Breast feeding

Once an employer has been informed that an employee is pregnant the equivalent dose to a foetus should not exceed 1 mSv during the remainder of the pregnancy and significant bodily contamination of breast-feeding employees must be prevented. 

Anticoagulants History of local radiotherapy History of Keloid formation Pregnancy/breast-feeding Heavy smokers... 

Medical referral is advised if the patient is pregnant, breast-feeding, younger than 3 or older than 70 years of age, or suffers from multiple medical conditions. 

Crosses into breast Yes 35-50% of Yes ratio of concentration Yes both drug and Yes considered compatible Yes breast-feeding not... 

Lithium can cause hypotonicity and cyanosis in the neonate, usually termed the floppy baby syndrome. Most data indicate normal neurobehavioral development once these symptoms resolve. Lithium is readily transferred via breast milk. Breast-feeding is not advised for patients who are taking lithium.30... 

There are fewer data on the frequency of medication use during lactation. Use does appear to be common. A recent Dutch study reported that 53% of all breast-feeding mothers had taken a medication, herb, or supplement (exclusive of iron, vitamins, and homeopathic remedies).5 Furthermore, more women in the United States are now abiding by the recommendation to breast-feed. It is now estimated that up to 50% of United States women breast-feed for at least a short time.6... 

American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into breast milk. Pediatrics. 2001 108(3) 776-789. (Lists drugs that are considered "compatible with breast-feeding" list is periodically updated.)... 

While unnecessary medications clearly should be avoided during pregnancy or lactation, clinicians also should avoid undertreating conditions that can lead to adverse maternal, fetal, or infant outcomes. Additionally, clinicians should avoid unnecessarily discouraging breast-feeding because breast milk provides nutritional and immunologic benefit to the infant. 

Metronidazole (Flagyl) Antenatal Steroids 2 g orally once Safe during pregnancy. During lactation, temporarily stop breast-feeding for 12-24 hours. 

During lactation, azithromycin and doxycycline are first-line choices for chlamydia38 (Table 44—5). Both are deemed compatible with breast-feeding by the AAP and generally are more effective and better tolerated than erythromycin or amoxicillin.14,38... 

During lactation, all CDC first-line recommended therapies for gonorrhea (Table 44-5) are deemed compatible with breast-feeding by the AAP.14 Quinolone therapy is not recommended for women residing in California or Hawaii due to the increasing numbers of quinolone-resistant species.38... 

During lactation, acyclovir is deemed compatible with breast-feeding by the AAP even though the drug does concentrate in milk.14 No recommendation has been made regarding the safety of valacyclovir or famcyclovir during lactation. 

Advise women requiring treatment for trichomoniasis during lactation to discontinue breast-feeding for 12 to 24 hours after receiving single-dose metronidazole therapy in order to minimize risk to the infant.14 During this time, advise women to pump and discard breast milk in order to avoid engorgement. 

Treat nipple candidiasis by applying topical ketoconazole, nystatin, or miconazole to the nipples after each feeding and by administering oral nystatin drops to the breast-feeding infant12 (Table 44-5). In severe or recurrent cases, the mother may be treated with oral fluconazole.12,14 Although messy, gentian violet applied topically to both the nipples and the infant s mouth is also effective for resistant cases.12... 

Treat acute mastitis with antistaphylococcal antibiotics such as dicloxacillin or cephalexin for 10 to 14 days in order to prevent recurrent disease and breast abscess12 (Table 44-5). Penicillin-allergic women alternatively may be treated with erythromycin.12 Occasionally, intravenous antibiotics are needed for resistant, recurrent, or chronic cases. Encourage women to continue breast-feeding through acute mastitis and to empty all leftover milk from the affected breast.12... 

One year later, the female patient returns to your clinic for a routine examination. She reports that she is 8 weeks pregnant, so she has not been taking her AR medication. She is especially troubled by severe congestion but also reports rhinorrhea and sneezing. She asks you to recommend a medication that will be "safe for her baby." She also would like to breast-feed after her baby is born and wonders if any medications are safe in breast-feeding. 

What do you tell her about medication use and breast-feeding ... 

Table 4.5. OCP concentration in breast-feeding mothers in Kiev from 1981-83 [106]... 

Children are more vulnerable to lead poisoning than adults. Children are exposed to lead all through their lives. They can be exposed to lead in the womb if their mothers have lead in their bodies. Babies can swallow lead when they breast feed, or eat other foods and drink water that contains lead. Babies and children can swallow and breathe lead in dirt, dust, or sand while they play on the floor or ground. These activities make it easier for children to be exposed to lead than adults. The dirt or dust on their hands, toys, and other items may have lead particles in it. 

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