Is it safe to receive a steroid injection, such as (corticosteroid), like prednisolone or methylprednisolone, while breastfeeding?

Steroid Injection Safety During Breastfeeding

Steroid injections are generally safe during breastfeeding, with prednisone or equivalent nonfluorinated steroids at doses less than 20 mg daily considered compatible with breastfeeding. 1

Recommendations Based on Steroid Type and Dose

Low-Dose Systemic Steroids (Safe)

• Prednisone/prednisolone <20 mg daily: Strongly recommended as compatible with breastfeeding 1
• Continue breastfeeding as normal
• No need to discard breast milk or delay feeding

High-Dose Systemic Steroids (Caution Required)

• Prednisone/prednisolone ≥20 mg daily: Still compatible, but requires precaution 1
• Recommendation: Discard breast milk obtained within 4 hours following medication administration 1
• This timing allows for significant reduction in steroid concentration in breast milk

Methylprednisolone IV Injections (Specific Guidance)

• Transfer into breast milk is very low (relative infant dose of 0.50-0.71%) 2, 3
• Highest concentration occurs at the end of infusion (2.09 μg/ml) 3
• Levels decrease rapidly after administration
• Recommendation: If receiving IV methylprednisolone, waiting 2-4 hours after infusion will further limit infant exposure 2, 3

Local/Intra-articular Injections

• Generally considered safe during breastfeeding 1
• Caution: Rare cases of temporary lactation suppression (24-48 hours) have been reported after local steroid injections 4
• Consider expressing and storing breast milk before receiving local steroid injections as a precaution

Important Considerations

Benefits vs. Risks

• The benefits of maintaining maternal disease control generally outweigh the minimal risk to the breastfed infant 1
• The American College of Rheumatology strongly recommends encouraging breastfeeding while maintaining disease control with compatible medications 1

Factors Affecting Steroid Transfer to Breast Milk

• Dose of steroid administered
• Timing of breastfeeding relative to administration
• Type of steroid (nonfluorinated preferred)
• Route of administration (local vs. systemic)

Common Pitfalls to Avoid

1. Unnecessarily stopping breastfeeding: This can lead to early cessation of breastfeeding altogether 5
2. Not considering timing: For high-dose steroids, timing breastfeeding appropriately can minimize infant exposure
3. Ignoring maternal disease control: Untreated maternal disease may have greater negative impacts than medication exposure through breast milk

Special Situations

Steroid Injections for Mastitis

• Continuing breastfeeding during mastitis treatment is recommended 5
• Regular milk removal is crucial for mastitis resolution 5

Premature Infants

• More caution may be warranted as premature infants may have reduced capacity to metabolize medications
• Consult with a pediatrician for individualized recommendations

In conclusion, most steroid injections are compatible with breastfeeding. For doses of prednisone or equivalent <20 mg daily, no special precautions are needed. For higher doses, discarding milk for 4 hours after administration provides additional safety. For IV methylprednisolone, waiting 2-4 hours after infusion minimizes infant exposure.