The tendency for some providers to be more cautious in their advising approach is likely a consequence of limited, unfamiliar, and unreliable existing information on medication use during lactation. A novel risk metric termed the Upper Area Under the Curve Ratio (UAR) was developed to overcome existing resource shortcomings. However, the perception and use of the UAR in practice by providers is not known. The aim of this study was to understand existing resource use and potential UAR use in practice, their advantages and disadvantages, and areas of improvement for the UAR. Methods Healthcare providers mainly practicing in California with experience advising on medication use during lactation were recruited. One-on-one semi-structured interviews that included questions on current practices when advising medication use during breastfeeding, and approaches to a given a scenario with and without information about the UAR were conducted. The Framework Method was applied for data analysis to construct themes and codes. Results Twenty-eight providers representing multiple professions and disciplines were interviewed. Six main themes emerged: (1) Current Practice Approaches, (2) Advantages of Existing Resources, (3) Disadvantages of Existing Resources, (4) Advantages of the UAR, (5) Disadvantages of the UAR, and (6) Strategies to Improve the UAR. Overall, 108 codes were identified that illustrated theme topics ranging from a general lack of metric use to the realities of advising. A workflow describing current practice approaches connected all other themes. Almost all disadvantages of existing resources could be overcome by advantages of other resources and the UAR. Several improvements to the UAR were identified to address its shortcomings. Conclusion Through interviews with providers who use resources to advise on medication use during breastfeeding, an improved understanding of current practice approaches and accessed resources was ascertained. Ultimately, it was found that the UAR would confer multiple benefits over existing resources, and improvements of the UAR were identified. Future work should focus on implementing the suggested recommendations to ensure optimal uptake of the UAR to improve advising practices.
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Affiliation(s)
- Cindy Hoi Ting Yeung
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Sherilyn K. D. Houle
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Philip O. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| | - Brookie M. Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| | - Samuel Dubinsky
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Andrea N. Edginton
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
- Correspondence: Andrea N. Edginton
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Byerley EM, Perryman DC, Dykhuizen SN, Haak JR, Grindeland CJ, Muzzy Williamson JD. Breastfeeding and the Pharmacist's Role in Maternal Medication Management: Identifying Barriers and the Need for Continuing Education. J Pediatr Pharmacol Ther 2022; 27:102-108. [PMID: 35241980 PMCID: PMC8837210 DOI: 10.5863/1551-6776-27.2.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/23/2021] [Indexed: 10/04/2023]
Abstract
Breastfeeding offers a multitude of benefits for infants, mothers, and society. Exclusive breastfeeding of infants is recommended for at least the first 6 months of life. Although transfer of drug into breastmilk can occur, most medications are safe to use during breastfeeding. Pharmacists, regarded as the most accessible health care professionals, recognize their role as medication specialists for breastfeeding women. Unfortunately, a lack of formal and continuing education on medication use during lactation often results in pharmacists providing the unnecessary recommendation to disrupt breastfeeding during medication use. In addition to lack of education, other barriers pharmacists experience in providing optimal patient care during lactation include difficulty identifying breastfeeding status and inconsistency in recommendations between scientific resources. Pharmacists must voice their need for additional continuing education and take action to close the knowledge gap and address barriers to providing care.
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Affiliation(s)
- Eva M. Byerley
- Department of Pharmacy Practice (EMB, DCP, SND, JDMW), North Dakota State University, Fargo, ND
| | - Dillon C. Perryman
- Department of Pharmacy Practice (EMB, DCP, SND, JDMW), North Dakota State University, Fargo, ND
| | - Sydney N. Dykhuizen
- Department of Pharmacy Practice (EMB, DCP, SND, JDMW), North Dakota State University, Fargo, ND
| | | | | | - Julia D. Muzzy Williamson
- Department of Pharmacy Practice (EMB, DCP, SND, JDMW), North Dakota State University, Fargo, ND
- Department of Pharmacy (CJG, JDMW), Sanford Children's Hospital, Fargo, ND
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Hanley L. Medication Use During Lactation: Either a Potential Contributor to Premature Weaning or Evidence-based Support of the Mother/Child Couplet. Clin Ther 2020; 42:393-400. [PMID: 32113701 DOI: 10.1016/j.clinthera.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/23/2023]
Abstract
It is well established that breastfeeding improves the health of women, children, and populations. According to the 2018 Centers for Disease Control and Prevention Report Card, 83% of women initiated breastfeeding, but only 58% maintained breastfeeding at the 6-month mark, and 36% continued to 12 months. Reasons for cessation of breastfeeding are multifactorial and include issues surrounding safe use of medications while breastfeeding for acute or chronic conditions. There are a wide variety of resources that clinicians may consult to help decide if medications are compatible with breastfeeding. The resources have varying data and recommendations, which can make counseling challenging for the clinician. There are some resources that are updated regularly with the most current information about drug safety in lactation, as well as call centers that can answer questions from clinicians and patients. A case scenario is presented to help illustrate the many facets of how medication use can affect breastfeeding. Very few medications are absolutely contraindicated during lactation. Involving the woman and her family in a shared decision-making approach regarding medication use may help women feel more confident in the medication recommendations given and ultimately help women achieve their breastfeeding goals. (Clin Ther. 2020; 42:XXX-XXX)© 2020 Elsevier HS Journals, Inc.
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Affiliation(s)
- Lauren Hanley
- Obstetrics, Gynecology and Breastfeeding Medicine, MGH Lactation Clinic, Massachusetts General Hospital, 55 Fruit St, Founders 430, Boston, MA, 02114, USA.
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Lutz BH, Bassani DG, Miranda VIA, Silveira MPT, Mengue SS, Dal Pizzol TDS, da Silveira MF, Bertoldi AD. Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020568. [PMID: 31963112 PMCID: PMC7014443 DOI: 10.3390/ijerph17020568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale's lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale's risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.
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Affiliation(s)
- Bárbara Heather Lutz
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Avenida Duque de Caxias, 250, Pelotas 96030-000, RS, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas 96020-220, RS, Brazil; (V.I.A.M.); (M.P.T.S.); (M.F.d.S.); (A.D.B.)
- Correspondence: ; Tel.: +55-53-3309-2400
| | - Diego Garcia Bassani
- Centre for Global Child Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada;
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Vanessa Iribarrem Avena Miranda
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas 96020-220, RS, Brazil; (V.I.A.M.); (M.P.T.S.); (M.F.d.S.); (A.D.B.)
| | - Marysabel Pinto Telis Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas 96020-220, RS, Brazil; (V.I.A.M.); (M.P.T.S.); (M.F.d.S.); (A.D.B.)
- Department of Physiology and Pharmacology, Institute of Biology, Federal University of Pelotas, Travessa André Dreyfus, s/n, Campus Capão do Leão, Pelotas 96010-900, RS, Brazil
| | - Sotero Serrate Mengue
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre 96020-000, RS, Brazil; (S.S.M.); (T.d.S.D.P.)
| | - Tatiane da Silva Dal Pizzol
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre 96020-000, RS, Brazil; (S.S.M.); (T.d.S.D.P.)
| | - Mariângela Freitas da Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas 96020-220, RS, Brazil; (V.I.A.M.); (M.P.T.S.); (M.F.d.S.); (A.D.B.)
| | - Andréa Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas 96020-220, RS, Brazil; (V.I.A.M.); (M.P.T.S.); (M.F.d.S.); (A.D.B.)
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