FDA labelling changes for new prescription products provide more guidance to health-care professionals on the safety of medications during breastfeeding.12 The three categories added to the lactation section include risk summary and clinical considerations and data, compared to previous recommendations that cautioned against breastfeeding in conjunction with medication administration. Unfortunately, this labelling change does not affect OTC products or previously approved prescription agents. Pharmacists should become familiar with readily accessible resources available to assess medication exposure and interpret the clinical risk (Table 2).
Lactation Considerations: Nicotine and Alcohol Avoidance
Mothers who use illicit substances should not breastfeed.9 They should avoid alcohol because it may contribute to reduced milk production and also because it passes into breast milk. An occasional, small alcoholic drink is acceptable, but breastfeeding should be avoided 2 hours after consumption of any alcoholic beverage. Mothers who smoke may still breastfeed, but infant exposure to secondhand smoke should be minimized and mothers should be supported and encouraged to quit smoking.
Infant and Maternal Supplements
Prenatal vitamins may be continued during breastfeeding and are considered safe.1 Breastmilk does not contain adequate amounts of Vitamin D or iron.8 The AAP recommends that all breastfed infants receive 400 IU vitamin D daily within the first few days of life.1 Once the child reaches 1 year of age and switches to at least 1 quart of whole cow’s milk daily, vitamin D supplementation may be discontinued. Iron supplementation is recommended for full-term breastfed infants until around 6 months when solid foods are introduced. Vitamin D and iron are available in most multivitamin supplements so that a parent can synchronize doses. Pharmacists can evaluate supplementation products to support the health and development breastfed infants since most infant vitamin products are OTC.
Women who resume contraception after delivery need to consider how many weeks postpartum they are and which method of birth control they wish to use.13,14 Progestin-only products are safe for use during breastfeeding, but are safest if postponed until 6 weeks postpartum. Combined oral contraceptives containing estrogen should be avoided during the first month of breastfeeding. Estrogen can cause a decrease in milk production resulting in an inadequate supply for the infant.