Women who are planning to be or who are pregnant, and those who wish to breastfeed, should ask their health care provider about medications, hormones, and herbs. Herbs, even if they are natural, are powerful and can affect your fetus and your breast milk just as medications can. Give them the same consideration you would drugs. For ease of discussion, drugs, herbs, and hormones are all referred to as "drugs" or "medications" in this section. In many cases, medications that may harm a fetus during pregnancy are much safer when taken during breastfeeding. That being said, you should know that a lot of experts don't know about the effects of medications on a developing fetus and on nursing infants, largely because it is not possible or ethical to test medications directly on fetuses and infants. Thus, consider these recommendations during pregnancy and breastfeeding: ● Discuss any medication with your doctor before taking it. ● Do not take any medication unless you have a sound medical reason to do so. Here are some specific precautions concerning medication use during pregnancy and breastfeeding. Consult your pharmacist or physician for additional details on these and other medications. Medication Use Before and During Pregnancy Many people believe that over-the-counter (OTC) medications are safe, and often this is true when they are taken as directed. Before and during pregnancy, however, they can be especially dangerous to your fetus and to you. Aspirin, for example, can increase the risk of bleeding for you and your fetus if you take full-strength aspirin during the last 3 months of your pregnancy. Women who take aspirin late in their pregnancy may experience a delay in the onset of labor, a decrease in the frequency and strength of their contractions, and an increase in the length of labor. For OTC medications that are safe and unsafe for you and your baby, see the accompanying list. If you plan to become pregnant and are taking prescription medications, consult your doctor before conceiving. Caffeine use during pregnancy is controversial. Caffeine is addictive and can increase heart rate, increase feelings of nervousness and anxiety, and reduce your body's ability to absorb iron. It is a diuretic, which means your body loses important nutrients (e.g., calcium, potassium, sodium, and magnesium) when you urinate. Caffeine can also cause temporary irregular heartbeat, tremors, and rapid respiration in the fetus. Some physicians strongly recommend that their patients avoid caffeine products; others say up to 3 cups per day is safe. Overall, though, caffeine has nothing positive to offer your unborn baby. Safety of OTC Medications During Pregnancy Unsafe ● Those that contain aspirin and caffeine, such as Anacin Analgesic Tablets, Excedrin Extra Strength, Vanquish Caplets, and Cope. ● Nonsteroidal anti-inflammatory drugs (NSAIDs), which are believed to have side effects similar to aspirin. These drugs include ibuprofen (e.g., Advil, Motrin, Nuprin) and naproxen (e.g., Anaprox, Naprosyn) and should be avoided during the last trimester. ● Cold medicines that contain alcohol (e.g., Nyquil). ● Nasal sprays that contain oxymetazoline, such as Afrin, Coricidin Decongestant Nasal Mist, Neo-Synephrine 12-hour nasal spray, and Vicks Sinex long-acting decongestant. ● Antacids, such as Alka-Seltzer (the type that contains aspirin) and Pepto-Bismol. Thorough testing has not been done on newer antacids, such as Tagamet, Pepcid, and Zantac. ● Sleep aids, including Sominex, Sleep-eze, and Excedrin. Generally safe ● Acetaminophen, such as Tylenol. Although acetaminophen does enter the baby's bloodstream, it is safe in recommended doses. Continued use of high doses, however, may result in birth defects. ● Antihistamines: Dramamine and Benadryl. ● Antacids: Maalox, Mylicon, Milch of Magnesia, Gelusil, di-gel, tums, and rolaids. ● Antidiarrheals: Kaopectate, Imodium A-D. ● Antifungals (for yeast infections): Gain-Lotrimin, Mycelex G, Femstat, Monistat. ● Sleep aid: Unisom, but only of uncertain use. Drug Use Before Breastfeeding If you plan to breastfeed, consider the effect any medication you take during labor and delivery may have on your infant. Anesthesia, including epidurals, passes through the placenta and enters the infant's bloodstream. Although your body may eliminate the medication within a few hours, a baby's immature system can hold on to the drug for weeks. If you receive large amounts of painkillers during delivery, they can make your baby sleepy and uninterested in nursing for a few days or longer. If you wish to breastfeed, discuss the use of painkillers with your attending physician before delivery.
