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Pediatrics Volume 108, Number 3, September 2001, 776-689
AMERICAN ACADEMY OF PEDIATRICS
Committee on Drugs
ABSTRACT. The American Academy of Pediatrics places emphasis on increasing breastfeeding in the United States. A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing. Such advice may not be warranted. This statement is intended to supply the pediatrician, obstetrician, and family physician with data, if known, concerning the excretion of drugs into human milk. Most drugs likely to be prescribed to the nursing mother should have no effect on milk supply or on infant well being. This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacologic treatment of breastfeeding mothers. Nicotine, psychotropic drugs, and silicone implants are 3 important topics reviewed in this statement.
A statement on the transfer of drugs and chemicals into human milk was first published in 1983, with revisions in 1989 and 1994. Information continues to become available. The current statement is intended to revise the lists of agents transferred into human milk and describe their possible effects on the infant or on lactation, if known (Tables 1-7). If a pharmacologic or chemical agent does not appear in the tables, it does not mean that it is not transferred into human milk or that it does not have an effect on the infant; it only indicates that there were no reports found in the literature. These tables should assist the physician in counseling a nursing mother regarding breastfeeding when the mother has a condition for which a drug is medically indicated.
In the previous edition of this statement, the Committee on Drugs placed nicotine (smoking) in Table 2, “Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported.” The reasons for placing nicotine and, thus, smoking in Table 2 were documented decrease in milk production and weight gain in the infant of the smoking mother and exposure of the infant to environmental tobacco smoke as demonstrated by the presence of nicotine and its primary metabolite, cotinine, in human milk. There is controversy regarding the effects of nicotine on infant size at 1 year of age. There are hundreds of compounds in tobacco smoke; however, nicotine and its metabolite cotinine are most often used as markers of tobacco exposure. Nicotine is not necessarily the only component that might cause an increase in respiratory illnesses (including otitis media) in the nursing infant attributable to both transmammary secretion of compounds and environmental exposure. Nicotine is present in milk in concentrations between 1.5 and 3.0 times the simultaneous maternal plasma concentration, and elimination half-life is similar-60 to 90 minutes in milk and plasma. There is no evidence to document whether this amount of nicotine presents a health risk to the nursing infant.