I used to run a weight loss clinic in my earlier role as a prescribing pharmacist. Losing weight is hard let alone when you are breastfeeding and sleep deprived.

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

Orlistat for Weight Loss and Breastfeeding

I’m sharing the brilliant information developed by Dr Hale and Dr Krutsch which I couldnt possibly improve on. It includes a weight loss calorie calculator if that interests you

https://www.infantrisk.com/content/weight-loss-lactation

https://www.infantrisk.com/weight-loss-while-breastfeeding-calculator

PDF https://breastfeeding-and-medication.co.uk/wp-content/uploads/2024/06/eye-preparations-and-breastfeeding.pdf

This is largely based on information from my book Breastfeeding and Medication (Routledge). For any queries please email wendy@breastfeeding-and-medication.co.uk

To minimise the absorption of any drug into the blood stream naso-lachrymal occlusion (pressing over the tear duct to close it off) as the drops are instilled can be applied.

Absorption of eye drops into breastmilk is unlikely in the majority of conditions:

• Local anaesthetic drops e.g. lignocaine;       
• Antibacterial eye drops e.g. chloramphenicol, fusidic acid (Fucithalmic );
• Antiviral eye drops e.g. aciclovir (Zovirax^®);
• Corticosteroid eye drops e.g. betamethasone (Betnesol^®), prednisolone (Predsol^®);
• Ocular lubricants e.g. hypromellose, carbomers.
• Anti-histamine eye drops for hayfever/allergy e.g. Sodium cromoglycate®

Compatible with use during breastfeeding due to poor bio-availability.

Eye Infections

Conjunctivitis treatment is one of the most commonly asked questions. Chloramphenicol drops can be sold over the counter by a pharmacist but in most cases this is outside of the product licence during breastfeeding. This does not imply risk only that the manufacturer has not conducted trials and accepts no responsibility. There is one reported case of bone toxicity but this was when the breastfeeding mother was taking the drug orally rather than using eye drops where absorption is lower. (https://www.ncbi.nlm.nih.gov/books/NBK501494/). Fucidic acid drops (Fucithalmic ®) are preferred where possible but currently this requires a prescription.                   

Beta blocker eye drops                                                                                                             

There is concern over the systemic absorption of beta blockers to treat glaucoma and consideration should be given if the baby suffers from asthma or heart disease and the mother alerted to the possibility, even if remote, of adverse reactions.

In a case report of a single mother (Lustgarten and Podos 1983) who used one drop of 0.5% timolol maleate, the authors estimated that use of 0.5% timolol drops in one eye twice daily gave the infant 0.63% of a cardiac dose . No side effects were reported.

Johnson et al. (2001) reported on one mother who used eye drops of timolol, dipivifrin, dorzolamide and brimonidine as well as oral acetazolamide. No apnoea or bradycardia was observed in the infant.

Compatible with use during breastfeeding, according to the results of limited studies.

References

• Johnson SM, Martinez M, Freedman S, Management of glaucoma in pregnancy and lactation, Surv Ophthalmol, 2001;45:449–54.
• Lustgarten JS, Podos SM, Topical timolol and the nursing mother, Arch Ophthalmol, 1983;101:1381–2.

Fluorescein ophthalmic solution                                                                                         

A 2% solution may be used to detect corneal abrasions, to fit contact lenses by direct application to the eye. It may also be used intravenously for fluorescein angiography. Maquire 1988 studied the breastmilk of a 29 year old mother who had an angiograph soon after delivering premature twins. She herself had lost central vision acutely soon after she gave birth. The fluorescein was detectable up to 76 hours after the procedure (half life 62 hours) . The peak concentration measured at 6 hours was 372 µg/L. This represents a milk/plasma ratio would be about 0.018 (Hale 2017) representing a small risk to the breastfed infant.

Compatible with use during breastfeeding, according to the results of limited studies.

Maquire AM, Bennett J. Fluorescein elimination in human breast milk. Arch Ophthalmol 1988; 106(6):718-719.

Anal fissures are very painful. They may initially be treated as piles but simple treatment does not heal them

PDF https://breastfeeding-and-medication.co.uk/wp-content/uploads/2024/06/anal-fissure-and-breastfeeding.pdf

Anal fissures are small tears in the inside in the lining of the large intestine near the anus. Sometimes they do not heal and produce severe pain. This may be treated with glyceryl trinitrate ointment (Rectogesic™) 0.2% or 0.4%. The ingredients may cause a headache and/or hot flush for the mother but there are no reports of adverse effects in babies whose mothers have applied it.

