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July 12, 2000 -- As far as most doctors are concerned, "breast is best" when it comes to feeding your infant.
But nursing moms have a lot more to worry about than the rest of us in deciding on everything from what to have for breakfast to whether to take medicine for a headache. That's because at least a tiny bit of whatever they consume is transferred through their milk to their babies. So how does the enlightened mom know which substances are potentially harmful and which are not?
The good news, doctors say, is that relatively few of us take medications on a regular basis that would be harmful if passed on in small amounts in breast milk.
"I really don't know of any common over-the-counter drugs that are a problem [for breast-feeding women]," says Cheston Berlin, MD, a pediatrician at Penn State College of Medicine, in Hershey. "That includes antacids, common cold remedies, and laxatives. They are all safe when used in suggested doses." Other medications considered safe include pain relievers and anti-inflammatories like Tylenol, Advil, and Motrin, as well as some antibiotics.
But women who need to take prescription medications to control conditions such as depression, epilepsy, or high blood pressure may be told to either stop breast-feeding or wait until they've weaned their babies before starting a drug regimen, says Shinya Ito, MD, of the Hospital for Sick Children in Toronto.
"Physicians have to be careful when they prescribe drugs to women, although people tend to be overcautious in these situations," Ito tells WebMD. "For some drugs, can safely take those drugs and continue breast-feeding."
In a review article published in The New England Journal of Medicine, Ito writes that one area of controversy is antidepressants like Prozac and Zoloft, given for postpartum depression. Experts typically urge caution in using these drugs and worry about how much of the drug gets passed on to the nursing baby.
Ito points out that of six studies involving a total of 19 women on Prozac, the drug affected weight gain slightly in their babies, but no other symptoms were reported. In two studies of Zoloft, none of 36 nursing infants whose moms took the drug had any adverse effects. Still, experts say, more studies of these drugs are needed to conclusively rule out any harm to infants.
Some heart medications and drugs to control high blood pressure can show up in substantial amounts in breast milk and should be used with caution, but they don't necessarily have to be avoided if the mother needs them. Ito says the infant's blood levels should be measured if the nursing mother is taking these drugs.
Drugs for epilepsy are another area of concern, because women with epilepsy need them to prevent seizures during which they could injure themselves or their babies. Some epilepsy drugs may transfer as much as 100% of the dose to the baby and should not be taken by nursing mothers. But others have been found only in levels of 3-5% of the dose in breast milk, and these are considered better alternatives for breast-feeding women, Ito says.
In his review, he also discusses the recent literature on cocaine and marijuana for nursing women, as well as caffeine, alcohol, and nicotine. Ito says alcohol and nicotine have both been shown to decrease milk volume and the baby's intake and should be avoided. In addition, he says, a mother's caffeine consumption can cause irritability in her baby, although studies show that the amount transferred through breast milk can vary widely.
Berlin agrees that, although excessive caffeine consumption should be discouraged, women should know that "it's OK to enjoy a cup of coffee."
In addition to drugs, Berlin says he is concerned about the herbal medications and other products that are becoming increasingly popular.
"I don't think nursing mothers should take these because the composition of them are totally unknown, and it would be very prudent to avoid those completely," he tells WebMD.
And, most important, if you have a question or are uncertain about a drug or other substance you wish to take, "definitely talk to your doctor," he says.
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