Avoiding risk at what cost? Putting use of medicines for breastfeeding women into perspective

International Breastfeeding Journal

Susan E Jordan¹  Kath M Ryan²  Lisa H Amir³ 

[1] Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK;School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia;Mother & Child Health Research, La Trobe University, Melbourne, VIC, Australia

关键词: Postpartum;    Maternal health;    Risk;    Side-effect;    Medication;    Lactation;    Breastfeeding;   

Others  :  801347
DOI  :  10.1186/1746-4358-7-14

 received in 2012-09-27, accepted in 2012-10-15,  发布年份 2012

【 摘 要 】

Breastfeeding women often need to take medicines, and therefore health professionals need to consider the effects of medication on lactation and the breastfed infant, and any associated risks. This commentary discusses the tragic case of a young woman with a history of mental illness who committed suicide in the postpartum period. She was determined to be a 'good mother' and breastfeed, and to avoid any potential adverse effects of medication on her breastfed infant. The final outcome was fatal for both mother and child. We argue that if women require medication during lactation, all risks need to be considered – the risk of not treating the maternal medical condition may greatly outweigh the potential risk to the breastfed infant.

【 授权许可】

   
2012 Amir et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Emson D: Obitury: Daksha Emson: Formerly Specialist Registrar community and rehabilitation psychiatrist Oxleas NHS Trust, died tragically 27 October 2000. Psychiatrist 2004, 28:152.
• [2]Garelick AI: Doctors’ health: stigma and the professional discomfort in seeking help. Psychiatrist 2012, 36:81-84.
• [3]Report of an independent inquiry into the care and treatment of Daksha Emson M.B.B.S., MRCPsych, MSc. and her daughter Freya. NHS, North East London; 2003.
• [4]Committee on Drugs, American Academy of Pediatrics: The transfer of drugs and other chemicals into human milk. Pediatrics 1994, 93(1):137-150.
• [5]Austin M-P, Highet N, Guidelines Expert Advisory Committee: Clinical Practice Guidelines for Depression and Related Disorders - Anxiety, Bipolar Disorder and Puerperal Psychosis - in the Perinatal Periodcp A Guideline for Primary Care Professionals. I. beyondblue: the national depression initiative, Melbourne; 2011.
• [6]Viguera AC, Newport DJ, Ritchie J, Stowe Z, Whitfield T, Mogielnicki J, Baldessarini RJ, Zurick A, Cohen LS: Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry 2007, 164(2):342-345.
• [7]Moretti ME, Koren G, Verjee Z, Ito S: Monitoring lithium in breast milk: an individualized approach for breast-feeding mothers. Ther Drug Monit 2003, 25(3):364-366.
• [8]Bogen DL, Sit D, Genovese A, Wisner KL: Three cases of lithium exposure and exclusive breastfeeding. Arch Womens Ment Health 2012, 15(1):69-72.
• [9]McDonald K, Amir LH, Davey M-A: Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. BMC Publ Health 2011, 11(Suppl 5):S5. BioMed Central Full Text
• [10]Ugarriza DN: Postpartum depressed women's explanation of depression. J Nurs Scholarsh 2002, 34(3):227-233.
• [11]Boath E, Bradley E, Henshaw C: Women's views of antidepressants in the treatment of postnatal depression. J Psychosom Obstet Gynaecol 2004, 25(3–4):221-233.
• [12]Schirm E, Schwagermann MP, Tobi H, den Berg LT d J-v: Drug use during breastfeeding. A survey from the Netherlands. Eur J Clin Nutr 2004, 58(2):386-390.
• [13]Matheson I, Kristensen K, Lunde PKM: Drug utilization in breast-feeding women. A survey in Oslo. Eur J Clin Pharmacol 1990, 38:453-459.
• [14]Gendron MP, Martin B, Oraichi D, Berard A: Health care providers' requests to Teratogen Information Services on medication use during pregnancy and lactation. Eur J Clin Pharmacol 2009, 65(5):523-531.
• [15]Chaves RG, Lamounier JA, César CC: Self-medication in nursing mothers and its influence on the duration of breastfeeding. J Pediatr (Rio J) 2009, 85(2):129-134.
• [16]Friguls B, Joya X, Garcia-Algar O, Pallas CR, Vall O, Pichini S: A comprehensive review of assay methods to determine drugs in breast milk and the safety of breastfeeding when taking drugs. Anal Bioanal Chem 2010, 397(3):1157-1179.
• [17]Menon SJ: Psychotropic medication during pregnancy and lactation. Arch Gynecol Obstet 2008, 277(1):1-13.
• [18]Chaves RG, Lamounier JA, Cesar CC: Association between duration of breastfeeding and drug therapy. Asian Pac J Trop Dis 2011, 1(3):216-221.
• [19]Amir LH: Medicines and breastfeeding: information is available on safe use (Letter). Med J Aust 2007, 186(9):485.
• [20]Drugs and Lactation Database (LactMed). http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT webcite
• [21]Perinatal Psychotropic Medicine Information Service (PPMIS). http://www.ppmis.org.au/ webcite
• [22]Hale T: Medications and Mothers' Milk. 13th edition. Hale Publishing L. P, Amarillo, Texas; 2008.
• [23]Koren G: Medication Safety in Pregnancy & Breastfeeding: The Evidence-Based A-to-Z Clinician's Pocket Guide. McGraw Hill, New York; 2007.
• [24]Loke YC: Pregnancy and Breastfeeding Medicines Guide. The Royal Women's Hospital, Pharmacy Department, Melbourne, Australia; 2010.
• [25]Lawrence R, Schaefer C: General commentary on drug therapy and drug risk during lactation. In Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment. 2nd edition. Edited by Schaefer C, Peters P, Miller RK. Elsevier, London; 2007:609-620.
• [26]Pearlstein T, Howard M, Salisbury A, Zlotnick C: Postpartum depression. Am J Obstet Gynecol 2009, 200(4):357-364.
• [27]di Scalea TL, Wisner KL: Pharmacotherapy of postpartum depression. Expert Opin Pharmacother 2009, 10(16):2593-2607.
• [28]Hale TW, Kendall-Tackett K, Cong Z, Votta R, McCurdy F: Discontinuation syndrome in newborns whose mothers took antidepressants while pregnant or breastfeeding. Breastfeed Med 2010, 5(6):283-288.