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Henderson E, Mackillop L.
Postgrad Med J. 2011 May;87(1027):349-54.

Abstract

Prescribing in pregnancy often causes uncertainty and anxiety for the clinician and may lead to the omission of necessary treatment. Many drugs have inadequate data to assure safety, and therefore the clinician is left with a dilemma as to where the balance of risks and benefits lie with respect to the mother and her fetus. Understanding under what circumstances women can be prescribed medication and using principles of prescribing in pregnancy to further clarify the potential risks will aid good clinical decision-making. An appreciation of the available resources and the conviction to find the best available evidence will best serve the patient and her fetus.

Christina Ronai, Julie Scott Taylor, Erin Dugan and Edward Feller
BREASTFEEDING MEDICINE Volume 4, Number 2, 2009

Abstract

Objective: Concerns about medications influence breastfeeding decisions. Mothers may stop breastfeeding when they take medications. After the distribution of Thomas Hale’s Medications and Mother’s Milk (MMM) (Hale Publishing, Amarillo, TX, 2006) by the Rhode Island Department of Health (Providence, RI) in November 2006 to Rhode Island pharmacies, we investigated, during the summer of 2007, what strategies and resources pharmacists were using to identify breastfeeding women and guide medication recommendations.

The amount of drug excreted into milk depends on a number of kinetic factors:

1. the lipid solubility of the drug,
2. the molecular size of the drug,
3. the blood level attained in the maternal circulation,
4. protein binding in the maternal circulation,
5. oral bioavailability in the infant, and the mother, and
6. the half-life in the maternal and infant's plasma compartments.

Monica Akus, PharmD BCPS CACP, Melissa Bartick, MD MS

The Annals of Pharmacotherapy: Vol. 41, No. 9, pp. 1352-1360. 2007 July

Abstract

BACKGROUND: Discontinuation of breast-feeding is linked with an increased risk of acute and chronic diseases in children, as well as increased risk of maternal disease. Mothers and physicians often depend on pharmacists for accurate drug information. Their information is only as good as the sources available to them.

Ito, S. N. Engl. J. Med., 2000, 343, 118.

Az anyatejben megjelenõ gyógyszerek mennyisége az anya szervezetébe került minõségi jellemzõitõl függ, ilyen például kötõdésük a plazmaproteinekhez, ionizációjuk, lipidoldékonyságuk, molekulasúlyuk és kinetikájuk. A gyógyszerek kiválasztódása az anyatejbe történhet mind passzív diffúzióval, mind karrier mediálta transzport útján, de lehetséges az organikus kation-transzportrendszerben is.

Often there is a need to decide whether a mother who is breastfeeding and who needs treatment with drugs can take the necessary medication and still continue breastfeeding safely. There are very few kinds of treatment during which breastfeeding is absolutely contraindicated. However, there are some drugs which a mother may need to take which sometimes cause side-effects in the baby. The summary box “Breastfeeding and Mother`s Medication” on page 3 provides a preliminary guide. This document gives more detailed information about specific drugs from the Eleventh Model List of Essential Drugs.
World Health Organization, 2003

A teljes dokumentum a WHO oldalán található.

Breastfeeding is the optimal form of infant feeding for the first months of an infant's life, and the majority of healthy women initiate breastfeeding after the birth of their infant. However, women on medication may default to formula feeding or not taking their drug therapy for fear of exposing their infant to the medication through the breast milk.
Advanced Drug Delivery Reviews Vol. 55 No. 5 2003. pp 617-627

Az absztrakt itt található.

Jennifer M. Marks, BS; Diane L. Spatz, PhD, RNC

J Pediatr Health Care 17(6):311-317, 2003.

Abstract and Introduction

Abstract
The current rise in breastfeeding rates coincides with a continuously expanding prescription medication market. Now more than ever, pediatric nurse practitioners (PNP) are responsible for ordering and consulting on maternal medications during lactation. PNPs are obligated to determine the safety of medications by critically reviewing recommendations that are based on recent clinical research. However, sources vary widely in the relevance of their information. Ideally, comprehensive research-based recommendations about medications and lactation should be based on the pharmacokinetics of drugs in the maternal system, the oral bioavailability of the medication to the infant, and the infant evaluation. Review of the data enables PNPs to effectively evaluate drugs and their actual risks to a breastfeeding infant, thereby supporting integration of sound evidence-based care into clinical practice.

