From the Guidelines
Corticosteroid injections are generally considered safe for patients who are nursing, with minimal amounts passing into breast milk, especially with local injections. When considering the use of corticosteroid injections in breastfeeding patients, it's essential to weigh the benefits of treating the mother's condition against the potential risks to the infant. According to the most recent and highest quality study, the 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1, prednisone or nonfluorinated steroid equivalent <20 mg daily is considered compatible with breastfeeding. However, for prednisone ≥20 mg daily, it is recommended to discard breast milk obtained within 4 hours following medication 1. This guideline suggests that the benefits of treating the mother's condition with corticosteroid injections typically outweigh the minimal risk to the nursing infant. Some key points to consider include:
- The amount of corticosteroids that pass into breast milk is generally minimal, especially with local injections.
- Common injectable corticosteroids like methylprednisolone, triamcinolone, and betamethasone are metabolized quickly and have limited systemic absorption when administered as local injections.
- For extra caution with higher doses or systemic administration, some providers might recommend waiting 3-4 hours after injection before nursing, which allows time for peak blood levels to decrease.
- The decision to breastfeed should be made independent of therapy and consider the advantages to the newborn and the potential benefits to the patient as well as patient preference, as suggested by the Toronto consensus statements for the management of inflammatory bowel disease in pregnancy 1.
- It's always important to discuss specific circumstances with the healthcare provider, as individual factors such as dose, injection site, and frequency may influence recommendations for each nursing mother. The American College of Rheumatology guideline also suggests that many rheumatic and musculoskeletal disease medications may be initiated or continued during lactation, and that disease control should be maintained with lactation-compatible medications 1. Overall, corticosteroid injections are not contraindicated in patients who are breastfeeding, but the decision to use them should be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential risks and benefits.
From the Research
Corticosteroid Injections and Breastfeeding
- There is no direct evidence in the provided studies to suggest that corticosteroid injections are contraindicated in patients who are breastfeeding (nursing) 2, 3, 4, 5, 6.
- The studies primarily focus on the uses, effects, and potential side effects of corticosteroid injections for various musculoskeletal conditions, but do not address breastfeeding specifically.
- None of the studies mention breastfeeding or nursing as a contraindication for corticosteroid injections, but they also do not provide information on the safety of corticosteroid injections during breastfeeding.
Potential Side Effects
- Corticosteroid injections can be associated with a range of potential side effects, including local and systemic effects 5.
- Local side effects include postinjection flare, skin hypopigmentation and atrophy, infection, tendon rupture, accelerated progression of osteoarthritis, and osseous injury 5.
- Systemic side effects include adrenal suppression or insufficiency, facial flushing, hypertension, hyperglycemia, and osteoporosis 5.
Contraindications
- Corticosteroid injections are contraindicated in the presence of superficial or deep infection, fracture, or a prosthetic joint 5.