Can a mother who has taken a steroid (corticosteroid) still breastfeed?

Can a Mother Who Took a Steroid Still Breastfeed?

Yes, a mother who has taken corticosteroids can and should continue breastfeeding—corticosteroids are found in only low concentrations in breast milk and pose minimal risk to the nursing infant. 1

Evidence-Based Safety Profile

Corticosteroids transfer into breast milk in minimal amounts that are too small to cause pharmacological effects in the infant. 2 The available data across multiple medical specialties consistently demonstrate that:

• Systemic corticosteroids appear in human milk but at concentrations that do not warrant discontinuation of breastfeeding 1
• Glucocorticoids are excreted minimally into breast milk, and breastfeeding by women on low-dose corticosteroid therapy is generally considered safe with low risk of adverse effects on nursing infants 2
• The use of prednisolone (a commonly used corticosteroid) is considered safe during lactation 1

Clinical Recommendations

Continue breastfeeding without interruption when using corticosteroids at typical therapeutic doses. 1, 2 The decision to breastfeed should be made independent of corticosteroid therapy, considering the advantages to the newborn and the benefits to the mother. 1

Timing Considerations

The evidence on timing breastfeeding around medication administration is mixed:

• The 2016 Toronto Consensus (Gastroenterology) explicitly rejected the need to avoid breastfeeding within 4 hours of corticosteroid administration, concluding there was little evidence to support discarding breast milk or timing feeds around medication intake 1
• However, for mothers using high-dose corticosteroids (≥20 mg daily prednisone equivalent), the 2020 American College of Rheumatology guideline suggests discarding breast milk obtained within 4 hours following medication to minimize infant exposure 1
• For prednisolone specifically, infant exposure can be further minimized by avoiding breastfeeding during the first 4 hours after medication intake when equilibrium between breast milk and maternal serum occurs—a strategy that may be applied to other corticosteroids if additional caution is desired 2

Dose-Specific Guidance

For low-dose corticosteroids (<20 mg prednisone daily or equivalent):

• Continue breastfeeding without any timing restrictions 1
• No need to discard breast milk 1

For high-dose corticosteroids (≥20 mg prednisone daily or equivalent):

• Continue breastfeeding but consider discarding breast milk obtained within 4 hours of medication administration 1
• Alternatively, time breastfeeding sessions to occur more than 4 hours after medication intake if feasible 2

Important Caveats

Fluorinated vs. Non-Fluorinated Steroids

• Prednisone or non-fluorinated steroid equivalents are preferred during breastfeeding 1
• Dexamethasone (a fluorinated steroid) transfers minimally into breast milk and breastfeeding can continue without interruption, though it is not the first-line choice 2

Disease Control Priority

Maintaining maternal disease control takes priority—discontinuing corticosteroids postpartum may lead to disease flare, which poses greater risk to both mother and infant than the minimal drug exposure through breast milk. 1 Postpartum discontinuation of medication can trigger disease relapse, and untreated maternal disease carries its own risks. 1

Benefits of Breastfeeding

The benefits of breastfeeding consistently outweigh the minimal theoretical risks from corticosteroid exposure:

• Breastfeeding has not been associated with increased risk of maternal disease flare and may actually be protective against relapse 1
• Breastfeeding may have a protective effect against development of early-onset inflammatory conditions in offspring 1

Common Pitfalls to Avoid

• Do not advise mothers to discontinue breastfeeding based solely on corticosteroid use—this is the most common error and deprives infants of breastfeeding benefits unnecessarily 3, 4
• Do not confuse systemic corticosteroids with topical/intranasal formulations—intranasal corticosteroids like fluticasone have even more minimal systemic absorption and are definitively safe during breastfeeding 5
• Avoid switching to less effective medications out of unfounded concern—the risk of undertreated maternal disease exceeds the minimal risk from corticosteroid exposure in breast milk 1