Breastfeeding and Women Who Abuse Drugs

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Should women who abuse drugs breastfeed their babies? In an ideal world, women would completely avoid drug use while they breastfeed, but the reality is somewhat different. Various Spanish researchers have outlined recommendations for women to follow in the journal Analytical and Bioanalytical Chemistry.

The general recommendation for women to totally avoid the use of drugs while breastfeeding extends to both the prenatal and postnatal periods, says Oscar Garcia Algar, co-author of the study and a physician in the Paediatrics Department at the Hospital del Mar in Barcelona. During the prenatal period, the drugs pass to the fetus through the placenta, and in the postnatal period they come from the environment and breastmilk.

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In the study, the research team used the average daily intake of a breastfeeding infant, which is about 150 milliliters of milk per kilo (2.2 lbs) of weight. They also considered the recommendations of the American Academy of Pediatrics for each substance studied.

  • Breast milk of mothers who smoke contains 2 to 240 nanograms of nicotine per milliliter, which means the infants receive 0.3 to 36 micrograms/kg/day. Infants of smoking mothers experience more colic and are more prone to respiratory infections. Women are urged to stop smoking during pregnancy and breastfeeding, or to at least limit their smoking, use nicotine patches, smoke outside the house, and avoid smoky environment.
  • Caffeine has a long half-life in infants, and thus women who consume caffeine are asked to reduce consumption during breastfeeding to no more than 300 mg/day, which is about three cups of coffee daily.
  • No studies have correlated the dose of alcohol and the risk to breastfeeding infants. Therefore the researchers in this study state that no amount of alcohol is safe until the levels in breast milk are established. Alcoholic mothers are advised to feed their infants with a bottle. Some studies indicate that alcohol can harm an infant’s motor development, disrupt sleep patterns, and increase the risk of hypoglycemia. The risks of alcohol use during pregnancy are already known.
  • Marijuana can be transmitted to infants through breast milk and via smoke, and it can cause lethargy, weakness, poor feeding habits, and sedation in breastfeeding babies. Women are advised not to use marijuana while breastfeeding, but if they use it occasionally, they should do so several hours before breastfeeding and never expose their infants to the smoke.
  • Cocaine use while breastfeeding should be avoided completely. The researchers noted a case of toxicity in a two-week-old infant who suffered trembling, dilated pupils, tachycardia, high blood pressure, and irritability after breastfeeding.
  • Mothers who use heroin should not breastfeed because the drug is excreted into the breast milk in amounts that can cause addiction in the baby. The authors note that in the case of “need,” they advise women to allow at least one or two days to pass after taking the drug before they breastfeed and to begin methadone or other substitute treatment as soon as possible.
  • Use of amphetamines can cause agitation, lack of sleep, and crying in infants who breastfeed. Women should not breastfeed if they are taking these drugs.
  • Opiates that are prescribed as medications, such as morphine, codeine, and meperidine, are passed into breast milk in minimal amounts, as are benzodiazepines. Breastfeeding women who are taking these drugs should follow their physician’s guidelines.
  • Antidepressants and antipsychotic drugs, according to the American Academy of Pediatrics, “can be a cause for concern during breastfeeding,” and their effects on breastfeeding infants are not yet known.

Ideally, women who are breastfeeding and who abuse drugs should stop doing one or the other. For the benefit of both the infant and the mother, stopping the drug abuse is the preferred approach. Barring that, the authors of the current study have set forth some guidelines for breastfeeding women who abuse drugs.

SOURCE:
Friguls B et al. Analytical and Bioanalytical Chemistry 2010 June; 397(3): 1157-79

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