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Hormones and hormone antagonists

The hormone and hormone antagonists prescribed during lactation have such a wide variety of substances that a summary would do no justification to the different issues dealt with here. 4.11.1 Pituitary and hypothalamic hormones Experience There are only a few publications that discuss tolerance of hypothalamic and pituitary hormones during breastfeeding. In a series of studies on the contraceptive effect of 600 μg of buserelin, a…

Immunomodulating and antineoplastic agents

Systemic auto-immune diseases commonly affect women during childbearing years. The control of maternal disease activity during pregnancy and lactation is imperative. With azathioprine, selective immune suppressants, some monoclonal antibodies or interferons, many breastfeeding mothers have sustained periods of disease quiescence and less disability. The evidence regarding the safety of all these medications during lactation is reviewed. With maternal antineoplastic drugs, the baby should be weaned. 4.10.1…

Psychotropic drugs

4.9.1 Introduction Psychiatric diseases frequently affect women of reproductive age and particularly during postpartum period. In the case of monotherapy, most psychopharmaceuticals are acceptable during lactation period. However, some drugs have more reassuring data than others. Therefore, careful selection should be made when a treatment is initiated. In cases of long-term therapy during pregnancy, a change of medication after birth is rarely necessary during breast feeding.…

Antiepileptics

4.8.1 Introduction All antiepileptics pass into the milk, albeit in differing amounts. Babies who are breastfed during maternal antiepileptic treatment apparently develop just as well as those who are not breastfed. At least, that is what was reported in one study of 82 mother–infant pairs in which breastfeeding was carried out during monotherapy with lamotrigine , carbamazepine , phenytoin or valproate by comparison to 112 non-breastfed…

Anticoagulants, thrombocyte aggregation inhibitors and fibrinolytics

Treatment with anticoagulants (heparin and derivatives), as well as with thrombin- and factor Xa-inhibitors, is acceptable during breastfeeding. Except for low dose acetylsalicylic acid, all other thrombocyte aggregation inhibitors should be used during lactation only if other alternatives are lacking. There are no human studies on the usage of fibrinolytics and antihemorrhagics during lactation. 4.7.1 Heparin and danaparoid Heparin does not pass into the mother’s milk…

Cardiovascular drugs and diuretics

There are cardiovascular drugs and diuretics that can be used during pregnancy and lactation. The decision to continue these medications during lactation depends on many factors. Some of these factors include the well-being of the mother, the blood/milk barrier, the pharmacological activity of the drug, and the consequences for the infant. The recommended drugs of choice are those which are best studied and do not show…

Vaccines and immunoglobulins

4.5.1 Maternal immunization A woman who has not received all the recommended immunizations before or during pregnancy may be immunized in the postpartum period even though she is breastfeeding. The presence of live viruses in the milk does not present a problem because the viruses have been attenuated. According to the statement of the American Academy of Pediatrics Committee on Infectious Diseases ( ), breastfeeding women…

Anti-infectives

With many antibiotics, a breastfed child receives less than 1% of the weight-related therapeutic dose when the mother is being treated. Thus only minimal concentrations – and in no case, bacteria-inhibiting concentrations – are achieved in the infant’s plasma. The following risks with antibiotic treatment during breastfeeding have been discussed repeatedly: ▪ Effects on the child’s intestinal flora (a “thinner” stool consistency, but seldom diarrhea). ▪…

Gastrointestinal drugs

Medications used to treat gastrointestinal symptoms are often prescribed during breastfeeding. However, there is little information describing the transfer into human milk for many of these drugs. Some of the gastrointestinal agents can be administrated during breastfeeding: antacids, sulcrafate, Helicobacter pylori therapy, domperidone, metoclopramide and carminatives. Other groups of gastrointestinal medications are drugs of choice: famotidine as H2-receptor blocker, omeprazole and pantoprazole as proton-pump inhibitors, bulking…

Antiallergics, antiasthmatics and antitussives

Second-generation antihistamines which have practically no sedative effect are compatible during breastfeeding. First-generation antihistamines with sedating action should be reserved during breastfeeding for special conditions. Should adverse effects such as restlessness or mild sedation occur, the consequences are to be considered individually. Medications for local use can be used. Desensitization with allergen extracts is not known to negatively influence breastfeeding. For asthma control during breastfeeding the…

