From the Guidelines
Aspirin can be continued in lactating women at low doses for vascular indications, as suggested by the American College of Chest Physicians evidence-based clinical practice guidelines. The recommended dose is not explicitly stated in terms of a specific amount, but it is implied to be low-dose aspirin, which is generally considered to be less than 100 mg per day 1. This guideline suggests that lactating women using low-dose aspirin for vascular indications can continue this medication, with a Grade 2C recommendation.
When considering the use of aspirin in lactating women, it's essential to weigh the benefits against the potential risks. Aspirin is a polar, acidic drug that is poorly lipid soluble and highly bound to plasma proteins, which means that maternal aspirin ingestion is associated with excretion of salicylates into breast milk 1. However, the use of low-dose aspirin has not been associated with significant effects on neonatal platelet function, and a prospective study of 15 breast-feeding mothers taking aspirin therapy found no negative effects.
Some key points to consider when using aspirin during lactation include:
- Monitoring infants for any unusual symptoms such as rash, unusual bleeding, or changes in feeding patterns while taking aspirin
- Consulting with a healthcare provider to weigh benefits against potential risks, especially for extended periods or high doses
- Considering alternative medications like ibuprofen or acetaminophen for chronic pain or anti-inflammatory needs, as they have better safety profiles. It's crucial to prioritize the health and well-being of both the mother and the infant when making decisions about medication use during lactation, and low-dose aspirin can be a viable option for lactating women with specific medical conditions, under the guidance of a healthcare provider.
From the Research
Aspirin in Lactation Dose
- The recommended dose of aspirin for lactating women is not explicitly stated in most guidelines, which primarily focus on pregnancy and preeclampsia prevention.
- However, a study on the transfer of low-dose aspirin into human milk found that the daily use of an 81-mg dose of aspirin should be considered safe during lactation 2.
- This study detected very low concentrations of salicylic acid, a metabolite of aspirin, in human milk, with an estimated relative infant dose of 0.4% 2.
- The American College of Obstetricians and Gynecologists and other organizations recommend low-dose aspirin (81 mg/day) for women at high risk of preeclampsia during pregnancy, but do not provide specific guidance for lactating women 3, 4.
- Other studies discuss the use of low-dose aspirin in pregnancy, including the optimal dose and timing of initiation, but do not address lactation specifically 5, 6.
- Based on the available evidence, it appears that an 81-mg dose of aspirin may be safe for lactating women, but more research is needed to confirm this and provide definitive guidance on aspirin use during lactation.