Pharmacology of Lactation

For most maternal medications, the potential for harming the breastfed infant is minimal; only small amounts of medication are transferred into human milk and absorbed by the infant. Most reviews of medications for breastfeeding women conclude that the benefits of medication use during lactation outweigh the risks. Yet, health professionals and families are often unsure about the safety of medicines on the breastfed infant, and this is still a barrier to achieving Australia’s breastfeeding goals.

Increasing diagnosis and self-recognition of neurodiversity, especially among women is occurring in increasing frequency worldwide. Attention- Deficit- Hyperactivity- Disorder (ADHD) is an often poorly understood condition of neurodivergence, with presentations in women having been traditionally missed. How healthcare providers approach this is an evolving area and yet there has been little discussion around the implications of ADHD diagnosis and pharmacological management during the peripartum and breastfeeding. There are increasing bodies of evidence demonstrating higher risks of complications during pregnancy and postpartum and that appropriate treatment greatly reduces these risks. Breastfeeding and pharmacological treatment are compatible with stimulants being not only the most efficacious treatment option but also the safest. Non-stimulant treatment options may be compatible but lack of data and higher rates of transfer in breastmilk can be problematic. Women however can be supported to have appropriate care of their ADHD during the peripartum and breastfeed also, with well-backed reassurance that this is often safe for their infant and is the gold standard for outcomes for both mother and child.

Whether real or perceived, low breast milk supply remains one of the most commonly reported reasons for early breastfeeding cessation. While non-pharmacological support strategies remain the first-line approach for addressing concerns with low breast milk supply, we know that many women are recommended, or turn to using galactagogues (substances thought to promote lactation). Domperidone is one of the most widely recognised and recommended pharmaceutical galactagogues across the world. This presentation will provide an evidence-based guide to potential benefits and harms associated with using domperidone as a galactagogue and describe key recommendations relating to treatment initiation, dosing, duration of treatment, and treatment cessation. Evidence relating to the association between domperidone and sudden cardiac death and ventricular arrhythmias will also be discussed with a focus on its relevance to lactating women and consideration of risk management approaches that can be utilized in clinical practice to reduce the risk of harm.

Sadly, many mothers are told that they cannot breastfeed when taking medication if they have a chronic condition. It is seen as more important that the mother’s health is managed and breastfeeding is seen as unimportant and a drain on the mother. This is rarely based on evidence-based information or an understanding of how drugs pass into milk and the value of term breastfeeding. In this presentation, we will look at the way to use specialist sources of information, illustrated by situations commonly encountered by lactating mothers with chronic conditions and how breastfeeding may protect the health of future generations.

This presentation reviews common radiology and nuclear medicine studies that breastfeeding women undergo and describes the safety of these with continued lactation.  It also will describe specific circumstances when lactation should be interrupted temporarily and identifies the rare situations when lactation should be stopped completely.  It will then transition to a discussion of what studies should be ordered for women who have a breast-specific concern while breastfeeding, and review guidelines for breast cancer screening during lactation.  The second half of the lecture will cover anaesthesia and analgesia recommendations for lactation as well as specific concerns related to surgical procedures.