Thomas W. Hale
Mothering Issue 111 March/April 2002
The decision to prescribe medication for a breastfeeding mother is one of the most contentious areas in the clinical practice of medicine. For legal reasons alone, most manufacturers and many physicians advise patients to discontinue breastfeeding while they take various medications. Look at any package insert; invariably, the manufacturer recommends that the physician avoid prescribing the drug for breastfeeding mothers. Often doctors advise nursing mothers to "pump and dump" while taking an antibiotic, not knowing that they may be initiating a dangerous spiral toward a poor milk supply, or endangering the infant by introducing a poorer food source such as formula early on.

AMERICAN ACADEMY OF PEDIATRICS Committee on Drugs

PEDIATRICS Vol. 108 No. 3 September 2001

ABSTRACT.

The American Academy of Pediatrics places emphasis on increasing breastfeeding in the United States. A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing. Such advice may not be warranted. This statement is intended to supply the pediatrician, obstetrician, and family physician with data, if known, concerning the excretion of drugs into human milk. Most drugs likely to be prescribed to the nursing mother should have no effect on milk supply or on infant well-being. This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacologic treatment of breastfeeding mothers. Nicotine, psychotropic drugs, and silicone implants are 3 important topics reviewed in this statement.

Jeanne P. Spencer, Luis S. Gonzalez, Donna J. Barnhart

Am Fam Physician 2001;64:119-26.

Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. A drug that is safe for use during pregnancy may not be safe for the nursing infant. The transfer of medications into breast milk depends on a concentration gradient that allows passive diffusion of nonionized, non­protein-bound drugs. The infant's medication exposure can be limited by prescribing medications to the breast-feeding mother that are poorly absorbed orally, by avoiding breast-feeding during times of peak maternal serum drug concentration and by prescribing topical therapy when possible. Mothers of premature or otherwise compromised infants may require altered dosing to avoid drug accumulation and toxicity in these infants. The most accurate and up-to-date sources of information, including Internet resources and telephone consultations, should be used.

Sharon Gardiner and Evan Begg

Prescriber Update No.21:10-23

Many mothers are required to use drugs during breastfeeding. Almost all drugs transfer into breast milk and this may carry a risk to a breastfed infant. Factors such as the dose received via breast milk, and the pharmacokinetics and effect of the drug in the infant need to be taken into consideration. Problems should not be overstated however, as many drugs are considered 'safe' during breastfeeding.

Kenneth F. Ilett, Judith H. Kristensen

Aust Prescr 1997;20:35-40

Summary

Assessing the safety of breast feeding during maternal drug therapy is an individualised risk:benefit analysis. An infant's exposure depends on drug transfer into milk, daily milk intake and the bioavailability of the drug in the infant. Exposure and the potential for adverse effects is greatest in premature neonates and decreases over the first few months of life as the infant's clearance mechanisms mature. Risk should be assessed in the light of the inherent toxicity of the drug and any published data on milk transfer and infant exposure. When maternal drug therapy is necessary, the breast-fed infant should be regularly assessed for adverse effects such as sedation, failure to thrive and achievement of developmental milestones. Laboratory measurement of drug transfer into the milk and the infant's blood should be used, where possible, to confirm suspected adverse effects.

Pediatric Pharmacotherapy
Volume 2, Number 4, April 1996

Assessing and Minimizing the Risk

Assessing the risk of maternal medication use in the breastfeeding infant continues to be one of the more difficult tasks faced by health care providers in obstetrics, pediatrics, and family medicine. Despite the dramatic increase in the percentage of women choosing to breastfeed, our knowledge of the safety of most medications remains limited. Research into the quantity of drug transferred into milk is complex and provides only a limited degree of certainty on the safety of medication use. However, this lack of scientific data should not lead to the conclusion that most medications are unsafe. Case reports and surveillance studies frequently provide examples of maternal medication use that does not result in adverse effects for the breastfeeding infant.