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Medication in breastfeeding

Irving Zucker
Breastfeeding women are excluded from clinical trials of psychoactive drugs because of ethical concerns. Animal testing, which often is predictive of adverse effects in humans, represents the only avenue available for assessing drug safety for human offspring exposed to drugs during lactation. I determined whether behavioral outcomes for children exposed during breastfeeding to antidepressants, anxiolytics, antipsychotics, anti-seizure medications, analgesics, sedatives, and marijuana can be predicted by rodent studies of offspring exposed to drugs during lactation...
March 16, 2018: Psychopharmacology
Marina Gomes, Vera Trocado, Mariana Carlos-Alves, Diana Arteiro, Paula Pinheiro
Non-pulsatile oxytocin given during labour can negatively affect breastfeeding. The aim of this study was to assess whether intrapartum oxytocin administration has any effect on breastfeeding. Secondly, to assess whether some maternal or neonatal variables influence breastfeeding. A retrospective cohort study was done, comparing two groups: women exposed (n = 101) and not exposed to oxytocin (n = 100) during labour. Women with caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation, premature neonates and with an Apgar score <7 at 5 minutes were excluded...
March 9, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Luke E Grzeskowiak, Catherine Leggett, Lynn Costi, Claire T Roberts, Lisa H Amir
AIMS: To examine the association between late pregnancy exposure to serotonin reuptake inhibitor (SRI) antidepressants and difficulties in achieving an adequate breast milk supply in women who gave birth to preterm infants, while accounting for the potential impacts of underlying maternal psychiatric illness. METHODS: Retrospective cohort study of 3,024 women delivering liveborn preterm infants (<37 weeks' gestation) between January 2004 and December 2008. The primary outcome was postnatal domperidone use, considered a valid proxy for presence and pharmacological management of low milk supply...
March 9, 2018: British Journal of Clinical Pharmacology
Tiffany L Green, Mandar V Bodas, Heather A Jones, Saba W Masho, Nao Hagiwara
Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression...
March 8, 2018: Journal of Community Health
Adiatma Y M Siregar, Pipit Pitriyan, Dylan Walters
Background: In Indonesia, 96% of children (< 24mo) are breastfed. However, only 42% of children (< 6mo) are exclusively breastfed, as per World Health Organization recommendations. Breastfeeding provides protective benefits such as reducing the risk of morbidity and mortality associated with diarrhea and pneumonia/respiratory disease (PRD). This study estimates the potential economic impact of not breastfeeding according to recommendation in Indonesia based on infants suffering from attributable diarrhea and PRD...
2018: International Breastfeeding Journal
Elaine Setiawan, Sophia Attwells, Alan A Wilson, Romina Mizrahi, Pablo M Rusjan, Laura Miler, Cynthia Xu, Sarita Sharma, Stephen Kish, Sylvain Houle, Jeffrey H Meyer
BACKGROUND: People with major depressive disorder frequently exhibit increasing persistence of major depressive episodes. However, evidence for neuroprogression (ie, increasing brain pathology with longer duration of illness) is scarce. Microglial activation, which is an important component of neuroinflammation, is implicated in neuroprogression. We examined the relationship of translocator protein (TSPO) total distribution volume (VT ), a marker of microglial activation, with duration of untreated major depressive disorder, and with total illness duration and antidepressant exposure...
February 26, 2018: Lancet Psychiatry
Huong T T Nguyen, Cuc H Tran, Anh D Dang, Huong G T Tran, Thiem D Vu, Thach N Pham, Hoang V Nguyen, Anh N K Nguyen, Emily G Pieracci, Duong N Tran
Human rabies deaths are preventable through prompt administration of postexposure prophylaxis (PEP) with rabies immune globulin and rabies vaccine after exposure to a rabid animal (1); there are no known contraindications to receiving PEP (1,2). Despite widespread availability of PEP in Vietnam, in 2015 the Ministry of Health (MoH) received reports of pregnant and breastfeeding women with clinically diagnosed rabies. MoH investigated factors associated with these rabies cases. MoH found that, during 2015-2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeeding mothers and four in pregnant women, all of whom had been bitten by dogs...
