What are the absolute contraindications for breastfeeding?

Absolute Contraindications for Breastfeeding

Absolute contraindications to breastfeeding include galactosemia in the infant, maternal HIV infection, HTLV-1 or HTLV-2 infection, untreated brucellosis, and suspected or confirmed Ebola disease. 1

Medical Conditions

Infant Conditions

• Galactosemia: Infants with galactosemia cannot metabolize lactose properly, making breast milk dangerous for them

Maternal Infectious Diseases

• HIV infection: Transmissible through breast milk
• HTLV-1 or HTLV-2 infection: Human T-cell lymphotropic viruses can be transmitted via breastfeeding
• Untreated brucellosis: Requires treatment before breastfeeding can be considered
• Suspected or confirmed Ebola disease: High risk of transmission

Medication Contraindications

Certain medications are absolutely contraindicated during breastfeeding due to potential harm to the infant:

• Anticancer agents/antineoplastics: These drugs can cause significant harm to the developing infant 2
• Radioactive drugs/radiopharmaceuticals: Can be concentrated in breast milk and expose the infant to radiation 2
• Drugs of abuse: Pose significant risks to infant development and health 2

Important Distinctions

Not Contraindications

It's important to note that many conditions previously thought to contraindicate breastfeeding are actually compatible:

• Hepatitis B: Not a contraindication to breastfeeding, even with cracked or bleeding nipples 1
• Hepatitis C: Transmission via breast milk has not been documented 3
• Mastitis: Women with mastitis are encouraged to continue breastfeeding as part of treatment 3
• Tobacco use: While not ideal, smoking is not a contraindication to breastfeeding, though mothers should take precautions to minimize infant exposure 1
• Moderate alcohol consumption: Not a contraindication, though mothers should wait at least 2 hours after consuming a drink before breastfeeding 1

Medications Requiring Monitoring

Some medications require careful monitoring but don't necessarily contraindicate breastfeeding:

• Amiodarone: Requires monitoring of infant thyroid function 2
• Cyclosporine: Requires monitoring of drug levels 2
• Lithium: Requires monitoring of infant serum levels 2

Clinical Approach

When evaluating whether a mother should breastfeed:

1. Screen for absolute contraindications (galactosemia, HIV, HTLV-1/2, untreated brucellosis, Ebola)
2. Assess medication use, particularly anticancer drugs, radioactive compounds, and drugs of abuse
3. For other medications, consult specialized resources like LactMed to determine safety
4. Remember that most medications are compatible with breastfeeding, and the benefits of breastfeeding often outweigh potential risks

Risk-Benefit Considerations

The American Academy of Pediatrics emphasizes that breastfeeding provides significant benefits, including reduced risk of sudden infant death syndrome, decreased respiratory infections, reduced otitis media, and lower infant mortality 1. These benefits should be weighed against the rare situations where breastfeeding is truly contraindicated.

In most cases, the dose of medications transferred into breast milk is small and does not lead to clinically significant effects on the infant 4. Therefore, in almost all instances, mothers should be advised to continue breastfeeding unless one of the absolute contraindications is present.