Thomas W. Hale

Use of nicotine patches in breast‐feeding mothers: Transfer of nicotine and cotinine into human milk

Our objective was to assess the extent of exposure to nicotine and cotinine in breast‐fed infants during maternal smoking and later during maternal use of the nicotine transdermal patch to achieve smoking cessation.

The use of antidepressants in pregnant and breastfeeding women: a review of recent studies.

Antidepressants are one of the most commonly prescribed medications for pregnant and lactating women. However, there have been some recent concerns about their safety. This article summarizes recent research on the impact of untreated depression on the baby, the effects of antidepressants on the baby when prescribed during pregnancy, the short- and longer-term effects of prenatal exposure on infants and children, and the passage of medications into breast milk. Recommendations are made on providing mothers and their health care providers with information so they can make accurate risk/benefit analyses about using these medications while pregnant or breastfeeding.

Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers' Sleep and Fatigue

The controversy around mother–infant bedsharing continues to grow. In order to make sound policy recommendations, policy makers need current data on where infants sleep and how families handle nighttime feedings. The present study is a survey of 4,789 mothers of infants 0–12 months of age in the U.S. The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Recommendations for promoting safe infant sleep are made.

The Absence of Candida albicans in Milk Samples of Women with Clinical Symptoms of Ductal Candidiasis

OBJECTIVE The objective of this prospective study was to determine if Candida albicans is present in the milk of women suffering from symptoms of severe nipple and deep breast pain. STUDY DESIGN The symptomatic group included women who reported sore, inflamed, or traumatized nipples or intense stabbing or burning pain. The control group included breastfeeding women without symptoms. The skin of the nipple and areola were washed with detergent and thoroughly rinsed. Milk samples were analyzed for (1 --> 3)-beta-D-glucan and grown on Candida growth medium. RESULTS There was no significant difference in (1 --> 3)-beta-D-glucan levels between the control and symptomatic group. No Candida species were culturable either before or after the addition of iron to stimulate growth, with the exception of one patient. The addition of pure C. albicans to milk samples suggested that milk does not inhibit Candida growth. CONCLUSION These data suggest that C. albicans is not present in milk ducts and may not be associated with this syndrome.

ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

The Effect of Feeding Method on Sleep Duration, Maternal Well-being, and Postpartum Depression

When a breastfeeding mother is depressed--or even at risk for depression--she is often advised to supplement with formula so that she can get more sleep. Results of recent studies suggest, however, that exclusively breastfeeding mothers actually get more sleep than their mixed- or formula-feeding counterparts. The present study examines the relationship between feeding method, maternal well-being, and postpartum depression in a sample of 6,410 mothers of infants 0-12 months of age. Our findings revealed that women who were breastfeeding reported significantly more hours of sleep, better physical health, more energy, and lower rates of depression than mixed- or formula-feeding mothers. Further, there were no significant differences on any measure between mixed- and formula-feeding mothers, suggesting that breastfeeding is a qualitatively different experience than even mixed feeding.

Transfer of interferon alfa into human breast milk.

Originally assumed to be antiviral substances, the efficacy of interferons in a number of pathologies, including malignancies, multiple sclerosis, and other immune syndromes, is increasingly recognized. This study provides data on the transfer of interferon alfa (2B) into human milk of a patient receiving massive intravenous doses for the treatment of malignant melanoma. Following an intravenous dose of 30 million IU, the amount of interferon transferred into human milk was only slightly elevated (1551 IU/mL) when compared to control milk (1249 IU/mL). These data suggest that even following enormous doses, interferon is probably too large in molecular weight to transfer into human milk in clinically relevant amounts.

Transfer of Interferon β-1a into Human Breastmilk

AIM This study determined the transfer of intramuscular interferon β-1a into human milk and provides an estimate of infant exposure to this antiviral in six women chronically receiving intramuscular interferon β-1a (Avonex(®), Biogen Idec, Research Triangle Park, NC). METHODS Interferon β-1a was measured at various times at steady state in milk samples collected from women receiving interferon β-1a at 30 μg/week. RESULTS Average milk concentrations were 46.7, 97.4, 66.4, 77.5, 103.1, 108.3, 124, and 87.9 pg/mL at 0, 1, 4, 8, 12, 24, 48, and 72 hours, respectively, after dosing. Using the highest value measured (179 pg/mL), the estimated relative infant dose would be 0.006% of the maternal dose. CONCLUSIONS These data clearly suggest that interferon β-1a does not penetrate the milk compartment significantly and that levels in milk are far subclinical. No side effects were noted in any of the breastfed infants.

Transfer of Natalizumab into Breast Milk in a Mother with Multiple Sclerosis

Natalizumab (Tysabri) is a recombinant humanized antibody to α4-integrin that is approved by the Food and Drug Administration for the treatment of multiple sclerosis (MS) and Crohn disease. This is a case report of a 28-year-old woman with MS who was taking natalizumab (300 mg intravenously infused over 1 hour every 4 weeks) while breastfeeding her 11.5-month-old daughter 3 times a day. Breast milk samples were collected over a 50-day period after the patient’s first drug infusion. The average concentration of natalizumab was 0.93 µg/mL/d, and the relative infant dose was 1.74% of the weight-adjusted maternal dose. Transfer of natalizumab into human milk increased over time and with subsequent injections, with the highest concentration of 2.83 µg/mL at day 50 with a relative infant dose of 5.3%. Because these data suggest continued accumulation of natalizumab in milk, and because we cannot provide an accurate assessment of levels of this drug at 24 weeks (steady state), we are unable to determine safety at this time.

Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis.

High-dose intravenous methylprednisolone, a glucocorticoid with powerful anti-inflammatory activities, has become increasingly important in treating acute relapses of multiple sclerosis (MS). This is a case report of a 36-year-old lactating female who was receiving a 3-day course of high-dose methylprednisolone (1000 mg IV) to treat MS. Breast milk samples were obtained at 1, 2, 4, 8, and 12 hours following a 2-hour intravenous infusion on days 1, 2, and 3. The relative infant dose was found to be 1.45%, 1.35%, and 1.15% for days 1, 2, and 3, respectively. Using the average measured concentrations (Cavg) for days 1, 2, and 3, the estimated infant exposure was 0.207, 0.194, and 0.164 mg/kg/day, respectively, which is below the recommended dose given to neonates requiring methylprednisolone drug therapy. Infant exposure is low and mothers could continue to breastfeed if treatment with IV methylprednisolone is very brief. However, if the mother wishes to limit infant exposure further, she could wait 2 to 4 hours after IV methylprednisolone administration, thus significantly limiting the amount of drug in the breast milk.