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    Promoting Drug Safety During Breastfeeding

    Pharmacists can help women who breastfeed by identifying the safest drugs and dosage schedules to minimize exposure.

    The American Academy of Pediatrics (AAP), and the CDC endorse exclusive breastfeeding for the first 6 months of life.1,2 Breastfed babies are less likely to experience otitis media, respiratory tract infections, asthma, and dermatitis.3 Mothers experience benefits such as accelerated recovery from childbirth and reduced rates of ovarian and breast cancer compared to women who never breastfed.3 Psychological benefits such as infant/maternal bonding are also improved with breastfeeding.3 The economic burden associated with not breastfeeding (increased direct costs of formula and indirect costs associated with disease risk) is estimated to be over $13 billion annually.1

    From the editorThe Department of Health and Human Services Healthy People 2020 objective plan promoted breastfeeding initiation as one of the priorities to improve the nation’s health.4 The CDC published a breastfeeding report card that captured the rates of meeting the 2020 targets based on 2016 data.2 Despite this strong support, persistence patterns and exclusive use of breast milk as a nutrition source require attention because half of all women who start breastfeeding have stopped by 6 months.4

    Pharmacists can help promote breastfeeding and keep women from weaning their babies too early by identifying and providing solutions to barriers that affect breastfeeding persistence.5

    There are few medical contraindications to breastfeeding, such as HIV, untreated tuberculosis, or herpes simplex virus (HSV) lesions on the breast.5 Medication contraindications include illicit drug use, antimetabolites, chemotherapy, and radioactive treatments.

    Related article: Babies Should Receive HepB Vaccine Immediately After Birth

    Some of the perceived barriers include a lack of knowledge of the benefits of breastfeeding, social norms, little family or health professional support, and lactation complications.5 Despite the positive outcomes associated with breastfeeding, patient knowledge of the benefits of nursing over formula is low.6 If education about the benefits breastfeeding is lacking, then pharmacists are well positioned to provide this education to women and their families and provide women with support so they can persist with breastfeeding for the first 12 months of their baby’s life.

    Complications of breastfeeding may influence persistence rates. Commonly reported maternal complications associated with nursing include insufficient milk supply, sore nipples or breast pain, engorged breasts, infection, and the infant improperly latching onto nipple.7,8 Poor latching can contribute to problems such as insufficient nutrition for the baby and cracked nipples, blocked milk ducts, and infections in the mother. 

    Approximately half of all mothers who initiate breastfeeding stop nursing because of insufficient milk supply, which may be due to infrequent feedings or poor technique. 

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