Use during breastfeeding is unlicensed.  It is assumed that diltiazem cream would similarly not affect the baby, but no research has been identified.

Both glyceryl trinitrate ointment and diltiazem cream are compatible with breastfeeding

References

•             Taylor T, Kennedy D. Safety of topical glyceryl trinitrate in the treatment of anal fissure in breastfeeding women. Birth Defects Research Part a-Clinical and Molecular Teratology. 2008; 82:411.

•             NICE 2% Topical diltiazem hydrochloride for chronic 2013: anal fissurehttps://www.nice.org.uk/advice/esuom3/resources/2-topical-diltiazem-hydrochloride-for-chronic-anal-fissure-pdf-17548582597

The pain and discomfort of piles after birth can make breastfeeding difficult. You do not need to avoid the over the counter products which do not pass significantly into breastmilk

PDF https://breastfeeding-and-medication.co.uk/wp-content/uploads/2024/06/haemorroids-and-breastfeeding.pdf

Haemorrhoids (piles) are common after birth, especially after an extended second stage of pushing. They can be incredibly painful or cause intense itching. They may also bleed. They can make breastfeeding difficult as it becomes too painful to sit for prolonged periods. They can also occur because of constipation due to taking strong opioid painkillers.

Symptoms according to the NHS https://www.nhs.uk/conditions/piles-haemorrhoids/

• bright red blood after you poo
• an itchy anus
• feeling like you still need to poo after going to the toilet
• mucus in your underwear or on toilet paper after wiping your bottom
• lumps around your anus
• pain around your anus

Simple measure that you can take include:

• drink lots of fluid and eat plenty of fibre or use bulk forming laxatives  to keep your poo soft https://breastfeeding-and-medication.co.uk/fact-sheet/constipation-laxatives-and-breastfeeding
• using soft wipes specially designed for wiping your bottom
• take paracetamol and ibuprofen
• take a warm bath to ease itching and pain
• use an ice pack wrapped in a towel to ease discomfort, some people recommend using frozen peas in a bag which can mould into your bottom

The over the counter remedies of creams, ointments and suppositories are all acceptable during breastfeeding despite what the manufacturer leaflet may suggest. Examples include Anusol™, Anusol HC ™, Preparation H ™, Germaloids™, Scheriproct™, Xyloproct™

Anusol has recently launched a product aimed at breastfeeding mothers but it is considerably more expensive, ” Anusol™ Natural Cream is a non-medicated formula that is safe to use during pregnancy and breastfeeding. “

 

this information is reproduced from my book Breastfeeding and Medication

pdf https://breastfeeding-and-medication.co.uk/wp-content/uploads/2024/06/vaccines.pdf

Vaccines have low bio-availability and absorption from breastmilk is unlikely in most circumstances other than with live vaccines. Cessation or interruption of breastfeeding is not normally required but individual regimens should be considered especially with yellow fever (Data taken from LactMed website [2012]; Martindale [2005]; Advisory Committee on Immunization Practices [ACIP]; CDC [Kroger 2006]; Advisory Committee on Immunization Practices [2006]). UK data are available in the Department of Health ‘The Green Book’ available on the internet (Plotkin and Orenstein 2004; Department of Health Green Book).

Although there is a theoretical risk of live vaccine being present in breastmilk, vaccination with common vaccines is not contra-indicated for women who are breastfeeding when there is significant risk of exposure to disease. There is no evidence of risk from vaccinating women who are breastfeeding, with inactivated viral or bacterial vaccines or toxoids (BNF).

References

•             Advisory Committee on Immunization Practices, MMWR Recomm Rep, 2006;55(RR15):1–48.

•             Immunisation against infectious disease – Department of Health Green Book 

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             Plotkin SA, Orenstein WA, Vaccines 4th edition, Philadelphia: WB Saunders, 2004 (cited in Department of Health Green Book chapter 34).

