Never Say ‘Never’ to Medication Use in Breastfeeding Women

To breastfeed or not to breastfeed, that is often the question women ask themselves about taking medications during lactation, particularly when it involves substances such as methadone and buprenorphine. Debra L. Bogen, MD, FAAP, FABM, will shed light on what to advise these women when she presents Course 3, “Breastfeeding and Margaritas, Marijuana, Methadone, and More,” from 2:30 to 4:30 pm today in Continental C, on the lobby level of the Hilton Chicago.

“Physicians are often ill-equipped to answer questions about whether it is OK for women to breastfeed while taking these medications, and there is a lot of misinformation out there,” said Dr. Bogen, Associate Professor of Pediatrics, Psychiatry, and Clinical and Translational Sciences, the University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC.

Approximately 80 percent of women who breastfeed take at least one medication. Some women will choose to stop breastfeeding to take medications while others will forego treatment to breastfeed, she said. The 6-8 percent of American women prescribed antidepressants during pregnancy face this decision. Study findings show that women taking antidepressants are more likely to select formula to feed despite evidence that for most antidepressants, the transfer of drug into breast milk is very low.

During the course, Dr. Bogen will review lactation pharmacology and provide resources to review when facing questions about medications or other substance use during lactation. Medications and substances she will address specifically are tobacco, methadone, buprenorphine, cannabis, and antidepressants. Her goal is to emphasize the importance of breastfeeding for the health of mothers and children, and how to support the breastfeeding decision-making process among women taking medications or those with substance-use disorders.

When asked if women taking methadone can breastfeed, Dr. Bogen said, “It depends where they are in their treatment. If they have been adherent to their drug treatment program and they have no other contraindications to breastfeeding, then women taking methadone should be supported to breastfeed.” Evidence shows that women who were prescribed methadone or buprenorphine can breastfeed their infants, she said.

The American Academy of Pediatrics indicates that women who smoke can breastfeed, although these mothers are encouraged to smoke as little as possible during lactation. However, cocaine, methamphetamine, and heroin use by the breastfeeding mother is as dangerous to the infant as it is to her.

“Physicians should make breastfeeding and medication choices part of their repertoire when they talk to women who are pregnant,” Dr. Bogen said. “Women often assume they can’t breastfeed if they are taking medications if no one talks to them about it.”

She recommends that physicians be proactive and take the first step in raising these issues.

“I am hoping to increase the number of providers who will give thoughtful comments to their patients and not just give a knee-jerk response such as ‘no medications with breastfeeding’ or ‘don’t breastfeed,’” Dr. Bogen said. “When they understand the benefits of breastfeeding for the mother and the child, they should understand that it is important to raise the issue with their patients and have an open and educated conversation about it.”