Contraindications to Breastfeeding

Question 1

Absolute contraindications to breastfeeding (including EBM)?

Answer 1

1. Brucellosis
2. HIV
3. HTLV 1 and 2 (human lymphotrophic virus)

Question 2

Breastfeeding contraindicated but may use EBM in what situation?

Answer 2

Active untreated TB

• Delay breastfeeding (but can use EBM) until mom received 2 weeks of anti-TB tx
• TB prophylaxis for infant

Question 3

Breastfeeding for:

• Maternal Hep A?
• Hep B?
• Hep C?

Answer 3

Hep A - continue breastfeeding, Ig prophylaxis for infant
Hep B - continue breastfeeding, HBIg and Hep B vaccine at birth
Hep C - continue breastfeeding, HBV vaccine

Question 4

Maternal HSV1 or 2?

Answer 4

• Continue breastfeeding
• Wear mask if orolabial lesions
• If lesions on breast, interrupt direct breastfeeding/use EBM until lesions crusted over

Question 5

Maternal VZV?

Answer 5

Continue breastfeeding

Give infant VZIG if peripartum VZV (consider if postpartum VZV)

Question 6

Breast abscess/mastitis?

Answer 6

Feed from other breast

Question 7

Maternal CMV (latent or active)?

Answer 7

Continue breastfeeding

• No definite association with DD or SNHL
• Likely will have transferred maternal antibodies
• CMV does reactivate postpartum in breastmilk commonly but low risk to term/preterm infants

Question 8

Which maternal antimicrobials require special caution when breastfeeding?

Answer 8

Antibiotics:

1. High dose metronidazole - d/c breastfeeding 12-24h to allow excretion of dose
2. Chloramphenicol - possible BM suppression
3. Septra, sulfisoxazole, dapsone - caution if ill/premature or neonatal jaundice/G6PD

Antiparasitics:
Primaquine, quinine - contraindicated unless normal mom and baby G6PD levels
(chloroquine, quinidine etc ok)