Medications in human milk
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Date
2022-03-31
Authors
Yakandawala, Uma
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Abstract
Many people require the use of medications during lactation to treat acute or chronic health conditions. One identified barrier to continued breastfeeding is medication use due to concerns of drug exposure risks to the infant through milk. Currently, there are no consistent and standardized practices for the collection and drug analysis in human milk. This thesis consists of two complementary studies.
In the first study, a systematic review was conducted to understand collection methods and analytical techniques used to study medications in human milk. The systematic review included 224 studies on 186 medications belonging to 46 different therapeutic categories. The five therapeutic categories most reported include antidepressants (N=58), anti-retroviral agents (N=43), antibiotics (N=16), non-steroidal anti-inflammatory drugs (N=14), and opioids (N=14). The most used sampling method was multiple collection time points within a 24-hour period (N=55,24.6%). There were 45 different assay methods used, the most common being high-performance liquid chromatography (HPLC) used in a third of the studies (N=74,33.0%).
The second study used a mixed-methods research design to understand parents’ and healthcare providers (HCP) preferences, decision-making and knowledge around medication use during lactation. A scoping review was conducted to inform the design of the survey study. There were 149 parents and 47 HCP participants. The majority of the parents in this study used medication during postpartum (N=138/146,94.5%). Over half (N=68/124,54.8%) of the parents found decision-making on medication use while nursing to be difficult and very few parents felt certain about what to do when making decisions (N=11/124,8.8%). Parents ranked the leading factor impeding decision-making to be lacking information about options, benefits, and risks of medications. HCPs listed their professional training on medication use during lactation as below average (N=9/29,31.0%) and extremely poor (N=9/29,31.0%). HCPs stated reliable resources, improved patient resources, more education on medication safety would help better support parents’ decision-making.
Results from the studies have identified medications of interest, that can be used to develop standardized protocols for future prospective studies. Future studies could focus on assessing decisional needs around commonly used medications by postpartum parents to develop a decision aid that can be used in clinical practice.
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Keywords
human milk, breastmilk, medication, breastfeeding, drug, lactation