However, live vaccines should not be given to immunocompromised mothers or children exposed to biological drugs during pregnancy until after 6 months of age. See https://breastfeeding-and-medication.co.uk/fact-sheet/live-vaccinations-and-immunosuppressant-medication-taken-by-breastfeeding-mothers

               Measles, mumps and rubella     

Rubella vaccine virus can appear in breastmilk and result in infections in some infants (Buimovici-Klein et al. 1977). There is no evidence of mumps and measles vaccine viruses being found in breastmilk. Some breastfed infants acquire passive immunity to rubella after maternal vaccination, as do infants of mothers with natural rubella immunity. However, neither group of infants has a decreased response to rubella vaccine administered directly (Krogh et al. 1989). The CDC (Kroger et al. 2006) state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contra-indication to MMR vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules (Plotkin and Orenstein, 2004; Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Buimovici-Klein E, Hite RL, Byrne T et al. Isolation of rubella virus in milk after pospartum immunization, J Pediatr, 1977;91:939–41.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             Krogh V, Duffy LC, Wong D, Rosenband M, Riddlesberger KR, Ogra PL, Post-partum immunization with rubella virus vaccine and antibody response in breastfeeding infants, J Lab Clin Med, 1989;113(6):695–9.

Diptheria, tetanus and pertussis             

One study of previously vaccinated infants found that at 21 to 40 months of age breastfed infants had higher immunoglobulin G (IgG) levels against diphtheria, higher secretory IgA levels in saliva against diphtheria and tetanus and higher fecal IgM against tetanus than formula-fed infants (Hahn-Zoric et al. 1990).

Pisicane et al. (2010) found that breastfed infants were also less likely to have fever after immunisation than their non-breastfed counterparts. Lopez-Alarcon et al. (2002) found they were also less likely to experience loss of appetite and reduced energy intake after routine childhood immunisation than those who are not breastfed. Although baseline calorie intakes were higher in the formula-fed infants mean intakes fell by 12% in the post-immunisation period.

There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Kroger 2006; Plotkin and Orenstein 2004; Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Hahn-Zoric M, Fulconis F, Minoli I, Moro G, Carlsson B, Böttiger M, Räihä N, Hanson LA, Antibody responses to parenteral and oral vaccines are impaired by conventional and low protein formulas as compared to breastfeeding, Acta Paediatr Scand; 1990;1979:1137–42.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             López-Alarcón M, Garza C, Habicht JP, Martínez L, Pegueros V, Villalpando S, Breastfeeding attenuates reductions in energy intake induced by a mild immunologic stimulus represented by DPTH immunization: possible roles of interleukin-1beta, tumor necrosis factor-alpha and leptin, J Nutr, 2002;132:1293–8.

•             Pisacane A, Continisio P, Palma O, Cataldo S, De Michele F, Vairo U, Breastfeeding and risk for fever after immunization, Pediatrics, 2010;125:e1448–52.

               Meningococcal vaccination         

Immunisation of pregnant or lactating women with meningococcal vaccine increased the specific secretory IgA content of milk ( Shahid et al. 2002). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated virus or bacterial vaccines or toxoids (Granoff et al. 2004, Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Granoff DM, Feavers IM, Borrow R, Meningococcal vaccines. In: Plotkin SA, Orenstein WA, Vaccines 4th edition, Philadelphia: WB Saunders, 2004 (cited in Department of Health Green Book, 959–88).

•             Shahid NS, Steinhoff MC, Roy E, Begum T, Thompson CM, Siber GR, Placental and breast transfer of antibodies after maternal immunization with polysaccharide meningiococcal vaccine: a randomized, controlled evaluation, Vaccine, 2002;20:2404–9.

Typhoid vaccination        ☺

Recommended as compatible with breastfeeding by the CDC and the American Academy of Pediatrics (AAP). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Kroger 2006; Plotkin and Orenstein 2004; Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Immunisation against infectious disease – Department of Health Green Book 

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

Influenza vaccination    

Use of live, attenuated or inactivated vaccine is recommended as compatible with breastfeeding by the CDC and the AAP. There is no evidence of risk from vaccinating pregnant women, or those who are feeding, with inactivated viral or bacterial vaccines or toxoids (Plotkin and Orenstein 2004). Where possible, pregnant women should receive a thiomersal-free influenza vaccine (Department of Health Green Book ).

Compatible with use during breastfeeding.

References

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

BCG vaccination             

BCG vaccination against tuberculosis is recommended as compatible with breastfeeding by CDC and the AAP (Kroger 2006). Although no harmful effects on the foetus have been observed from BCG during pregnancy, it is wise to avoid vaccination, particularly in the first trimester, and wherever possible to delay until after delivery. Breastfeeding is not a contraindication to BCG (Plotkin and Orenstein 2004; Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

Pneumococcal vaccines

Some evidence of decreased pneumococcal disease has been found among breastfed infants of vaccinated mothers (Lehmann et al. 2003). Pneumococcal-containing vaccines may be given to pregnant women when the need for protection is required without delay. There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Kroger 2006; Plotkin and Orenstein 2004; Department of Health Green Book).

