Pregnancy + BF Flashcards
(42 cards)
What are the 8 benefits of breastfeeding for the baby?
- Breast milk is nutritionally tailored to meet babies needs
- Boost babies immune function – maternal hormones and immunoglobulins passed to baby to stimulate immune system
- IgA important to protect mucosal barriers and reduces incidence of ear, G.I., respiratory and UTI infections
- Reduces diarrhoea
- Iron anaemias
- reduces risk SIDs by 50%,
- Improves cognitive development
- Possible long term benefits of reduced risk of obesity, diabetes and osteoporosis
What are the 8 benefits of breastfeeding to the mother?
- Lowers blood pressure and post-partum blood loss
- Decreased risk of bone problems
- Protection against breast cancer
- Reduced risk of ovarian cancer
- Reduced risk of postmenopausal cardiovascular disease
- Improves mood
- Bonding
- Convenient, flexible and cost-effective
What are the 6 best pain killers to take while breastfeeding?
Paracetamol – Very low risk
Ibuprofen - very low risk
Diclofenac – very low risk
Tramadol – very low risk
Dihydrocodeine - low Risk
Morphine – opioid of choice - Infant monitoring required
Why is codeine not recommended during breastfeeding?
- Codeine is metabolised to Morphine via CYP2D6
- Some people will be have excess CYP2D6 and be ultra-rapid metabolizers
- New-borns have a limited capacity for opioid elimination so accumulation can easily occur
- Not practical to identify ultra-rapid metabolisers – needs to be done by genotyping and this is not readily available.
What are the recommendations around pregab + gabapentin?
Gabapentin and pregabalin are small molecules with low protein binding which enable them to pass into breast milk. Limited evidence shows only transfers in small amounts (Gabapentin estimated 1.3 to 3.8%, pregabalin estimated 7%)
Monitor side effects in baby – poor feeding, drowsiness, respiratory depression, G.I. disturbances
What are the recommendations for penicillins while breastfeeding?
- Flucloxacillin, Pen V and Amoxicillin are all ok to use – lots of evidence and experience to support use
- All acidic in nature so negligible quantities pass into milk
- Lots of these are also used for treatment in neonates
What are the recommendations for nitrofuratoin while breastfeeding?
- Excretion into breastmilk is clinically insignificant but
- Not to be used in premature infants, younger than 2 weeks of age, G6PD deficiency, jaundice – risk of neonatal haemolysis
What are the recommendations for metronidazole while breastfeeding?
- Excreted in moderate amounts (low molecular weight; low protein binding), fully orally bioavailable, short half-life, minimal risk accumulation. Ok to use short courses, monitor GI effects
- Premature or new-borns are unable to metabolize metronidazole well so use minimum effective dose or see alternative
What are the recommendations for Gentamicin while breastfeeding?
Excreted in insignificant amount
Poorly absorbed from G.I.Tract
Used in Neonates
What are the recommendations for macrolides while breastfeeding?
Erythromycin
- Excreted in negligible amounts
- Potential risk of hypertrophic pyloric stenosis – avoid in 1st month life
Clarithromycin
- Excreted in negligible amounts
- Low risk – monitor for G.I Side effects
What are the recommendations for SSRIs while breastfeeding?
Paroxetine and Sertraline are SSRI’s of choice due to shorter half-lives and pass into milk in smaller amounts compared to others
What are the recommendations for tricyclics while breastfeeding?
Imipramine and nortriptyline are TCAs of choice as less sedating and reduce risk of infant sedation
Most can be used – limited evidence shows levels are low and because TCAs undergo first-pass metabolism the actual amount available for infant to absorb are substantially less.
Long half-lives could result in accumulation and increased side-effects
What are the recommendations for anxiolytics and sleeping pills while breastfeeding?
Use short-acting benzodiazepine – Lorazepam, oxazepam
Use lowest effective dose
Excreted in milk in clinically significant amounts – risk of sedation and poor sucking in infant
Use ‘Z’ drugs for sleeping disorders – zopiclone and zolpidem – again short half-life and small amounts in breastmilk
Withdrawal effects may occur in infant
What are the recommendations for Haloperidol while breastfeeding?
Haloperidol
- Excreted in milk in variable amounts, so could be clinically significant
What are the recommendations for Olanzapine while breastfeeding?
Olanzapine
- Doses up to 20mg daily produce low levels in breast milk
- Long half-life so need to monitor for signs of accumulation – sedation, poor feeding etc.
What are the recommendations for Risperidone while breastfeeding?
- Excreted in small amounts, okay to use
What are the recommendations for Quetiapine while breastfeeding?
Quetiapine
- Excreted in clinically insignificant amounts
What are the recommendations for Lithium while breastfeeding?
Lithium
- Excreted in milk in moderate amounts which could be clinically significant
- Plasma levels in infant can reach 10% to 60% of therapeutic levels in mother
- Use with caution – regular checks on infant for signs of lithium toxicity – monitor poor feeding, poor weight gain, changes in behaviour, diarrhoea, monitoring, tremor
- Can do infant lithium levels
What are the recommendations for Methylphenidate while breastfeeding?
Methylphenidate
- Excreted in milk in clinically insignificant amounts or not at all
- No short or long term problems observed in infants exposed via breastmilk
- Monitor weight gain and irritability
What are the recommendations for heparins while breastfeeding?
Heparins
- LMWH or Unfractionated both safe to use in breastfeeding
- large molecular weight so very little getting into breast milk.
- Also inactivated in the G.I Tract so unlikely to get into infants system
What are the recommendations for warfarin while breastfeeding?
Warfarin
- Oral anticoagulant of choice in breastfeeding – Very highly protein bound so less ‘free’ drug to pass into milk
What are the recommendations for DOACs while breastfeeding?
DOAC’s
- Limited information.
- All DOAC’s may pass into breast milk
- Dabigatran is one of the largest DOAC molecule and has a large volume of distribution so would be expected to pass into breast milk in low amounts. It also has very low oral bioavailability, so infant unlikely to absorb clinically significant amounts
- Rivaroxaban, pharmacokinetic data shows large Vd and small passage in to milk
- Apixaban and Edoxaban are not recommended
- Apixaban levels in milk appear to be quite high
What must be watched for in infants while breastfeeding with anti-coagulants?
Bruising and bleeding – in vomit, urine, stools
What are the recommendations for beta-blockers while breastfeeding?
- Labetalol, metoprolol and propranolol are the beta-blockers of choice to use during breastfeeding
- Very small amounts get into milk and they have shorter half-lives to lower risk of accumulation.
- Atenolol – excreted in small to moderate amounts
- Bisoprolol – used with caution – very limited published data and has low protein binding and high oral bioavailability so suggests would be excreted into breast milk and be absorbed by infant. Half-Life 9 to 12 hours and 50% excreted in urine so potential for accumulation
