Literature review for - Flourish Paediatrics

The Merck Manual online version also includes a table of drugs contraindicated in
breastfeeding. ( http://www.merck.com/mmhe/sec22/ch259/ch259a.html)
Postnatal Depression
As discussed in the section on Postnatal Breastfeeding, depression occurs postnatally in
approximately 10-15% of mothers. The more severe cases require treatment with antidepressants
(Academy of Breastfeeding Medicine 2008). “Data from a recent meta-analysis
indicated that all antidepressants were detected in breastmilk but not all were found in infant
serum (Weissman, Levy et al. 2004). Infant serum levels of nortriptyline, paroxetine, and
sertraline were undetectable in most cases. Infant serum levels of citalopram and fluoxetine
exceeded the recommended 10% maternal level in 17% and 22% of cases, respectively. Few
adverse outcomes are reported for any of the antidepressants. There were an insufficient
number of cases for all other antidepressants to make conclusions.”
Drugs of Dependence
The use of drugs of dependency is a difficult problem during lactation (Jansson, Bunik et al.
2009). The WHO Guidelines on Acceptable use of Breastmilk substitutes gives the
following guidance on Substance use (WHO 2009):
-“ maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants
has been demonstrated to have harmful effects on breastfed babies;
- alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and
the baby.
Mothers should be encouraged not to use these substances, and given opportunities and
support to abstain.”
Alcohol
Mothers who drink alcohol have a shorter duration of breastfeeding (Giglia and Binns 2006;
Giglia, Binns et al. 2008). Advice to mothers who are breastfeeding is available in a
pamphlet from the Alcohol Education and Research Foundation (Giglia and Binns 2006)
The Australian categorisation of the risk of drug use in pregnancy is as follows:
• Category A—drugs that have been taken by a large number of pregnant women and women
of child-bearing age and for which no proven increase in the frequency of malformations or
other direct or indirect harmful effects on the foetus has been observed
318