Compatible with use during breastfeeding.

References

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             Lehmann D, Pomat WS, Riley ID, Alpers MP, Studies of maternal immunisation with pneumococcal polysaccharide vaccine in Papua New Guinea, Vaccine, 2003;21:3446–50.

Varicella vaccine            

Recommended as compatible with breastfeeding by the CDC and the AAP (Kroger 2006). Women who are pregnant should not receive varicella vaccine and pregnancy should be avoided for 3 months following the last dose. Studies have shown that the vaccine virus is not transferred to the infant through breastmilk (Bohlke et al. 2003) and therefore breastfeeding women can be vaccinated if indicated (Plotkin and Orenstein 2004; Department of Health Green Book ).

Compatible with use during breastfeeding.

References

•             Bohlke K, Galil K, Jackson LA, Schmid DS, Starkovich P, Loparev VN, Seward JF, Vaccine Safety Data link Team. Post-partum varicella vaccination: is the vaccine virus excreted in breastmilk?, Obstet Gynecol, 2003;102 (5 Pt 1):970–7.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

Yellow fever vaccine     

Until 2009 no adverse effects to yellow fever vaccine had been reported in infants exposed via breastfeeding. In 2009, the first case of meningoencephalitis caused by the yellow fever vaccine virus transmitted via breastmilk was confirmed.

Traiber et al. reported on a 38-day-old infant who was exclusively breastfed by a mother who had received yellow fever vaccination, the baby was discharged when convulsions resolved.

Kuhn et al. reported a case study of a previously healthy 5-week-old baby admitted to hospital with a 2-day history of fever and irritability, he subsequently fitted in the emergency department. When the baby was 10 days of age his mother was given travel vaccinations including yellow fever for a holiday to Venezuela. Hospital tests showed symptoms consistent with encephalitis. His symptoms resolved following a 21-day course of aciclovir.

The CDC (Kroger 2006) recommend against vaccinating nursing mothers with yellow fever vaccine before the baby is 6 months of age. However, if travel by the nursing mother to a high-risk yellow fever endemic area cannot be avoided or postponed, the mother may be vaccinated. Exposure to yellow fever vaccine via breastmilk would not increase the risk to an infant who receives the vaccination after the age of 6 months (Plotkin and Orenstein 2004, Department of Health Green Book ).

Compatible with use during breastfeeding. Avoid in first 6 months unless essential.

References

•             Centers for Disease Control and Prevention (CDC), Transmission of yellow fever vaccine virus through breastfeeding – Brazil, 2009, MMWR Morb Mortal Wkly Rep, 2010;59:130–32.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             Kuhn S, Twele-Montecinos L, MacDonald J, Webster P, Law B,Case report: probable transmission of vaccine strain of yellow fever virus to an infant via breastmilk, CMAJ, 2011;183(4):E243–5.

•             Staples JE, Gershman M, Fischer M, Centers for Disease Control and Prevention (CDC). Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR, 2010;59 (RR-7):1–27.

•             Traiber C, Amaral PC, Ritter VR, Winge A, Infant meningoencephalitis probably caused by yellow fever vaccine virus transmitted via breastmilk, J Pediatr (Rio J), 2011;87:269–72.

Hepatitis B vaccine        

Recommended as compatible with breastfeeding by the CDC and the AAP (Kroger 2006). Breastfed infants of hepatitis B surface antigen positive mothers have a different response in the development of Ig subtypes after vaccination with hepatitis B vaccine than do formula-fed infants. However, breastfeeding does not interfere with the infant’s antibody response to hepatitis B vaccine (Azarri et al. 1990; Wang et al. 2003). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Plotkin and Orenstein 2004; Department of Health Green Book ).

Compatible with use during breastfeeding.

References

•             Azzari C, Resti M, Rossi ME et al. Modulation by human milk of IgG subclass response to hepatitis B vaccine in infants, J Pediatr Gastroenterol Nutr, 1990;10:310–15.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             Wang JS, Zhu QR, Wang XH, Breastfeeding does not pose any additional risk of immunoprophylaxis failure on infants of HBV carrier mothers, Int J Clin Pract, 2003;57(2):100–102.

