Lecture 9 - Prescribing in breastfeeding

Question 1

Name the advantages of breastfeeding to the baby

Answer 1

Boosts babies immune function - maternal hormones and immunoglobulins passed to baby to stimulate the immune system
IgA is important to protect the mucosal barriers and reduces the incidence if ear, GI, respiratory and UTI infections
Reducing incidence of diarrhoea, iron related anaemias and adult osteoporosis
Improves cognitive development
Possible long-term benefits of reduced risk of adult obesity, adult diabetes and adult osteoporosis

Question 2

Name the advantages of breastfeeding to the mother

Answer 2

Protection against breast cancer
possible reduced risk of ovarian cancer
improves mood
bonding with baby
convenient, flexible and cost-effective
decreased risk hip fracture, osteoporosis and RhA
lowers BP and reduced blood loss post-partum
reduced risk of postmenopausal CVD disease

Question 3

What information should you gather before making a decision about a medication during breastfeeding?

Answer 3

Think risk vs benefit
Maternal information, what medications is the mother taking - dose, route, frequency, duration of treatment and medical history

baby information:
- gestation at birth
- any renal/liver dysfunction
- prescribed any medications themselves
- exclusively breastfeeding

Question 4

Name the top resources of prescribing in breastfeeding

Answer 4

BNF
SPC
E-lactancia
Lactmed
BNF/BNFc => generally over cautious and lack of all available information

Question 5

What factors should you consider for medication safety in breastfeeding?

Answer 5

maternal plasma conc
bioavailability
drug properties - acid-base balance, protein binding capacity, fat solubility, MW and half-life
milk is slightly acidic - could get accumulation of weak base drugs, weakly acidic drugs tend not to accumulate. Only free drug passes into milk, lipophilic drugs are more likely to dissolve in milk and therefore more passed into milk
Metabolism and elimination
do we use the medications in babies