Potential contraindications to breastfeeding

(i) Drugs. Most prescription and over-the-counter drugs are minimally excreted through breast milk and are pharmacokinetically benign to the infant. Illegal drugs of abuse are contra-indicated during breastfeeding (CICH, 1996). Breastfeeding is not advised for infants of mothers who are receiving long-term chemotherapy. Breastfeeding should be temporarily stopped (anywhere from 1 day to 2 weeks depending on the type of isotope used) when radioactive compounds for diagnostic or therapeutic reasons are required (Fulton and Moore, 1990). Some of the drugs that may be contraindicated during breastfeeding include bromocriptine, cyclophosphamide, cyclosporine, doxorubicin, ergotamine, lithium, methotrexate and phencyclidine (AAP Committee on Drugs, 1994). Local drug information lines are useful in keeping up to date with information on drug usage and breastfeeding (CICH, 1996).

Herbal remedies may contain pharmacologically active substances. It is recommended that they be used with caution by breastfeeding mothers (Newall et al., 1996).

  • ii) Alcohol. Mennella and Beauchamp (1991) demonstrated that significantly less breast milk was consumed by infants of mothers drinking alcohol during a 3-hour period compared to when non-alcoholic beverages were consumed. The habitual ingestion of more than a moderate amount of alcohol (> 0.5 g/kg/day, equivalent to about 2 drinks) is contraindicated during breastfeeding. The Mother Risk Program (The Hospital for Sick Children, Toronto) suggests that if several alcoholic drinks have been ingested, nursing should be postponed at least 1 hour for each drink (personal communication). It takes an adult woman (55 kg) about 1.25 hours to metabolize 10 g of alcohol. Since the average drink contains 10 g of alcohol, a recommendation to wait 1 hour after a drink is reasonable.
  • iii) Environmental contaminants. There is no current justification to warrant restriction in breastfeeding due to environmental contaminants (Rogan, 1996). Reports have continued to document accumulation of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) in breast milk (Abraham et al., 1996). Accumulation of lipid soluble environmental contaminants in breastfed infants due to relatively high daily exposure via breast milk (about 50 times higher per kg body weight than in adults) has caused concern about possible adverse health effects (Beck et al., 1994). Although there is documentation of adverse neurodevelopmental outcomes and impaired intrauterine growth associated with prenatal exposure to polychlorinated biphenyls (PCBs), at present, exposure to PCBs, PCCDs or PCDFs in breast milk has not been associated with adverse outcomes (James et al., 1993; Tilson et al., 1990; Koopman-Esseboom et al., 1996).
  • iv) Maternal infections. The role of breastfeeding in the horizontal transmission of HIV has been uncertain because of the difficulty in differentiating congenital from early postnatal infection. Transmission of HIV through breast milk was initially recognized in situations where the mother acquired the infection shortly after birth (Goldfarb, 1993). The chances of the virus being spread to the infant depended on the mother's degree of infection. A woman who is viraemic during the acute phase of the primary infection is more likely to shed viruses into her milk than if she were HIV antibody positive with an established infection (Dunn et al., 1992). The estimated risk of transmission through breast milk by a woman of high viral burden is 29% (95% C.I.: 16%-42%); by a woman who is already HIV antibody positive during the pregnancy, 14% (95% C.I.: 7%-22%) (Newell and Peckham, 1994).

When the mother is known to be HIV antibody positive, alternatives to breastfeeding are indicated. This recommendation is consistent with that of the Canadian Institute of Child Health (CICH, 1996), as well as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (AAP and ACOG, 1992). If the infant is HIV antibody positive at birth, breastfeeding would be indicated; however; currently, there are no diagnostic tools to determine HIV infection status of the newborn with an acceptable level of confidence (Goldfarb, 1993).

Tuberculosis is rarely transmitted by breast milk, but can be transmitted by exposure to sputum from an infected mother or other caretaker. Mothers with active tuberculosis should breastfeed their infants only after they are receiving adequate therapy and are considered to be non-infectious (AAP and ACOG, 1992).

Cytomegalovirus and rubella have been found in milk of infected mothers. The presence of these viruses in human milk is not considered a contraindication to breastfeeding since in the term infant they cause asymptomatic infections (Goldfarb, 1993). If present in the mother, hepatitis B is most likely to be transmitted during delivery, although it has been isolated from breast milk. For the nursing mother who acquires hepatitis while nursing, an important preventative measure for the infant is prompt immunization with the hepatitis B vaccine. Breastfeeding can then be encouraged. Although herpes simplex virus is unlikely to be shed into breast milk, breastfeeding would be contra-indicated in women who have active herpetic lesions on or near the nipple (Sullivan-Bolyai et al., 1988).

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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