Hepatitis A vaccine        

Recommended as compatible with breastfeeding by the CDC and the AAP (Kroger 2006). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Plotkin and Orenstein 2004; Department of Health Green Book )

Compatible with use during breastfeeding.

References

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

Cholera vaccine

Use of oral cholera vaccine to the mother decreased the risk of cholera in their breastfed infants by 47% in one study (Clemens et al. 1990). The authors hypothesised that vaccination of the mothers reduced their transmission of cholera to their infants. There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Kroger 2006; Plotkin and Orenstein 2004; Department of Health Green Book ).

Compatible with use during breastfeeding.

References

•             Clemens JD, Sack DA, Chakraborty J, Rao MR, Ahmed F, Harris JR, van Loon F, Khan MR, Yunis M, Huda S, Field trial of oral cholera vaccines in Bangladesh: evaluation of anti-bacterial and anti-toxic breastmilk immunity in response to ingestion of the vaccines, Vaccine, 1990;8:469–72.

•             Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

Polio vaccine    

Two types of poliomyelitis vaccine are available: inactivated poliomyelitis vaccine (for injection in combination with diphtheria vaccine) and live (oral) poliomyelitis vaccine.

Administration of oral poliovirus vaccine to nursing infants is less effective if it is given the neonatal period, due to maternal antibodies in colostrum and breastmilk (WHO 1995; Zaman et al. 1991). However, breastfeeding does not interfere with the infant’s response to oral polio vaccine, when given at the normal scheduled times (Kim-Farley et al. 1982; John et al. 1976). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids according to the CDC and the AAP (Kroger et al. 2006) and the Department of Health Green Book (Plotkin and Orenstein 2004; Department of Health Green Book  )

Compatible with use during breastfeeding.

References

•             John TJ, Devarajan LV, Luther L, Vijayarathnam P, Effect of breastfeeding on seroresponse of infants to oral poliovirus vaccination, Pediatrics, 1976;57:47–53.

•             Kim-Farley R, Brink E, Orenstein W, Bart K, Vaccination and breastfeeding, JAMA, 1982;248:2451–2. Letter.

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

•             World Health Organization Collaborative Study Group on Oral Poliovirus Vaccine, Factors affecting the immunogenicity of oral poliovirus vaccine: a prospective evaluation in Brazil and the Gambia, J Infect Dis, 1995;171:1097–1106.

•             Zaman S, Carlsson B, Jalil F, Jeansson S, Mellander L, Hanson LA, Specific antibodies to poliovirus type I in breastmilk of unvaccinated mothers before and seven years after start of community-wide vaccination of theirinfants with live, oral poliovirus vaccine, Acta Paediatr Scand, 1991;80:1174–82.

Japanese encephalitis vaccine  

Recommended as compatible with breastfeeding by the CDC and the AAP (Kroger 2006) and the Department of Health Green Book (2013). There is no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated viral or bacterial vaccines or toxoids (Plotkin and Orenstein 2004).

Compatible with use during breastfeeding.

References

•             Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR Recomm Rep, 2006;55(RR-15):1–48.

The development of anaesthetic data was prompted at least in part by the questions from mothers are diagnosis, treatment and surgery for gallstones whilst pregnant. Women are more likely than men to have gallstones and they are more common after the birth of several children so unsurprisingly this frequently covers breastfeeding mothers.

So here are my thoughts and a fact sheet on the topic

gallstones and breastfeeding fact sheet

Gallstones are present in at least 10% of the population. They vary in size and shape and consist primarily of cholesterol or the bile pigment bilirubin. They occur twice as frequently in women as men. Risk factors include high cholesterol intake, obesity, having had several children and the use of oral contraceptives (Gould 2006).

Symptoms of gallstones

Gallstones frequently cause no symptoms but larger calculi (stones) can obstruct a duct causing sudden severe waves of pain in the upper right-hand side of the abdomen (just under the ribs) often radiating to the back and right shoulder.  Feeling sick or vomiting, with a high temperature, shivering and sweating are also common.

Severe pain (biliary colic) may be precipitated by eating a fatty meal. Chronic symptoms may include intolerance to fatty foods, belching, bloating and mild epigastric pain.

