Most Medications OK During Breast-Feeding, Report Says: MedlinePlus

Most Medications OK During Breast-Feeding, Report Says: MedlinePlus

 

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Most Medications OK During Breast-Feeding, Report Says

Mothers may be able to take needed drugs while nursing

Monday, August 26, 2013

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MONDAY, Aug. 26 (HealthDay News) — Most breast-feeding moms can safely take the medications and vaccines they need, without fear they’ll harm a nursing infant, according to a new report from a leading group of U.S. pediatricians.
The report, from the American Academy of Pediatrics in consultation with the U.S. Food and Drug Administration, describes proposed changes to drug labels. The new labels would replace the current “Nursing Mothers” section with a heading called “Lactation,” which would give much more detailed information about a drug’s transfer to breast milk and potential to harm a breast-fed baby.
The proposed changes are part of a push by the FDA to require drug makers to study how medications may affect breast-feeding and to better communicate that information to women and their doctors.
“Because we know that breast-feeding has both developmental and health benefits for the mom and the baby, we are encouraging research in this area so physicians can make informed decisions about how best to treat their patients,” said study author Dr. Hari Cheryl Sachs, a pediatrician and leader of the pediatric and maternal health team within the FDA’s Center for Drug Evaluation and Research.
Breast-feeding advocates cheered the new report, published online Aug. 26 in the journal Pediatrics.
“The general takeaway message — that most drugs are compatible with breast-feeding, that mothers don’t have to wean to take drugs and that the labels should accurately reflect the science — is really great news and progress for breast-feeding mothers,” said Diana West, a lactation consultant and spokesperson for La Leche League International.
Most drug labels now have a blanket legal statement that cautions against taking nearly any medication while pregnant, something that irks Thomas Hale, director of the InfantRisk Center at Texas Tech University Health Sciences Center in Lubbock. Hale has been doing research on the transfer of medications to breast milk for more than 30 years. He also is the author of the book Medications and Mothers’ Milk, which has become something of a bible on the subject.
“If you pick up any package insert, you see the same language: ‘There are no data available on this drug. Do not use in breast-feeding mothers,’” Hale said.
He said he was recently invited to give a presentation to the FDA committee developing the new drug labels. The first slide he put up was a picture of the blanket caution from the label of the antidepressant drug Zoloft (sertraline).
But in the case of Zoloft and many other drugs, he said, that’s not the whole story.
Hale said 60 breast-feeding mothers who were taking Zoloft and their babies have been studied. “We knew exactly how much got into milk and it was almost nothing,” he said. And that’s just one example.
“We now know the risk of untreated depression is far, far worse than the risk of taking a drug,” he said.
The report refers women and their doctors to LactMed, a database of information on the transfer of drugs to breast milk maintained by the U.S. National Library of Medicine.
LactMed contains information on more than 450 drugs, a fraction of the roughly 3,000 unique pharmaceuticals available. That’s because other medications have not been studied in breast-feeding women.
Hale said even when specific lactation studies haven’t been done, doctors can still make educated guesses about whether a drug will pass into breast milk and whether it will harm a baby, based on the size of the molecule and other chemical properties of the drug.
Doctors also should consider the length of treatment — the risks of short-term therapy versus long-term therapy — when making a determination about drug use, the report said.
There are some clear cases where medications can harm nursing infants. Radioactive compounds that are used as contrast agents in imaging studies or in cancer treatments require at least a temporary cessation of breast-feeding, according to the report. For that reason, elective imaging procedures should be delayed until a woman is no longer nursing.
Some narcotic pain relievers, including codeine, oxycodone (Oxycontin) and propoxyphene (Darvon), have caused serious problems in breast-fed infants. For that reason, the report suggests doctors steer clear of prescribing narcotic painkillers for nursing moms. Medications such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and naproxen (Aleve) may be safer choices for pain relief.
The report also cautioned against the use of herbal products and off-label drugs — particularly metoclopramide (Reglan) — to increase breast milk production. Off-label drugs are medications used for an unapproved purpose.
Metoclopramide, a heartburn drug, boosts levels of the milk-producing hormone prolactin by blocking the brain chemical dopamine. Blocking dopamine can have a host of negative consequences for infants and new moms, including depression and thoughts of suicide.

