(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).
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).
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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.