Maternal Contraindications to Breastfeeding
In the United States, breastfeeding is contraindicated for mothers with HIV infection, human T-cell lymphotropic virus (HTLV) types I or II, untreated active tuberculosis, suspected or confirmed Ebola virus disease, untreated brucellosis, or current use of drugs of abuse, chemotherapeutic agents, or radioactive materials. 1
Absolute Maternal Contraindications
Infectious Diseases
- HIV infection: In the United States and other developed countries where safe replacement feeding is available, HIV-positive mothers should not breastfeed due to risk of viral transmission through breast milk 1
- HTLV types I or II: These retroviruses can be transmitted through breast milk and breastfeeding is contraindicated 1
- Active untreated tuberculosis: Mothers with untreated TB disease should not breastfeed until they are no longer infectious 1
- Ebola virus disease: Suspected or confirmed Ebola is an absolute contraindication 1
- Untreated brucellosis: Active infection requires treatment before breastfeeding 1
Medications and Substances
- Drugs of abuse: Current alcohol and drug use/dependence contraindicate breastfeeding 1
- Chemotherapeutic agents and antimetabolites: These medications pose significant risk to the infant 1
- Radioactive isotopes: Diagnostic or therapeutic radioactive materials or exposure to radioactive substances contraindicate breastfeeding 1
Infant-Related Contraindication
- Classic galactosemia: This is the only absolute infant metabolic contraindication to breastfeeding, as affected infants cannot metabolize galactose in breast milk 1
Temporary or Conditional Contraindications
Localized Maternal Infections
- Herpes simplex lesions on the breast: The infant can feed from the unaffected breast; direct contact with lesions must be avoided 1
Medications Requiring Caution
- Methadone: While methadone is secreted into breast milk at concentrations of 50-570 µg/L, the decision to breastfeed should balance risks and benefits; women on high-dose methadone maintenance who are already breastfeeding should wean gradually to prevent neonatal abstinence syndrome 2
- Lithium, certain antidepressants, and other mood-altering drugs: These require careful evaluation and monitoring 1
Important Clinical Caveats
Most maternal infections are compatible with breastfeeding because breast milk provides protective antibodies with minimal risk of viral transmission through milk itself 1. The primary transmission risk often comes from respiratory secretions or direct contact rather than the milk 1.
For mothers with conditions making pregnancy high-risk, the lactational amenorrhea method may not be appropriate due to higher typical-use failure rates, but breastfeeding itself is not contraindicated 1.
The key principle: In developed countries like the United States, the contraindications are limited primarily to HIV, HTLV, active untreated TB, Ebola, untreated brucellosis, drugs of abuse, chemotherapy, and radioactive materials 1. All other maternal conditions require individualized risk-benefit assessment rather than absolute contraindication 3.