Life & Health: Impact of Maternal Medications on Children

    World Breastfeeding Week kicks off in the first week of August. Today, the benefits of breastfeeding for the first six months of a baby’s life are well-known. Breastfeeding offers vital nutrition, boosts immunity, fosters a strong bond between mother and child, and is cost-effective, saving families money on formula and healthcare.

    Given these benefits, it is crucial for breastfeeding mothers to consume a nutritious diet and avoid foods that might be contaminated or harmful, such as those with germs, heavy metals, excessive spices, or allergens. Mothers should also steer clear of tea, coffee, and all alcoholic beverages.

    What a mother consumes is passed on to her baby, beginning from pregnancy. Many medications can harm a developing fetus, posing risks such as miscarriage or birth defects. Additionally, herbal and traditional medicines, while often overlooked, can be just as dangerous due to the lack of safety information for pregnant women. For example, Andrographis paniculata is an herbal remedy that pregnant women should avoid.

    Certain medications must be used with caution or avoided altogether during pregnancy, especially in the first three months when the baby’s organs are developing. Medications that cross the placenta during this critical period can cause disabilities or fetal death. Notably, drugs like Isotretinoin (for acne), Valproate (an anticonvulsant), and Ergotamine (for migraines) are strictly prohibited during pregnancy. These medications are usually prescribed under strict medical supervision, requiring confirmation that the patient is not pregnant and the use of contraception to prevent harm to a potential baby.

    A common issue in our country is the use of over-the-counter medications that mothers might have used regularly before pregnancy or breastfeeding, such as non-steroidal anti-inflammatory drugs, cold medicines, antihistamines, stomach medications, and remedies for diarrhea or constipation. It's vital for mothers to consult with a doctor or pharmacist before using any medication. The Drug Information Center at the Faculty of Pharmacy, Chulalongkorn University, can provide guidance.

    When a baby is born, breastfeeding mothers need to be cautious with medications as many can be excreted in breast milk. Adult doses taken by the mother can result in significant amounts of the drug reaching the baby, potentially causing adverse effects. For example, Ergotamine in migraine medications can cause ergotism in babies, leading to symptoms such as nausea, vomiting, diarrhea, and convulsions. Similarly, the antihistamine Chlorpheniramine, which causes drowsiness in adults, can overly sedate a baby if passed through breast milk.

    If a mother needs to take a medication that is excreted in breast milk, she should verify whether breastfeeding is safe during the medication course. If not, she may need to temporarily switch to formula feeding until the drug has cleared from her system. The timeframe for this varies with each drug, and healthcare providers can offer specific guidance.

    Ultimately, the safest approach for using any medication, be it modern pharmaceuticals, traditional medicines, herbs, or supplements, is to first ensure they are safe for breastfeeding. If not, necessary medications should be used with careful planning and medical consultation to determine when breastfeeding can safely resume. Always seek advice from a doctor or pharmacist to address individual cases.

Assoc. Prof. Dr. Nattada Areepiam and Assoc. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University