Human milk provides valuable nutrition for infants.
People may require medications post-partum during lactation which may impact milk production, quality or pose infant safety risks.
One of the most commonly reported barriers to breastfeeding is the lack of data on the safety of medications used during lactation.
We studied the use of medications during breastfeeding in more than 3500 moms and babies. We found that moms who were breastfeeding were more likely to be taking prescription medications than women who were not breastfeeding.
The most common medication? Domperidone, of course! Domperidone is a medication that is frequently prescribed off-label to increase milk production.
Thank-you to the Rady Innovation Fund for supporting our work. The open access publication of this work will be posted once available.
Past Events
Dr. Kelly participated in a Cafe Scientifique at McNally Robinson on February 5th, 2020. She had the opportunity to share some of our work on medications used during breastfeeding and helped Drs. Azad and Nickel launch the Manitoba Interdisciplinary Lactation Centre (MILC).
In February 2020, we hosted a community event for mothers who wanted to share their experiences and views on breastfeeding. In order to conduct patient oriented research we need to engage with those who are going to participate in the research and with those who are going to benefit most from the research results. We asked mothers how they prefer to be engaged in research, what they would need to know before participating in research, how data collection should be done and what outcomes are important to them. What we learnt will be incorporated into our study design and we are hoping to further engage with interested mothers as we develop and pilot prospective breastmilk collection methods.
Publications
2024
The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study International Breastfeeding Journal, 08 April 2024
Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation.
Methods: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use.
Results: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum.
Conclusions: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.
2021
Messaging and methodological considerations when researching breastfeeding and obesity European Journal of Clinical Nutrition, 25 September 2020
2012
Neonatal Benzodiazepines Exposure during Breastfeeding The Journal of Pediatrics, September 2012
Objective: To assess central nervous system depression and other adverse effects in infants exposed to benzodiazepines through breast milk.
Study design: A prospectively recruited, retrospectively assessed cohort study of mothers who contacted the Motherisk program regarding the safety of benzodiazepines and were invited to participate in a follow-up program regarding the effects of these medications on their infants during lactation.
Results: A total of 124 consenting women participated. Adverse outcomes, specifically sedation, was identified in only 1.6% (2 of 124) of infants and was not associated with benzodiazepine dose, number of hours breastfed, or any demographic trait. Mothers reporting adverse outcomes in themselves (26% [32 of 124]) were more likely to be taking concomitantly a greater number of central nervous system depressants.
Conclusions: This study supports the continued recommendation to initiate breastfeeding while taking benzodiazepines postpartum.