A comprehensive review of assay methods to determine drugs in breast milk and the safety of breastfeeding when taking drugs

Unitat de Recerca Infància i Entorn (URIE), Institut Municipal d'Investigació Mèdica (IMIM)-Hospital del Mar, 08003 Barcelona, Spain.
Analytical and Bioanalytical Chemistry (Impact Factor: 3.44). 04/2010; 397(3):1157-79. DOI: 10.1007/s00216-010-3681-0
Source: PubMed


Most of the licit and illicit drugs consumed by the breastfeeding woman pass into the milk and can modify the production, volume and composition of the milk, as well as hypothetically have short- and long-term harmful effects on the infant. There is much confusion in the scientific community regarding this issue: should a woman breastfeed her baby while continuing to use prescription drugs and/or drugs of abuse? There are many case reports of clinically significant toxicity in breast-fed infants from some substances used by mothers (such as irritability, vomiting, sedation, respiratory depression, shock), but there are too few data on studies conducted in breastfeeding women and their infants to make a realistic risk assessment. The objective measurement of a drug and/or metabolites in maternal milk is the first step when investigating the amount of drug excreted in milk and subsequently calculating the daily dose administered to the breast-fed infant. The present review reports the analytical methods developed to detect different drugs in the breast milk, listing the principal characteristics and validation parameters, advantages and disadvantages. Furthermore, the mechanisms of drug transfer into breast milk are discussed, the correlation between the concentration of the drug in breast milk and potential adverse outcomes on the infant are described for each drug, and suggested harm minimization strategies and approved breastfeeding recommendations are indicated.

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Available from: Oscar Garcia-Algar, Jul 28, 2014
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    • "These results are in accordance with previous studies [16] [17] [18] [19], where CAF in breast milk from CAF-consuming mother was between 47 and 4000 ng/mL. CAF is considered compatible with breastfeeding [7] because occasional use appears to have little effects on infant but it would seem advisable to restrict caffeine consumption to less than 300 mg/day (approximately three cups of coffee) while breastfeeding [1]. With respect to the 34 milk samples collected and analyzed before and after pasteurization process, no difference in concentration of CAF, the only analyte found in few of these samples, was highlighted and none of the other psychoactive drugs were determined before or after the process. "
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