Pediatricians: Most medications safe during breast-feeding

7:14 PM, Aug 27, 2013   |    comments
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(CBS News) Nursing moms may worry medications they need for their own well-being may harm their newborns through their breast milk, but a leading medical society wants to ease those fears.

In a new report released Monday, the American Academy of Pediatrics says most medications won't harm a baby through breast milk, and many mothers are being wrongfully advised to stop taking necessary medications when nursing or avoid breast-feeding altogether.

"This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants," wrote report's authors, led Dr. Hari Cheryl Sachs, a Maryland-based pediatrician who is a pediatrician and fellow of the American Academy of Pediatrics.


Breast-feeding has been linked to protective health benefits for both newborn babies and their mothers.

"Before assuming that you need to stop breast-feeding, there may be information that lets you know whether that really is advisable," Sachs added to the Wall Street Journal.

About 77 percent of new moms breast-feed their babies, according to an August report from the Centers for Disease Control and Prevention (CDC). And almost half of them continue to do so for at least the Academy-recommended first six months of a newborn's life. Moms are also asked to breast-feed to give supplemental breast milk until a child is aged 1-year-old or older.

Sachs, and the academy's Committee on Drugs, said advice to skip breast-feeding due to medication is often not evidence-based. 

For the academy' first policy update on the subject since 2001, the committee reviewed new evidence for any potential effects from taking medications including increasingly popular drugs like antidepressants or prescription painkillers, while breast-feeding.

Certain drugs or herbal supplements could pose safety risks for developing newborns because high levels may accumulate in breast milk or any amount of the drug could cause problems, according to the report.

The committee found no concerns associated with taking medications except for the following classes of drugs: pain medications, antidepressants, and drugs to treat substance or alcohol abuse, or to help women quit smoking.

People taking these medications may want to speak with their doctor about potential risks.

According to the report, much remains unknown about how drugs taken by a mother for depression, anxiety or other behavioral or mental health problems may affect a baby in the long term. The authors pointed out many anti-anxiety drugs, antidepressants and mood stabilizers appear in a mother's milk in low concentrations, and data on drug excretion in human milk are lacking for up to one-third of drugs used for psychological treatments.

The policy update concludes that moms who want to breast-feed while taking these medications should be counseled about both the benefits of breast-feeding and the unknown health risks, before deciding how to proceed. They may also want to monitor their infant's growth and brain development if they decide to take these pills.

Prescription painkillers like codeine or hydrocodone (Vicodin) are not recommended for nursing mothers because both them and some children may be"rapid metabolizers" of the drugs, due to a pathway in the body that causes the drug to be converted to higher-than-normal levels of opiates

Other narcotics including oxycodone (Oxycontin), pentazocine, propoxyphene, and meperidine should be avoided by lactating moms, according to the academy, for reasons including a risk high levels could be excreted in breast milk, potentially leading to problems including breathing difficulties in infants.

The authors also note that some women may be taking medications to help them stave off substance abuse during pregnancy, like methadone for narcotic abuse or pills for smoking cessation. Studies have shown drug, alcohol and tobacco use may harm a developing baby.

The report says methadone levels in breast milk are low despite some side effect reports in infants, and women enrolled in methadone-treatment programs are still encouraged to breast-feed.

Women taking nicotine-replacement therapy can also breast-feed as long as the amount of nicotine they are taking in is less than the amount they had previously smoked, due to how the drugs are absorbed.

Vaccines that are recommended for a mother won't interfere with the infant's immune system development during breast-feeding, the report's authors added, and may even protect against fever in the child.

An up-to-date list for hundreds of medications, and whether there are safety concerns for nursing moms, can be found at LactMed, a website from the National Institutes of Health.

Even though most of these drugs are safe, the academy says that doctors should make sure they obtain the most current information on any drug a breast-feeding mom may be taking.

Thomas Hale, director of the InfantRisk Center at Texas Tech University Health Sciences Center in Lubbock, told HealthDay that it's bothered him that most drug labels have blanket statements that caution against taking the pill when pregnant, even if the evidence of risk isn't there.

"If you pick up any package insert, you see the same language: 'There are no data available on this drug. Do not use in breast-feeding mothers,'" Hale said. But, he added, "We now know the risk of untreated depression is far, far worse than the risk of taking a drug," he said.

Hale called for better safety labels, and added that doctors can make educated guesses about whether drugs will pass through breast milk, based on the pharmaceutical's molecule size and chemical properties.

The Academy's new guidance on medications during breast-feeding was published Aug. 26 in its journal, Pediatrics.


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