Breastfeeding Quiz
1. Why is it important to ask if the infant is healthy when asked about the use of drugs in breastfeeding mothers?
Primarily because impaired kidney or liver function impairs drug elimination. But also some side effects of drugs in breast milk would be more problematic in babies with particular medical conditions. In addition, if the infant has been exposed to certain drugs during pregnancy he/she might be suffering from withdrawal reactions.
2. If an infant has been exposed to a drug throughout pregnancy, then further exposure from breastfeeding is not likely to cause any problems: any harm will already have been done. Is this correct?
No. After birth it is the infant that must eliminate the drug rather than the mother, and because babies’ clearance mechanisms are immature this leads to an increased risk of accumulation.
3. Why do you think that caution is advocated with the use of labetalol in mothers breastfeeding premature babies, as opposed to full-term ones?
Premature babies are smaller and will have even more immature clearance mechanisms than full-term babies. This will prolong the half-life of labetalol and could lead to drug accumulation in the infant, thus increasing the risk of side effects. Cardiovascular monitoring would be recommended at least initially if breastfeeding took place.
4. If a drug is safe in pregnancy then it follows that it will be safe in breastfeeding. Is this correct?
No. The drug characteristics that favour transfer through the placenta are different to those that favour transfer into breast milk e.g. lipid/water solubility. Also see answer to question 2.
5. What background information do you need before answering a call about medicines use during breastfeeding?
How old is the baby?
Was the baby premature or full-term?
Is the baby fit and well?
Frequency of feeds
Are bottle feeds being used at all
Details of medicine (dose, frequency, indication)
What is the medicine for?
Does the GP know you are breastfeeding?
Taken or planning to take
Full details of any other medicines (including OTC)
Handling calls about medicines during pregnancy & breastfeeding