The Organization of Teratology Information Specialists OTIS provides information, in English and Spanish, for women and health care providers on the risks and safety of taking medication during pregnancy and breastfeeding. This group maintains a website called Mother to Baby external icon. The InfantRisk Center external icon provides up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.
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In This Topic. Can what you eat and drink affect your breast milk? Here are some nutrients you may need supplements for during breastfeeding: DHA. You can get iodine by: Eating foods that are high in iodine, like fish, bread, cereal and milk products Taking an iodine or iodide supplement. Iodide is a form of iodine. Using iodized salt. This is salt that has iodine added to it. Read the package label to make sure your salt is iodized.
You may need extra vitamin B12 if you: Are a strict vegetarian or vegan. A vegan is someone who doesn't eat meat or anything made with animal products, like eggs or milk. Have had gastric bypass surgery.
This is surgery on the stomach and intestines to help you lose weight. These conditions affect how your body digests breaks down food. Can smoking while breastfeeding hurt your baby? It passes to your baby in breast milk and can cause problems, like: Making your baby fussy Making it hard for your baby to sleep Reducing your milk supply so your baby may not get all the milk he needs Secondhand smoke also is bad for your baby.
Can you pass alcohol or street drugs to your baby through breast milk? Tell each provider about any medicine you take. Your treatment is closely supervised and monitored. You have social support from friends and family throughout your treatment. Your baby continues to gain weight as you breastfeed. Is limp Has trouble breathing Has trouble breastfeeding To find out more about prescription medicines and breastfeeding, visit LactMed.
Read the label on the package for information about how an OTC drug may affect breastfeeding. Take the smallest dose amount of medicine to help lessen the amount that gets passed to your baby in breast milk.
These medicines may have larger doses that stay in your body and breast milk longer than medicines with smaller doses. What medical conditions make breastfeeding unsafe for your baby? Breastfeeding may be harmful to a baby if: Your baby has galactosemia.
They can have brain damage or even die if they eat or drink breast milk, milk or anything made with milk. Babies with galactosemia need to eat a special formula that is not made with milk of any kind. Your baby gets tested for this condition soon after birth as part of newborn screening.
You have HIV. You can pass HIV to your baby through breast milk. You have cancer and are getting treated with medicine or radiation. You have human T-cell lymphotropic virus. This is a virus that can cause blood cancer and nerve problems. You have untreated, active tuberculosis. This is an infection that mainly affects the lungs.
Of particular interest are the drugs that are active in the central nervous system CNS. CNS active drugs invariably have unique characteristics to enter into milk. Therefore, if a drug is active in the central nervous system, somewhat higher milk levels can be expected.
Protein binding also plays a very important role. Most drugs circulate in the maternal plasma bound to a large molecular weight protein called albumin. That that is not bound, remains freely soluble in the plasma. It is the "free" component that transfers into milk, while the bound fraction stays in the maternal plasma unable to reach the tissues.
Therefore, drugs that have high maternal protein binding, almost invariably produce lesser levels in milk. So, when choosing between medications of the same class, always choose the medication with the greater protein binding. Once a drug has entered the mother's milk and has been ingested by the infant, it must traverse through the infant's GI tract and be absorbed.
The term "Oral Bioavailability" refers to the amount of a drug that actually reaches the circulation of the individual. While, many drugs have poor oral absorption kinetics and are poorly absorbed into the infant's blood stream, others are destroyed in the acidic milieu of the stomach, while others are rapidly extracted by the liver and fail to ever reach the infant's circulation. Although we understand oral bioavailability in adults reasonably well, our understanding of the specifics of oral absorption in infants is somewhat rudimentary.
Still, many drugs that are poorly bioavailable in adults, are similarly so in infants. Oral bioavailability is a useful tool to estimate just how much of the drug will be absorbed by the mother or infant. In general, the infant's stomach is quite acidic and can denature many drugs. Further, some drugs are poorly absorbed when ingested with calcium rich foods and particularly milk. In addition, many drugs are sequestered in the liver and never actually reach the plasma compartment where they are active.
These absorption problems tend ultimately to reduce the overall effect of many drugs. Classic illustrations of poor oral bioavailability include the aminoglycoside antibiotic Gentamycin, the third generation cephalosporins such as Rocephin, and morphine. There are certainly exceptions to this rule, and one must always be aware that the action of a drug in the GI tract can also be profound such as with the antibiotics, producing diarrhea, constipation, and sometimes syndromes such as pseudo membranous colitis with the overgrowth of the bacteria C.
In general, the lower the molecular weight of a medication, the more likely it is to penetrate into human milk,simply because diffusion through the alveolar epithelial cell is much easier. Medications with molecular weights less than are considered smaller and will tend to penetrate to milk in higher concentrations than those with higher molecular weights.
An example of a low molecular weight drug is ethanol Alcohol. With a molecular weight of , it rapidly equilibrates between the plasma and milk compartments. Many of the amphetamines and diet medications unfortunately have low molecular weights as well. Drugs with molecular weights of or greater are unlikely to penetrate milk in high concentrations.
Typical examples of drugs with high molecular weights that are basically excluded from milk would include heparin 30, , antibodies such as Remicade , and insulin The pKa of a drug is the pH at which the drug is equally ionic and nonionic.
The more ionic a drug is, the less capable it is of transferring from the milk compartment to the maternal plasma compartment. Hence they become trapped in milk ion-trapping. This term is useful, because drugs that have a pKa higher than 7.
Drugs with higher pKa generally have higher Milk:Plasma ratios. Hence, choose drugs with a lower pKa. Determine if the drug is absorbed from the GI tract. Many drugs such as the aminoglycosides, vancomycin, cephalosporin antibiotics third generation , Epsom salts, and magnesium salts are so poorly absorbed that it is unlikely the infant will absorb significant quantities.
At the same time, be observant for GI side effects from drug trapped in the GI compartment of the infant. Review the data on the drug. Determine if the amount absorbed by the infant has been reported to produce side effects. Review the dose that is expected to be absorbed,and compare that to the pediatric dose if known.
Although useful, the milk:plasma ratio has one great weakness, and that is that it is only a ratio.
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