Medications in Pregnancy and Breastfeeding

As I was working on my “Preparing for a Healthy Pregnancy” podcast, I realized medications (aka medicines or prescriptions) in pregnancy and breastfeeding (aka lactation) definitely deserved their own post with links (scroll straight down for those!) and more explanation (read on, my friend!).

Why do medications deserve so much attention?

When grown adults take a medication, we usually do it to help our bodies make up for something that’s missing, or to interfere with some process in our bodies that’s not working quite right. When a woman is pregnant, she is suddenly two bodies! Her own, of course, plus the little body growing inside her. They are connected, but also independent. Some medications* that a pregnant woman may take pass will pass to her baby; some of those medications can actually cause harm to the growing baby. If a woman breastfeeds, medication passed in breastmilk can also be a problem. The liver and kidneys (which clear medications out of the body) of a fetus/newborn are not as mature as those of an adult, or even an older child. Because of this, medications can build up to higher levels in their blood and cause side effects that would be unusual or more significant than in an adult.

*Due to some fancy stuff about chemical solubility and molecular size, not every medication can pass through the placenta to a fetus, or through a woman’s body into breastmilk.

Wait…so probably I shouldn’t take any medication at all, right?

Not necessarily! A healthy mother is better suited to grow a healthy baby. Both physical and mental health make a difference! Poor health in a mother is often connected to pregnancy complications. There are many cases where a women definitely should stay on her medications throughout pregnancy and breastfeeding. On the flip side, there are some medications that absolutely must be avoided for a woman to become pregnant and carry a pregnancy. Then, of course, there’s the gray area in the middle, where the pros and cons of continuing or stopping a medication need to be weighed. Which trimester of pregnancy a woman is in makes a difference, as well as how old a breastfeeding baby is. In summary – it’s not simple!

Are all medications that are safe in pregnancy also safe in breastfeeding, and vice versa?

Interestingly, no. There is significant overlap, for sure. As a general rule, a medication that is safe in pregnancy, or that is prescribed to infants, is more likely to be safe while breastfeeding. However some medications that are safe in pregnancy can negatively affect breastmilk production. And some medications that a breastfeeding woman can safely take would pass too significantly through the placenta and harm the growth of a baby in the womb (in utero), especially in the early months of pregnancy.

Won’t my doctor have all the answers? What’s so important about having these links?

First of all, it’s best to do the research and have this information before you get pregnant! A preconception or pre-pregnancy appointment is a great idea, but doesn’t happen as often as it should. (You can also bring up your medication list at your yearly annual exam, if you’ve been going for those.) Being an educated patient is one of the best ways to make sure your questions and concerns get addressed by your provider.

Secondly, the data is always changing, and your doctor or midwife may not have the latest and greatest. Recommendations change as medications are on the market for longer amounts of time and women have the opportunity to report what happened during their pregnancies. Sometimes a medication will get the green light for pregnancy and/or breastfeeding, sometimes it will become obvious that there were more risks than anyone realized. (Interesting point – when medications go for clinical trials, pregnant and breastfeeding women are excluded from the studies, so every new medication is an unknown. Learning about them takes time.)

Lastly, and this one is unfortunate, not every provider will have the interest in doing good research on your behalf. Sometimes it’s easier to just say “you shouldn’t get pregnant” or “you shouldn’t breastfeed.” They may not want to be liable if anything chas v’shalom goes wrong, or they may not share a value that is driving your actions.

On to the RESOURCES!

1. MotherToBaby (sometimes referred to as OTIS, in case you see that somewhere)

MotherToBaby Fact Sheets cover how different medical conditions, medications, foods, vaccines, even cosmetics, can impact pregnancy and breastfeeding. I’ve also had the opportunity to call and speak with them in the past, and they were pleasant and helpful! (Seems they now have text and chat options listed on their website – pretty cool.)

I “met” MotherToBaby after I was recruited for a trial during my second pregnancy to collect outcome data on a certain medication. (Baruch Hashem, the outcome was a beautiful healthy baby girl.) At the end of my next pregnancy, they enrolled me in a study on breastmilk, and I was shipping the stuff off on ice to California from Texas. 🙂 So I can testify that their information does come from real people!

2. LactMed – Drugs and Lactation Database

Ok – I love this website, but also recognize that the information is not neatly packaged for consumers. It’s probably the best internet source (and definitely the best free source) out there on medications and breastfeeding. There’s a Summary of Use During Lactation for each medication, plus details on drug levels in milk, and any noted effects on breastfed infants or breastmilk production.

If you go to check out this website and think, “wow, this is dry and not something I’m interested in reading through,” just do yourself a favor and bring it along to your next appointment. When you enter the brand name of a medication, it will probably direct you to the generic name. If something looks strange, just double check that they’re the same thing.

Website: https://www.ncbi.nlm.nih.gov/books/NBK547437/

That’s it for now! Comments, questions, and feedback welcome below.