Drug Use During Breastfeeding
Whenever possible, consider natural remedies instead of conventional medications first when breastfeeding (see "Reduce or eliminate infant exposure to drugs in breast milk,"). You can safely take most commonly used medications and continue nursing your baby." Dr. Egger believes that, "All too often, physicians unnecessarily ask breastfeeding mothers to tell you if they are taking any medications, for fear that the substance will hurt the baby." Although many drugs enter a mother's breast milk, not all of them have a negative effect on breastfed infants. One reason is that drug levels are typically less than 1 to 2% of the dose taken by the mother.
This doesn't mean you have free rein to take a high dose of a "safe" drug. The drugs on the list are labeled "safe" and "safe." Drugs "considered safe for nursing mothers" may be taken in recommended doses and in limited quantities where indicated. If you are breastfeeding please advise your doctor about any medications you are taking or need to take. Some medications are known to be dangerous for babies and either should not be taken while you are breastfeeding, or you should stop nursing. These include chemotherapeutic agents (used to kill cancer cells), lithium (for bipolar disease), medications that suppress the immune system, illicit drugs (e.g., marijuana, cocaine), and radioactive medications used during diagnostic scans. Drugs whose effects are unknown include antianxiety agents (e.g., Valium), antipsychotics (e.g., Thorazine), antidepressives (e.g., Prozac), and certain antibiotics (e.g., ciprofloxacin and chloramphenicol).
Nicotine interferes with milk production and may make your infant queasy. The effects of alcohol on breastfed infants continue to be debated. The latest consensus is that both binge drinking and daily consumption of one to two drinks are harmful to nursing infants. La Leche League International reports that it takes up to 13 hours for a 120-pound woman to eliminate the alcohol from one drink from her body. Dr. Marianne Neifert (Dr. Mom's Guide to Breastfeeding) recommends limiting alcohol consumption to less than 2 hours per drink and limiting alcohol consumption to two drinks per week when not breastfeeding.
Drugs considered safe for nursing mothers
• Acetaminophen (Tylenol and others)
• Acyclovir (for shingles)
• Antacids (Maalox, Tums, and others)
• Antibiotics (not all; check with physician)
• Antiepileptic drugs
• Antihypertensives (some beta-blockers are not safe; consult your physician)
• Aspirin (one to two tablets daily for a few days; ibuprofen is preferred)
• Caffeine (in moderation: Marianne Neifert, M.D., author of Dr. Mom's Guide to Breastfeeding, recommends no more than two cups of a caffeinated beverage daily)
• Cimetidine (Tagamet)
• Codeine cold and flu remedies (over-the-counter)
• Decongestants fluconazole (diflucan)
• Ibuprofen (Advil and others; use only for a few days)
• loperamide (Imodium)
• oral contraceptives (estrogens can reduce milk production; progestin-only ones have no effect)
• phenobarbital (very low doses only)
• prednisone tolbutamide (for diabetes) Vaccines
Reducing or eliminating infant exposure to drugs in breast milk
Before you reach for that laxative, cold remedy, or headache pill, consider an alternative, nondrug method to relieve your symptoms. If you're experiencing constipation, for example, add more fiber to your diet and drink at least eight glasses of water a day. Instead of a decongestant, try steam treatments with a humidifier. Many headaches can be tamed with deep breathing, ice packs, and meditation. Muscle pain often responds to cold or hot compresses or massage. The form of the medication you take affects how much of it enters your breast milk. Capsules, pills, and other ingested forms send higher levels of medications into your breast milk than lozenges, nasal drops, and gargles. Although herbal or nutritional supplements are often safer than conventional drug treatments, don't assume they won't have an effect on your infant. Always check with your doctor or pharmacist before taking any natural remedies. When you take a medication affects how much of the drug reaches your infant. Breastfeeding is recommended before you are scheduled to take the medication, as its levels in your body will be at their lowest point. You can also take a dose before your infant's longest sleep period, which gives the medication time to clear your body. Avoid sustained-release or long-acting medications (e.g., those you take every 12 hours) because they stay in your system longer.
