From the Guidelines
Breastfeeding is contraindicated in mothers with HIV infection, human T-cell lymphotropic virus type I or II infection, untreated brucellosis, or suspected or confirmed Ebola virus disease, as well as in infants with classic galactosemia, as stated in the most recent guidelines from the American Academy of Pediatrics 1.
Contraindications to Breastfeeding
The following are contraindications to breastfeeding:
- HIV infection in the mother
- Human T-cell lymphotropic virus type I or II infection
- Untreated brucellosis
- Suspected or confirmed Ebola virus disease
- Classic galactosemia in the infant
Medications and Breastfeeding
Most medications are compatible with breastfeeding, but certain medications, such as chemotherapy drugs, radioactive compounds, and drugs of abuse, are contraindicated 1.
Infectious Diseases and Breastfeeding
Mothers with certain infectious diseases, such as active untreated tuberculosis or active herpes simplex lesions on the breast, should avoid breastfeeding until properly treated 1.
Other Contraindications
Women who have undergone breast surgery that has severed milk ducts may have insufficient milk production, and breastfeeding may not be possible 1.
Benefits of Breastfeeding
Despite these contraindications, breastfeeding remains safe and beneficial for both mother and infant in most situations, including most common illnesses and medications, and has been shown to decrease the severity of neonatal withdrawal syndrome in infants born to women with opioid use disorder 1.
From the Research
Contraindications for Breastfeeding
The contraindications for breastfeeding are limited and primarily related to maternal illness, the need for certain medications, or rare infant conditions. Some of the key points to consider include:
- Maternal illness: Certain maternal illnesses may necessitate the cessation of breastfeeding, although this is not common 2.
- Medications: The use of medication by the nursing mother is a common reason for the cessation of breastfeeding, but few drugs have been demonstrated to be absolutely contraindicated during breastfeeding 3, 4.
- Infant conditions: Rare infants with inborn errors of metabolism may have contraindications to breastfeeding 2.
- Drug accumulation: Identifying situations with potential for drug accumulation in the breastfed infant is crucial when assessing the risk of breastfeeding while taking medication 5.
Assessment of Risks and Benefits
When considering the contraindications for breastfeeding, it is essential to assess the risks and benefits for both mother and child. This includes:
- Pharmacokinetics: Understanding how drugs are transferred from the mother's blood to the milk and the potential impact on the infant 3, 4.
- Risk to the infant: Evaluating the potential risk to the infant from exposure to drugs in the milk 5, 4.
- Benefits of breastfeeding: Weighing the benefits of breastfeeding against the potential risks, including the benefits for maternal and infant health 6.
- Maternal willingness: Considering the mother's willingness to breastfeed and her concerns about medication use 5.