March 2, 2018: MMWR. Morbidity and Mortality Weekly Report
Vanessa Garcia-Larsen, Despo Ierodiakonou, Katharine Jarrold, Sergio Cunha, Jennifer Chivinge, Zoe Robinson, Natalie Geoghegan, Alisha Ruparelia, Pooja Devani, Marialena Trivella, Jo Leonardi-Bee, Robert J Boyle
BACKGROUND: There is uncertainty about the influence of diet during pregnancy and infancy on a child's immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease. METHODS AND FINDINGS: Two authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease...
February 2018: PLoS Medicine
Laurence Collin-Lévesque, Yosra El-Ghaddaf, Madeleine Genest, Martin Jutras, Grégoire Leclair, Etienne Weisskopf, Alice Panchaud, Ema Ferreira
BACKGROUND: Duloxetine and methylphenidate are commonly prescribed for the management of depression and attention-deficit/hyperactivity disorder (ADHD), respectively. However, little information is available concerning their safety during lactation. The purpose of this case series was to provide additional information to the medical literature concerning infant exposure to methylphenidate and duloxetine through breast milk. METHOD: Bioanalytical method (liquid chromatography coupled to mass spectrometry) was developed and validated before its use to determine the concentrations of both medications in breast milk samples...
February 27, 2018: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
Katie Murphy, Helen Coo, Ruth Warre, Vibhuti Shah, Kimberly Dow
Background: There are no evidence-based national guidelines for managing neonatal abstinence syndrome (NAS) and surveys from other countries have demonstrated considerable variations in practice. Objective: To describe NAS management practices in Canada. Method: The directors of all Level 2 and Level 3 neonatal intensive care units (NICUs) were contacted to request their participation in a structured telephone survey. Frequency distributions were generated and associations between practice variations and unit type (Level 2 or 3) and size were examined...
June 2017: Paediatrics & Child Health
Monika Sarkar, Kate Bramham, Michael Moritz, Lisa Coscia
Fertility is commonly impaired in women with end-stage kidney and liver disease although most women will have restoration of fertility within one year of transplant. Family planning is therefore critical to discuss with reproductive-aged transplant recipients in the early post-transplant period, in order to ensure timely initiation of contraception, and optimal timing for conception. For women seeking pregnancy the risks to the mother, graft, and baby should be discussed, including evaluation of immunosuppression safety and potential for adjusting medications prior to conception...
February 15, 2018: American Journal of Transplantation
Rosa Maria Soares Madeira Domingues, Valeria Saraceni, Maria do Carmo Leal
AIMS: to estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country. METHODS: Descriptive study using data obtained from the consultation of different databases: the "Birth in Brazil" study database and the Brazilian National Information Systems (NIS) databases...
2018: PloS One
Molly R Rabinowitz, Laura R Kair, Heather L Sipsma, Carrie A Phillipi, Ilse A Larson
BACKGROUND: Breastfeeding is fundamental to maternal and child health and is the most cost-effective intervention to reduce child mortality. Pasteurized human donor milk (HDM) is increasingly provided for term newborns requiring temporary supplementation. Few studies examine maternal perspectives on supplementation of term newborns. MATERIALS AND METHODS: We conducted semistructured in-person interviews with mothers of term newborns (n = 24) during postpartum hospitalization...
February 13, 2018: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
Celia O'Hare, Diana Kuh, Rebecca Hardy
Importance: Higher resting heart rate (RHR) is associated with increased risk of cardiovascular and all-cause mortality. Limited attention has been paid to early-life determinants of life-course RHR. Objective: To describe trajectories of RHR in the same individuals from age 6 to 69 years. Design, Setting, and Participants: Data were from the Medical Research Council National Survey of Health and Development population-based cohort of individuals who were followed up from birth in 1946 until 2015...