SOURCES: Hari Cheryl Sachs, M.D., pediatrician and leader, pediatric and maternal health team, Center for Drug Evaluation and Research, U.S. Food and Drug Administration; Diana West, spokesperson, La Leche League International; Thomas Hale, R.Ph., Ph.D., professor of pediatrics, director, InfantRisk Center, Texas Tech University Health Sciences Center, Lubbock, Texas; September 2013 Pediatrics

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Mother"s Asthma During Pregnancy May Raise Child"s Health Risks: MedlinePlus

Mother’s Asthma During Pregnancy May Raise Child’s Health Risks: MedlinePlus

 

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Mother’s Asthma During Pregnancy May Raise Child’s Health Risks

Large study of Danish women followed their children up to age 6

Monday, August 5, 2013

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MONDAY, Aug. 5 (HealthDay News) — A large new study of Danish women has tied a mother’s asthma during pregnancy to a higher risk for developing a wide range of childhood diseases among her offspring.
The finding does not broadly concern all mothers who have a history of asthma, but rather those who actually experience an asthma attack while pregnant.
The observation could lead to heightened scrutiny of asthma status during pregnancy, and increased efforts to better control the condition, the researchers suggested. It may also encourage more vigilant monitoring of children who are born to mothers whose pregnancy included asthma flare-ups.
“There were previous indications that maternal asthma during pregnancy is linked to fetal development and some selected diseases in the offspring,” said study co-author Gunther Meinlschmidt. “However, we were surprised that maternal asthma during pregnancy appears to be related to such a broad range of different diseases in the offspring.”
Diseases with increased risk included infection and parasitic illness, nervous and respiratory system complications, and diseases of the ear and skin.
“Potentially” increased risks for offspring — which were not confirmed in a follow-up analysis — included digestive diseases, endocrine and metabolic disorders, and malformations.
Meinlschmidt, with the division of clinical psychology and epidemiology in the department of psychology at the University of Basel, in Switzerland, and colleagues report their observations in the September issue of Pediatrics.
To explore the impact of asthma in the context of pregnancy, the authors crunched data collected by a nationwide Danish study concerning slightly fewer than 67,000 mothers who gave birth between 1996 and 2002.
About one-quarter were smokers, most were in generally good health, and most were middle class or relatively well off.
Overall, just over 6 percent of women had struggled with an asthmatic event during their pregnancy, a figure gleaned from maternal interviews conducted three times during and six months after the pregnancy.
In turn, all the children were tracked — using statistics from the Danish National Hospital Register — for the onset of a variety of medical problems up to an average age of 6.
The result: Maternal asthma was associated with a higher risk for developing a wide array of childhood diseases among newborns. However, while the study found this association, it did not prove a cause-and-effect relationship.
So what are concerned mothers to do?
“There are different types, causes and treatments of asthma,” Meinlschmidt said, “so mothers should discuss individual strategies to reduce their asthma risk with their GPs or other health care providers, considering benefits and risks of asthma treatment for mother and offspring.”
Dr. Alan Baptist, an assistant professor and director of the University of Michigan’s asthma program in Ann Arbor, Mich., said that he was “not completely surprised” by the study findings.
“It’s mostly in line with what we currently feel, which is that uncontrolled asthma can have multiple deleterious effects on the fetus and infant. But it’s very important that this research was done so we can clarify the impact as children grow,” Baptist said.
“And the bottom line,” he continued, “is that it’s very important that asthma is kept under very good control during pregnancy. Because, in fact, for about one-third of women with asthma, their asthma actually worsens with pregnancy.”
Baptist, who was not involved with the new study, pointed out that there is a balancing act between avoiding asthma effects in the mother and protecting the unborn child.
“You always want to avoid meds when possible while pregnant because of the potential to affect the fetus,” he acknowledged. “But what has been shown over and over again is that it’s far worse to have uncontrolled asthma than any potential drug side effects,” Baptist said.
“I would also emphasize the importance of regular follow-up care for women with asthma,” he said. “That means a visit to your ob/gyn or an asthma specialist at a minimum of once a month.”

SOURCES: Gunther Meinlschmidt, Ph.D., division of clinical psychology and epidemiology, department of psychology, University of Basel, Switzerland; Alan Baptist, M.D., M.P.H., assistant professor, and director, asthma program, University of Michigan, Ann Arbor; September 2013, Pediatrics

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