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Fexofenadine and Breastfeeding

Fexofenadine can be used as an antihistamine during lactation if other antihistamines e.g., cetirizine and loratadine are not effective although studies are limited

Fexofenadine is being asked about frequently this year when symptoms of hayfever seem worse than usual. It can be bought over the counter (but the leaflet will say don’t take if breastfeeding and the pharmacist may suggest that it isn’t compatible with breastfeeding). I hope this information sheet helps you decide what is right for you and your baby.

wendy@breastfeeding-and-medication.co.uk

Factsheet Fexofenadine and Breastfeeding

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/06/fexofenadine.pdf

Acne and breastfeeding

Acne affects 95% around 95% of people between the ages of 11 and 30 years to some extent. It usually disappears in the mid-20s but 3% of people still have symptoms beyond 35 years. It most commonly develops on the face but 50% of sufferers have lesions on their backs and 15% on their chest as well.

This is a chapter from Breastfeeding and Chronic Medical Conditions still available on Amazon as a paperback or download.

For factsheet on acne see https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/06/acne-vulgaris.doc.pdf

Monkeypox and breastfeeding

I sincerely hope this information is never needed but as of 6 june 2022 this is the recommendation on pregnancy and breastfeeding when a mother is suspected/proven to have monkeypox. This data is taken from the paper as below

RCOG 6 June 2022 New paper provides best practice for managing monkeypox in pregnancy (and breastfeeding) https://www.rcog.org.uk/news/new-paper-provides-best-practice-for-managing-monkeypox-in-pregnancy/

Highlights pasted from the paper below- basically we dont know about breastfeeding and the passage of monkeypox and need to protect the infant.

‘There is currently no evidence on the risk of viral transmission to the infant during breastfeeding, whether via the breast milk, direct contact with maternal skin lesions or via large droplet spread.

MVA-BN is considered safe in breastfeeding

Neonatal care

There is little evidence to guide neonatal care following the birth of a baby to a woman with monkeypox infection. Apart from macroscopic examination, the baby should undergo viral PCR testing either by throat swab or any lesions that are present. The baby should be isolated at birth from its mother and others, in a single room, with carers wearing appropriate PPE. The baby should be carefully monitored for signs of compromise or monkeypox infection. If the baby tests positive, the mother and baby can be reunited. Ideally, both mother and baby should be tested in parallel thereafter; after the mother is de-isolated (e.g. two negative PCR tests), mother and baby should be reunited. If a mother has reached a threshold to warrant PCR testing for the monkeypox virus, the baby should be isolated pending her swab result.

Breastfeeding

The proposed strategy for neonatal care would preclude most women with active monkeypox infection from breastfeeding their newborn. The WHO advises against breastfeeding; this seems reasonable in high-income country settings, such as the UK, in order to minimize the risk of neonatal monkeypox infection”

Proposed management of suspected or confirmed monkeypox infection in labor or if urgent delivery is needed.

• Advise delivery via Cesarean section

• Assess need for steroids and magnesium sulfate

• Maternity and neonatal staff to wear PPE

• Mother and baby should be isolated separately; avoid NNU admission if possible

• Mother should not breastfeed

• Encourage expressing so mother has opportunity to breastfeed after de-isolation; follow

recommendations for pump cleaning after each use

• Milk should be discarded as infected waste*

• Discuss with virologist testing needed

• If mother is negative, these precautions can be lifted

• If maternal infection confirmed, baby to be isolated for 3 weeks

• If both mother and baby test positive, they can be reunited https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.24968

Monkeypox is usually a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks. https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates

Symptoms

Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals. The rash changes and goes through different stages – it can look like chickenpox or syphilis, before finally forming a scab which later falls off.

Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms.

“A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging these men to be alert to the symptoms” Dr Susan Hopkins, Chief Medical Adviser, UKHSA

UKHSA health protection teams are contacting people considered to be high-risk contacts of confirmed cases and are advising those who have been risk assessed and remain well to isolate at home for up to 21 days. In addition, UKHSA has purchased supplies of a safe smallpox vaccine (called Imvanex) and this is being offered to identified close contacts of someone diagnosed with monkeypox to reduce the risk of symptomatic infection and severe illness.