February 12, 2018: JAMA Pediatrics
Allison C Munn, Susan D Newman, Shannon M Phillips, Martina Mueller, Sarah N Taylor
BACKGROUND: Mothers in the southeastern United States, including rural-dwelling and African American mothers, have historically had low rates of breastfeeding; however, no studies have investigated these mothers' experiences of breastfeeding support processes associated with the Baby-Friendly Hospital Initiative. Research aim: This study aimed to determine factors influencing southeastern U.S. mothers' participation in Baby-Friendly practices and breastfeeding decisions. METHODS: Using a convergent parallel mixed-methods design, medical record review of mother-infant dyads ( n = 234) provided data to determine if those who participated in more than half of the Ten Steps to Successful Breastfeeding had improved breastfeeding outcomes...
January 1, 2018: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
Nerys Benfield, Felicia Hawkins, Laurie Ray, Andrea McGowan, Ketty Floyd, Dawn Africa, Myrta Barreto, Erika Levi
OBJECTIVES: Nurses play an integral role in intrapartum and postpartum patient education. This exploratory study aims to assess the attitudes, knowledge, and practices of labor and delivery and postpartum nurses regarding contraception, and evaluate for changes in these measures one year after an institutional initiative allowing routine availability of immediate postpartum long-acting reversible contraception (LARC). STUDY DESIGN: In 2014 Montefiore Medical Center began to routinely offer comprehensive immediate postpartum contraception...
February 8, 2018: Contraception
Anne Gadomski, Moira Riley, Katherine Ramiza, Lauren Onofrey, Ruth Zinkievich, Nicole Krupa, Melissa Scribani
OBJECTIVE: Our level I nursery and pediatric unit in a rural hospital adopted a family-centered, symptom-based oral morphine weaning protocol for Neonatal Abstinence Syndrome (NAS) in 2009. Length of stay (LOS), treatment duration (TD) and hospital charges for infants treated for NAS were then compared to published data in neonatal intensive care units (NICUs) nationwide. METHODS: The electronic medical records (EMRs) of infants born 1/1/11 to 4/1/17 whose discharge diagnosis included an ICD9 or ICD10 code for NAS or prenatal drug exposure were paired with maternal EMR and reviewed...
February 8, 2018: Academic Pediatrics
Pamela Douglas, Donna Geddes
BACKGROUND: breastfeeding optimises health outcomes for both mothers and infants. Although most women want to breastfeed, they report commencing infant formula because of nipple pain, unsettled infant behaviour, and infant growth concerns. To date, existing approaches to fit and hold ('latch and positioning') have been demonstrated not to help breastfeeding outcomes, and women report widespread dissatisfaction with the quality of support and conflicting advice they receive. Breast and nipple pain, difficulty with latching and sucking, fussing at the breast, back-arching, marathon feeds, excessively frequent feeds, poor weight gain, breast refusal, and crying due to poor satiety often signal suboptimal positional instability and impaired milk transfer, but may be misdiagnosed as medical conditions...
March 2018: Midwifery
Philip O Anderson
One impediment to breastfeeding is the lack of information on the use of many drugs during lactation, especially newer ones. The principles of drug passage into breastmilk are well established, but have often not been optimally applied prospectively. Commonly used preclinical rodent models for determining drug excretion into milk are very unreliable because of marked differences in milk composition and transporters compared to those of humans. Measurement of drug concentrations in humans remains the gold standard, but computer modeling is promising...
February 6, 2018: Pharmaceutical Research
Yu-Hsuan Wu, Yen-Ju Ho, Jo-Ping Han, Shu-Yueh Chen
BACKGROUND: World Health Organization (WHO) guidelines recommend that infants should be breastfed for six month after childbirth. The average duration of breastfeeding in Taiwan still falls short of this sixth-month timeline. In order to improve the duration of breastfeeding, it is crucial to understand the factors that affect related behavior. PURPOSE: To explore the effects of breastfeeding self-efficacy and breastfeeding intention among exclusive-breastfeeding women during the initial six months after childbirth and to verify the reliability and validity of the infant feeding intentions scale (Chinese version)...
February 2018: Hu Li za Zhi the Journal of Nursing
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