Prednisone and Breastfeeding

Prednisone at doses ≤20 mg daily is safe and compatible with breastfeeding without any special precautions or interruption needed. 1, 2

Dose-Specific Safety Algorithm

Continue breastfeeding normally without any interruption or timing restrictions 1, 2, 3
The American College of Rheumatology provides a strong recommendation for this approach, with the relative infant dose at this level considered safe (typically <10% of maternal dose) 1
No need to pump and discard milk or delay feeding 1, 3

Delay breastfeeding for 4 hours after taking the medication to minimize infant exposure to peak drug concentrations in breast milk 4, 1, 2, 3
Plan medication administration around the infant's longest sleep interval 1
Consider pumping and discarding milk during the 4-hour window if breast engorgement occurs 1
This conditional recommendation balances maternal disease control with infant safety 1

Step 1: Determine the minimum effective dose needed for maternal disease control 1

Prioritize maintaining disease control while using the lowest effective dose 1, 3
Calcium and vitamin D supplementation should be provided to the mother on chronic corticosteroid therapy 1

Step 2: Apply dose-specific breastfeeding protocol

Step 3: Coordinate multidisciplinary care

Collaboration between rheumatologists, primary care physicians, and pediatricians is recommended when managing breastfeeding women on corticosteroid therapy 1, 2

Only 10% of the maternal concentration of prednisone and prednisolone is found in fetal blood, and transfer to breast milk follows similar patterns 4
Systemically administered corticosteroids do appear in human milk 5
With prolonged treatment at high maternal doses, it is advisable to delay breastfeeding for 3-4 hours after the dose to minimize transfer to breast milk 4
Corticosteroids have been used extensively during breastfeeding with no evidence of harmful effects on infants when used appropriately 3

Do not unnecessarily discontinue breastfeeding for low-dose prednisone (≤20 mg daily), as this dose is strongly recommended as compatible 1, 2
Do not use higher doses of steroids than necessary for maternal disease control 3
Do not fail to consider timing of medication administration in relation to the breastfeeding schedule when doses exceed 20 mg daily 3
Do not advise stopping breastfeeding based on excessive caution without assessing the risk-benefit ratio, as most medications including prednisone at appropriate doses are compatible with breastfeeding 6, 7

If high-dose prednisone continues until birth, adrenal insufficiency in the newborn must be considered 4
Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism 5