It’s very uncommon to get monkeypox from a person with the infection because it does not spread easily between people. But it can be spread through:

  • touching clothing, bedding or towels used by someone with the monkeypox rash
  • touching monkeypox skin blisters or scabs
  • the coughs or sneezes of a person with the monkeypox rash
https://www.westsevengp.nhs.uk/conditions/monkeypox/

For full information from the UK Government  and WHO see:

The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.

Transmission can occur via the placenta from mother to fetus (which can lead to congenital monkeypox) or during close contact during and after birth.

Vaccination with smallpox vaccine during breastfeeding

MVA-BN is not contraindicated if breast-feeding. It is not known whether MVA-BN is excreted in human milk, but this is unlikely as the vaccine virus does not replicate effectively in humans. Individuals who are breast feeding and have a significant exposure to monkeypox should therefore be offered vaccination, after discussion about the risks of monkeypox to themselves and to the breast-fed child. UKHSA Recommendations for the use of pre and post exposure vaccination during a monkeypox incident May 22 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1077678/Recommendations-for-use-of-pre-and-post-exposure-vaccination-during-a-monkeypox-incident.pdf?fbclid=IwAR2mS-bJgP3LLvvzNUS5aQf4SR3ZIdvg1Fn7XAxHTe7Vpm3KTDt0JPauNbg

Further information on monkeypox infection in pregnancy

Hypertension (raised blood pressure) and Breastfeeding

Many mothers experience raised blood pressure it seems. Is this due to our busy lifestyles, more mums giving birth at an older age? Who knows but it causes a lot of confusion. The drug normally initiated if a mother has symptoms of pre-eclampsia is labetolol. It is usually continued after delivery until the BP has settled. Virtually none passes into breastmilk. However, some mothers with poor circulation may notice sore, white nipples where the supply to the tip is decreased . If this happens the drug may need to be changed. Prolonged high BP in pregnancy can lead to restricted growth of the baby who may be born sleepy. Rather than just monitoring blood glucose levels the baby should be helped to attach to the breast and feed regularly or be given colostrum by spoon or syringe. A drop of colostrum can work magic.

Later blood pressure rises can be treated with enalapril, amlodipine and felodipine which are all compatible with breastfeeding according to expert sources. The NICE Guidelines NG 133 (2019) can also guide good practice.

The data for this fact sheet is taken from my book Breastfeeding and Medication which provides more detail and references to studies. Please consider buying a copy for future reference.

There is much information in this factsheet.

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/06/hypertension-and-breastfeeding.doc

Breastfeeding for Professionals – CPD

Back long ago before books and training material, let alone the website, I wrote a training pack for professionals with support from Roberta Roulstone from Peterborough Hospital. She inspired me to share my knowledge and changed my life. Another person who helped with the IT was Sarah Saunby a very great friend who I miss seeing.

This is an up to date version of that training which I have been picking up and putting down for a while. I hope it helps professionals to protect and support breastfeeding whilst adding to their own CPD.

For once I got round to recording it! But have included a link to the powerpoint as some links got covered up in my recording

Breastfeeding for Professionals Powerpoint

Pain relief when breastfeeding

It is not acceptable to leave any mother in pain because she is breastfeeding nor to suggest that she could have more effective pain relief if she stopped breastfeeding.

I’m often asked about the safety of opioids during breastfeeding so this is a really interesting study

Despite opioids being used first line in emergency settings to treat severe acute extremity pain, there is limited evidence available to inform this practice.