Analgesics, antiphlogistics and anesthetics

Paracetamol and ibuprofen are the drugs of choice for treating pain and their use requires no limitation of breastfeeding. Continuous treatment with acetylsalicylic acid is not recommended and selective COX-2 inhibitors should be avoided because of limited experience on their use during breastfeeding. Sumatriptan or eletriptan can be used to treat migraine. Muscle relaxants should not be taken during breastfeeding. Opiates can be used for a…

General commentary on drug therapy and drug risk during lactation

3.1 The advantages of breastfeeding versus the risks of maternal medication No discussion of the risks of maternal medications can be undertaken without an understanding of the benefits of being breastfed for the child. Advantages to breastfeeding have been recognized in general terms for decades. However, new information and evidence-based studies following breastfed infants for months and even years have identified many additional advantages and protections…

Occupational, industrial and environmental agents

It is ambitious to describe the risk assessment of occupational, industrial and environmental agents, since they are the sum total of all agents which are potentially capable of producing an effect, whether physical, chemical or biological. They are found everywhere and influence the development of an individual. Both synthetic and naturally occurring substances may have significant pharmacological and toxicological properties, but few have been tested. Among…

Poisonings and toxins

2.22.1 The general risk of poisoning in pregnancy Poisoning in pregnancy may be accidental or intentional, and may reflect acute (e.g. deliberate overdose, therapeutic error) or chronic (e.g. environmental or occupational) exposure to one or more substances. Whilst risk to both mother and fetus will be determined primarily by the nature of the exposure(s) involved, the greatest risk in managing such patients is likely to arise…

Recreational drugs

Introduction Use of recreational drugs and other substances by women of childbearing potential, and during pregnancy varies widely across different populations. Whilst some women discontinue, or attempt to reduce use of alcohol, nicotine and other recreational drugs once pregnant, a significant number continue use throughout pregnancy. With half of all pregnancies being unplanned, exposure in the weeks prior to identification of pregnancy is therefore common. Despite…

Diagnostic agents

Before exposing a woman who is, or may be, pregnant to diagnostics, a pertinent risk-benefit estimation should be made, as exposure towards ionizing radiation must be minimized. Magnetic resonance tomography (MRT) can be safely used but ultrasonography remains the imaging method of choice. Contrast agents should only be applied if the diagnosis cannot be made without their use. After 12 weeks of gestation, intrauterine exposure to…

Herbs during pregnancy

Plants and plant extracts have been used for medicinal purposes since before recorded time. Many pharmaceutical agents have their origins in plant-based compounds. In a trend towards returning to the “natural,” and believing that such agents are safer, patients worldwide are more and more frequently consulting natural therapists and taking herbs to enhance their nutrition, stay healthy, and treat their illnesses. Women taking herbs can and…

Vitamins, minerals and trace elements

Vitamins and minerals are organic foods found only in plants and animals, and are essential to the normal functioning of the body. However, the actual definition of the term “essential” is not applied to all vitamins. Vitamin imbalances can be divided into three categories: 1. Hypovitaminosis – shortage of one or more vitamins. 2. Avitaminosis – depletion of one or more vitamins. 3. Hypervitaminosis – excess…

Dermatological medications and local therapeutics

In this chapter, the most important dermatological medications as well as other frequently used topical therapeutics will be discussed. More extensive information on individual medications can be found under the substance headings in other chapters. Anti-infectives are discussed in Chapter 2.6 . 2.17.1 Typical skin changes during pregnancy The adaptation of the woman during pregnancy leads to typical morphological and functional changes in the skin. These…

General and local anesthetics and muscle relaxants

Due to their lipid solubility, general anesthetic agents rapidly cross the blood–brain barrier and the placenta. In addition to their sleep-inducing effect in the brain, they also frequently have a depressant effect on the respiratory center. Thus, during the perinatal phase, there is a risk of hypoxia from neonatal respiratory depression. Fortunately there is no indication that an uncomplicated general anesthetic can lead to developmental disorders.…