Treatment is usually necessary if gallstones are causing symptoms – such as abdominal pain or complications – such as jaundice or acute pancreatitis

In these cases, keyhole surgery to remove the gallbladder may be recommended. This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications. It is possible to lead a perfectly normal life without a gallbladder. The liver will still produce bile to digest food, but the bile will just drip continuously into the small intestine, rather than build up in the gallbladder (NHS www.nhs.uk/conditions/gallstones/#treating-gallstones)

Diagnosis of gallstones

Apart from acute symptoms often requiring emergency admission, diagnosis is by Ultrasound, MRI and CT scans all of which can be undertaken without interruption to breastfeeding together with blood tests. https://breastfeeding-and-medication.co.uk/fact-sheet/breastfeeding-after-ct-and-mri-scans

Treatment of gallstone

Simple over the counter painkillers (paracetamol and ibuprofen) may be sufficient. Anti spasmodic drugs may also be prescribed e.g. Hyoscine (Buscopan®). Anti nauseants e.g. cyclizine or ondansetron may be required. All can be used with continued breastfeeding (Jones 2018)

Ursodeoxycholic acid has been used for the management of gallstone disease, there is no evidence to support its use.

Surgery for gallstones

A laparoscopic cholecystectomy involves only small cuts in the abdomen to pass the instruments. It is normally carried out as a day case enabling return home on the same day or at most after an overnight stay. Full recovery takes around 10 days and mothers may need help with lifting and caring for toddlers.

It is possible to breastfeed as soon as the mother is awake and alert after surgery as the drugs stay in the system a short time. Doses of antibiotics and painkillers may be administered in theatre or in recovery, but these would normally be suitable for breastfeeding.

Analgesia (pain relief) after surgery for gallstones

Response to pain after surgery is very individual. The use of paracetamol plus non- steroidal drugs such as ibuprofen, naproxen and diclofenac may be sufficient for some. Others may need opiate drugs. Oramorph and dihydrocodeine are the preferred drugs during breastfeeding. Codeine should not be prescribed https://breastfeeding-and-medication.co.uk/fact-sheet/pain-relief-when-breastfeeding

It is not acceptable to prescribe a drug which is unsuitable to be taken by breastfeeding mother as there are risks to not continuing normal breastfeeding (risk of engorgement or mastitis, risk baby will not take milk from a bottle, risk of allergy on exposure to artificial formula) but above all prescription should be in accordance with the stated wishes of the mother to continue to feed as normal.

For more information on anaesthetics, anti-nauseants and analgesics see https://breastfeeding-and-medication.co.uk/fact-sheet/anaesthesia-and-breastfeeding and https://breastfeeding-and-medication.co.uk/fact-sheet/pain-relief-when-breastfeeding

References

Gould  B.E. Pathophysiology for the Healthcare professional 3^RD Ed Elsevier 2006

Hale TW Medications and Mothers Milk Springer 18^th Ed  2019

Jones W Breastfeeding and Medication 2^nd Ed Routledge 2018

LactMed actmed.nlm.nih.gov

NHS Choices – Gallstones www.nhs.uk/conditions/gallstones/

NICE Gallstone disease: diagnosis and management CG188 2014

Pdf https://breastfeeding-and-medication.co.uk/wp-content/uploads/2024/06/vaginal-thrush-and-bf.pdf

Most women have suffered the intense itching associated with vaginal thrush. It can also cause a white vaginal discharge (often described as like cottage cheese), which does not usually smell. It can also sting when you pass urine or have sex. It is a fungal infection but can occur after antibiotics, during hot weather or after wearing tight jeans regularly. It can also be caught from your partner during intercourse particularly if this has been maybe rapid or over enthusiastic. As an undergraduate I had this described as “honeymoon disease” but that was maybe in a different era!

It is not harmful but can be very uncomfortable. Some people experience symptoms more frequently than others.

Treatment:

Many treatments can be purchased over the counter rather than needing a GP appointment. The leaflets may say “ ask your GP or pharmacist if you are breastfeeding” which relates to licensing application rather than risk

• Vaginal creams and pessaries containing clotrimazole (Canesten™)
• External creams eg clotrimazole (Canesten™), Vagisil™
• Single dose antifungal medication containing fluconazole (Canesten Once™, Diflucan™, Own brands
• Combinations of internal and external creams, oral tablet and cream

Your partner can be treated with clotrimazole cream applied to the penis and extra lubrication during sex may help.

One natural remedy often recommended is to apply live, natural yoghurt on a tampon to restore natural flora and to eat live yoghurt/ take probiotics. Cotton pants, loose clothing and even going commando helps. Do not try to be over enthusiastic about wiping after going to the loo and try not to scratch as this will further damage the skin. Symptoms should resolve within a week