The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study

International Breastfeeding Journal
Youstina Soliman1, Uma Yakandawala2, Christine Leong3, Emma S. Garlock4, Fiona S. L. Brinkman4, Geoffrey L. Winsor4, Anita L. Kozyrskyj5, Piushkumar J. Mandhane5, Stuart E. Turvey6, Theo J. Moraes7, Padmaja Subbarao7, Nathan Nickel8, Kellie Thiessen9, Meghan B. Azad10, Lauren Kelly10
1Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
2George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
3College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
4Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
5Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
6Department of Pediatrics, University of British Columbia, Vancouver, Canada
7Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
8Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
9College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
10Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

Tóm tắt

Abstract Background A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. Conclusions In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.

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International Breastfeeding Journal

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