Lactation/Breastfeeding Flashcards
Current breastfeeding recommendations
- Babies should be exclusively breastfed for the first 6 months
- Breastfeeding in combination with the introduction of complementary foods until at least 12 months
- Continuation of breastfeeding as long as mutually desired by mom and baby
Barriers to breastfeeding
- Lack of experience or understanding among family members on how to support mothers and babies
- Not enough opportunities to communicate with other breastfeeding mothers
- Lack of up-to-date information and instruction from HCPs
- Lack of accommodation to breastfeed to express milk at the workplace or in public areas
- Racial disparities
Risk medications could have on a breastfeeding mother and/or child
What the infant receives in the breastmilk of the medication is totally different than what the mom takes in; the amount that’s been changed in the liver and kidneys depends on the infant’s age and how much is excreted
Protein binding on medication transfer into breastmilk
Low-bound drugs transfer in higher amounts
MW on medication transfer into breastmilk
Low MW drugs (8000-10000Da) passively diffuse into breastmilk
Lipid solubility/corresponding fat content of milk on medication transfer into breastmilk
Higher lipid solubility of drugs also increases likelihood of transfer
Maternal plasma concentration on medication transfer into breastmilk
Higher the concentration of the drug in the mother’s serum, the higher the concentration will be in the breast milk
Half-life on medication transfer into breastmilk
Drugs with longer half-lives are more likely to maintain higher levels in breast milk
pH on medication transfer into breastmilk
Weak bases can easily transfer to breast milk
What doesn’t RID tell you?
How safe the medication is in breastfeeding
What RID is considered safer in breastfeeding?
<10%
RID not considered safe in breastfeeding
> 25%
Factors that influence a breastfed infant’s exposure to medications
Frequency of feedings, amount of milk ingested, drugs unstable in gastric acid are less likely to be absorbed by infants, infants may vary in their ability to metabolize and excrete ingested medications
How to reduce risk to the infant
- Select medications safe to use in infants: drugs with shorter half-lives accumulate less, drugs that are more protein-bound, drugs with lower bioavailability and lower lipid solubility
- Take once-daily medication before the infant’s longest sleep period
- Take multiple-dose medications immediately after breastfeeding
- For short-term drug therapy, the mother can pump and dump milk to preserve milk-producing capability
Risks of pumping or stopping breastfeeding for the mother and/or child
It can get rid of her milk-producing capability or at least diminish it greatly; doing this may not be necessary so use clinical judgment
