Mother's Medical Conditions

You may have a chronic health concern or condition, but that does not necessarily prevent you from breastfeeding successfully. Both your obstetrician (OB) and your pediatrician can give you information on the best way to accommodate your situation while providing the best feeding option for your baby.

Diabetes

Many diabetic mothers have successfully breastfed their children, and lactating can even help you control your blood sugar during the transition from pregnancy to postpartum. You'll need to pay close attention to your diet because lactating can seriously affect your blood sugar. Keep lots of water and snacks handy when nursing to help avoid becoming hypoglycemic. Your regular insulin injections are safe for your nursing child. Unfortunately, oral hypoglycemic medications are not safe for you to use when breastfeeding. Discuss medication options with your doctor.

Diabetes will present you with some special challenges. Diabetic moms tend to get more yeast infections and suffer from mastitis more than nondiabetics. You'll need to give extra attention to your breasts and watch out for plugged milk ducts. While these extra steps can make breastfeeding more complicated, studies show breastfeeding your baby will help him to avoid becoming diabetic, too.

HIV

The number of human immunodeficiency virus (HIV)–positive mothers with HIV-negative children is small in the United States, but the breastfeeding debate is huge. HIV can be transmitted to a baby through breastmilk. The rate of transmission is between 9–16 percent for breastfeeding infants whose mothers have HIV, but that's a risk most moms don't want to take.

Because of this, the AAP recommends that HIV-positive mothers in the United States use an alternative source of nutrition for their babies (infant formula). On the other hand, many breastfeeding advocates, such as the World Health Organization, believe that the risk of infection is so low and the benefits of breastfeeding so significant that everyone should breastfeed her baby. For mothers in extreme poverty or without access to safe drinking water, the protection breastfeeding offers a baby does seem to outweigh the chance of infection. For the rest of us, formula feeding is the more cautious route to take. In deciding to breastfeed, a woman with HIV should always be aware of the possibility of transmitting the virus to her baby.

One thing seems clear: If you are HIV positive and you decide to breastfeed, breastfeed exclusively. Don't supplement your child's nursing with formula or solids. A 2008 study in Zimbabwe found that exclusive breastfeeding was safer than partial breastfeeding. HIV-positive mothers who exclusively breastfed their babies had healthier breasts, and their babies had healthier intestinal linings. For moms, exclusive breastfeeding results in fewer cases of mastitis and breast abscesses, both of which can result in bleeding and HIV transmission. The baby's intestinal lining acts like a filter, blocking out the HIV virus, and breastmilk strengthens that lining. Solid foods may cause damage to this lining, allowing the HIV virus to enter the baby's body.

A woman with HIV is more likely to be infectious if she contracts the virus during the second trimester of pregnancy or later. Babies are most susceptible to HIV during the first few months of life. If you are HIV positive and decide to nurse, take extra care of your breasts. Your baby is more at risk if you're suffering from mastitis. Cracked and bleeding nipples, along with scrapes or cuts in your baby's lips, mouth, or throat, can also result in HIV transmission.

HIV-infected women who take the drug AZT are much less likely to transmit HIV to their babies, either through birth or breastfeeding, although it does happen. Studies continue to show that anti-retroviral drugs can and do significantly reduce the risk of HIV transmission through breastmilk. But there is still a chance, and if HIV turns into AIDS, breastfeeding is no longer an option since the risk of infection is simply too great.

Herpes

Herpes can be deadly to newborns if a mother contracts it during the last trimester of pregnancy. If you become infected at that time, a C-section might be your only option. Herpes on a woman's breast is less of a threat. With a few precautions, you can safely nurse your baby.

If you develop a herpes sore on your nipple, it's best not to let your baby nurse from that side until it's healed. Use a pump on the affected breast to maintain your milk supply, and discard the expressed milk. If the sore is somewhere else on your breast, cover it with a bandage or pad and continue to nurse as usual. Anytime you have an active outbreak of herpes, whether genital or oral (cold sores), you should take extra precautions. Wash your hands before handling your baby or your breasts and always keep your child away from herpes sores.

Cancer

A diagnosis of cancer doesn't mean it's time to wean. Babies cannot catch cancer through breastmilk and many cancer treatments are compatible with breastfeeding. If you are determined, you can continue to nurse your child despite biopsies or even more involved surgeries. There are, however, some treatments that can affect your ability to breastfeed. With any type of cancer, it's important that you discuss your desire to breastfeed with your doctor and follow her advice.

If your cancer treatment involves chemotherapy or the injection of radioactive compounds, you must wean your baby until those substances have left your body. Some radioactive agents remain in your body for many months. Chemotherapy drugs will enter your breastmilk and, since they are among the most toxic medicines used, even a tiny amount can be harmful to your child. If you plan to resume nursing, you should pump and dump your milk until your doctor gives you the “all clear” sign.

Mental Illness, Antidepressants, and Psychiatric Drugs

Many women take prescription drugs for the treatment of mental or behavioral disorders. The safety of these during pregnancy varies, so the best approach is to follow your doctor's advice. There are times when certain drug therapy is worth the risk. For example, many doctors consider the treatment of a mother's depression so important to a baby's health and safety that the minimal risk posed by certain antidepressants is acceptable, even while breastfeeding. In contrast, lithium, which is commonly prescribed to treat bipolar disorder, is a danger to your breastfeeding child.

The following list contains some common medications used to treat psychiatric and mood disorders. In every case where the effects of the drug are unknown, the manufacturers recommend that you not use it while breastfeeding unless your doctor has specifically decided that you should.

MOTHER'S DRUG COMMENTS (EFFECTS ONLY ON INFANT ARE INCLUDED)
Antidepressants
Phenelzine (Nardil) Effects unknown, should not be used
Tranylcypromine (Parnate) Effects unknown, should not be used
Doxepin (Sinequan) Poor sucking and swallowing, drowsiness, vomiting, poor muscle tone, jaundice
Imipramine (Tofranil) Found in breastmilk, effect unknown
Citalopram (Celexa) Possible decreased feeding, weight loss, sleepiness
Fluoxetine (Prozac) Possible slowing of infant growth, not recommended
Fluvoxamine (Luvox) Effects unknown, should not be used
Paroxetine (Paxil) Effects unknown, but some studies indicate it is safe
Sertraline (Zoloft) Effects unknown but very low transfer to breastmilk
Escitalopram (Lexapro) Effects unknown but possible weight loss, tiredness, decreased feeding
Venlafaxine Hydrochloride (Effexor) Effects unknown, should not be used
Mood Stabilizers
Carbamazepine Breastfeeding considered safe but some reports of drowsiness, poor suck, and liver problems
Lithium (Lithobid, Eskalith) Unsafe for babies, builds to toxic levels
Valproic Acid (Depakote) Breastfeeding considered safe
Antipsychotics
Haloperidol (Haldol) Controversial
Fluphenazine (Prolixin) Effects unknown
Perphenazine (Trilafon) Breastfeeding unsafe
Thioridazine (Mellaril) Effects unknown
Chlorpromazine (Thorazine) Controversial but linked to drowsiness, lethargy
Clozapine (Clozaril) Effects unknown, not recommended
Olanzapine (Zyprexa) Possible drowsiness, jaundice, heart murmurs
Quetiapine (Seroquel) Effects unknown
Risperidone (Risperdal) Controversial
Ziprasidone (Geodon) Effects unknown
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