In a study in JAMA (7 November 2017), researchers randomly assigned 416 patients in the emergency department with moderate-to-severe acute extremity pain to one of the following groups: 400mg ibuprofen/1000mg paracetamol; 5mg oxycodone/325mg paracetamol; 5mg hydrocodone/300mg paracetamol; or 30mg codeine/300mg paracetamol[1].

https://jamanetwork.com/journals/jama/article-abstract/2661581?redirect=true

I have written this powerpoint presentation which I hope explains the analgesic ladder and helps professionals to understand the compatibility of analgesics and breastfeeding

  • Paracetamol or NSAID
  • Paracetamol + NSAID
  • Paracetamol+NSAID+Opioid (at the lowest possible dose for the shortest possible time co prescribed with a laxative)

Non steroidal anti inflammatory drugs

Opioids 

https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine 

https://breastfeeding-and-medication.co.uk/fact-sheet/accidental-dose-of-codeine-when-breastfeeding

 

Analgesics and breastfeeding Powerpoint 

see also https://www.breastfeedingnetwork.org.uk/analgesics/

https://breastfeeding-and-medication.co.uk/fact-sheet/dihydrocodeine-and-breastfeeding

https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine

https://breastfeeding-and-medication.co.uk/fact-sheet/breastfeeding-and-neuropathic-pain-gabapentin-and-pregabalin

https://breastfeeding-and-medication.co.uk/fact-sheet/migraine-treatment-and-breastfeeding

https://breastfeeding-and-medication.co.uk/fact-sheet/breastfeeding-and-pain-relief-for-acute-back-injury

Prescribing during breastfeeding for midwives

I had been asked to talk to midwives for an update today but sadly due to timing wasnt bale to do so. But having saved the day I decided to record the talk anyway

Happy to answer any questions wendy@breastfeeding-and-medication.co.uk

This is the handout of the presentation https://breastfeeding-and-medication.co.uk/wp-content/uploads/2022/05/Prescribing-during-breastfeeding-midwives-2022.pdf

and the link to the YouTube video which includes my presentation https://youtu.be/L3b43BgeiR8

Migraine prophylaxis and breastfeeding

So many people now seem to have regular migraines which are debilitating and make life with babies and children a nightmare.

Preventive treatment may be appropriate if the mother suffers at least two attacks a month, an increasing frequency of headaches, suffers significant disability despite suitable treatment for migraine attacks or cannot take suitable treatment for migraine attacks.

  • Beta-blockers e.g., propranolol are effective.
  • Tricyclic antidepressants e.g., amitriptyline 
  • Topiramate
  • Pizotifen
  • Botox
  • Riboflavin

all of which are safe in breastfeeding. More information in the factsheet on other supplements including magnesium, zinc and co enzyme Q10

Migraine prophylaxis (prevention) and breastfeeding factsheet

References are available by emailing me wendy@breastfeeding-and-medication.co.uk or can be found in Breastfeeding and Medication

PET scans whilst breastfeeding

Having a PET scan is scary because it is often associated with a possible diagnosis of cancer, something which as mothers we probably fear most. It is important to take one day at a time and not leap ahead – not the easiest thing to do I know. If possible, store some milk in advance to feed your baby whilst you are seperated. This factsheet contains data on the process of having a scan, preparation and breastfeeding all taken from expert sites which I hope helps.

If the diagnosis does turn out to be cancer then the wonderful organisation Mummy’s Star offer amazing support and deserve more recognition https://www.facebook.com/MummysStar

If you need chemotherapy, I can provide information on how long the drug stays in your system. Some mothers have expressed a desire to pump and dump their milk to maintain a supply until they can feed again. Others plan to relactate at the end of treatment. I will do my best to support your decision.

But for today let’s concentrate on the PET scan and continuing to feed your nursling.

PET Scans and Breastfeeding Factsheet

A large, white circular scanner with a hole in the centre. In front is the flat bed that is moved into the scanner before the scan begins.

Polycystic Ovary Syndrome and Breastfeeding (PCOS)

PCOS affects 1 in 10 women and causes problems with infertility and breastfeeding. This factsheet is based on a chapter from Breastfeeding and Chronic Medical Conditions (available on Amazon) but extended to include information on myo-inositol which generates many questions.

Polycystic Ovary Syndrome and Breastfeeding Factsheet

Any questions please feel free to email me wendy@breastfeeding-and-medication. co.uk

Breastfeeding and Chronic Medical Conditions, Wendy Jones