Breastfeeding While Taking Immune Suppresants

Prednisone, Side Effects Prednisone, ITP and Prednisone, breastfeeding with ITP - Itp and pregnancy, pregnancy complications, pregnancy information

Are you pregnant or trying to get pregnant while taking the immune suppressant steroid Prednisone? There is so much you need to be thinking about right now, wondering if you will able to breastfeed after the baby is born is just another consideration that needs to be investigated.

Question

Is it safe to breastfeed my baby while I am taking Prednisone?

1. The Quick Answer – Yes.

2. The Real Answer – There is a very big difference between a drug being ‘SAFE’ and and drug being ‘GOOD’ for you and your baby.  Just because a drug is classified as safe, should I still take it?  There is a very big difference between something being proven to be good for you and scientists not being able to prove it’s bad for you.

Just because it is ‘safe’ should I do it? – 

Though many drugs are quite safe for a mother to take while nursing her child there are several agents for which ‘safety’ during breast-feeding is not well-defined and may be a risk to the infant.  What is safe for one person may not be safe for another.  Prednisone, according to every medical doctor I have talked to, is safe to consume while pregnant and breast feeding.  There is evidence that a small amount of the drug can pass through the breast milk and into the blood stream of the feeding child, an amount small enough for doctors to consider the drug safe.  However, I found the contributions of MotherRisk.org quite relevant to this discussion.  ‘Even if only a small amount of the drug were to be excreted into the milk, the inherently toxic nature of these medications warrants caution with their use.’

Prednisone is not ‘Good’ for me and I am sure it is not ‘Good’ for you either.

It is not recommended to take Prednisone over a long period of time.  All my doctors are aiming to get me off prednisone eventually; and even years without a break from Prednisone raises eyebrows in even the most ignorant of pharmaceutical enthusiasts.  Prednisone has side effects – it damages my skin, nails, hair, liver, adrenal glands and immune system.  So how ‘safe’ is that?

Deciding for Yourself – 

Prednisone can travel through the mother’s milk to the baby.  It may be a very small amount but it is still there.  And if it is something that you are worried about then you should ask about it.  Don’t let a doctor disregard your concerns because they have seen it all before.  If there is one thing I have learnt from going to doctors for the last 7 years is that if there is a chance that things might go wrong, then there is an actual chance that things might go wrong.

It is a decision that you and your partner should make with all the information you can possibly gather and all the advice you can find from as many different people.  Breast milk is always best for the child.  But what if your breast milk was not like everyone else’s breast milk?

Prednisone, Side Effects Prednisone, ITP and Prednisone, breastfeeding with ITP, ITP and kids

Things to consider when you are researching and looking into breastfeeding while taking prednisone is how much medication are you taking?  What time of the day you are taking the medication?  What is your approach to feeding (Demand feeding Vs feeding on a schedule)   How quickly do you metabolise your medications and food?  Also consider the age of your baby – premature babies are always the most vulnerable.

The levels of Prednisone in your blood will be highest approximately 1 hour after you consume the drug.  Which means you may simply need a plan, one that will involve being strict about the times of feeding and make sure there is a long space between taking prednisone and feeding the baby.

Consider the Alternative –

What will you give your child if you choose not to feed them breast milk?  Formula?  What are the risks with that?  The Australian Breastfeeding Association recommend that each mother take an and to analysis each situation individually with pharmacists, doctors and lactation specialists.

Itp and pregnancy, pregnancy complications, pregnancy information, pregnancy facts, itp pregnancy complications, Pregnancy and immune suppressants, Breastfeeding HelplineMany common prescription and over-the-counter medications are compatible with breastfeeding.  Mothers who need to take medication while breastfeeding should consult with a pharmacist or a specialist drug information helpline for advice relevant to their particular situation. The use and potential risks of any medication, illegal drugs, cigarettes or alcohol in a breastfeeding mother require a careful risk/benefit analysis. For example, the known risks of the use of artificial baby milk need to be considered if used in place of breast milk.  There is even a Helpline you can call to talk to someone about your concerns.

Lactation specialists who work with women who are taking medications and drugs to make the best plan possible for them, and give the feeding/non-feeding parents as much information as possible so that they can make an informed and comfortable choice in regards to the care of their child.

Importantly – you need to remind yourself of the importance of taking your medication and the risks involved in not taking them.  Are those risks greater than the risk of not taking your medication at all.

Keep Reading – What others are Saying…

Below is a small collection of information gathered from websites, forum posts and blogs online from medical professionals and other mothers who are going through the same experience.  While there seems to be no definitive Yes or No answer, as with many things to do with ITP, I did think this offered a great platform to begin your own research and make up your own mind about what is right for you and your baby.

A Circle of Mums

Yes. Small amounts of prednisone and prednisolone enter breast milk. Prednisone is very similar to the body’s naturally occurring hormones, which are necessary for milk production and the health of infants. Since people produce these hormones naturally, it is not expected that the amount of prednisone or prednisolone in the breast milk would cause harmful effects in the nursing infant or the mother’s milk production.
The amount of prednisone or prednisolone in breast milk is highest approximately one hour after taking the medicine. To limit the amount in the breast milk, you can wait four hours after taking prednisone or prednisolone before breastfeeding your baby. Keeping your dose as low as possible will also help to limit the amount of medicine in your breast milk.
The American Academy of Pediatrics classifies prednisone and prednisolone as usually compatible with breastfeeding.  A Circle of Mums

The Infant Risk Centre

Small amounts of most corticosteroids are secreted into breastmilk. Following a 10 mg oral dose of prednisone, peak milk levels of prednisolone and prednisone were 1.6 µg/L and 2.67 µg/L, respectively.  In a group of 10 women who received 10-80 mg/d prednisolone, the milk levels were only 5-25% of the maternal serum levels.

In one patient who received 80 mg/day prednisolone, the Cmax at 1 hour was 317 µg/L. The AUC average milk concentration in this mother was 156 µg/L over 6 hours.[2] This is significantly less than 2% of the weight-normalized maternal dose. Because this last estimate was only determined over 6 hours and this dose was administered once each 24 hours, the total daily estimate would be much less than the 2% estimate.In small doses, most steroids are certainly not contraindicated in nursing mothers. Whenever possible use low-dose alternatives such as aerosols or inhalers. Following administration, wait at least 4 hours if possible prior to feeding infant to reduce exposure. With high doses (>40 mg/day), particularly for long periods, steroids could potentially produce problems in infant growth and development, although we have absolutely no data in this area, or which doses would pose problems. Brief applications of high dose steroids are probably not contraindicated as the overall exposure is low. With prolonged high dose therapy, the infant should be closely monitored for growth and development.  The Infant Risk Centre

Mom, Parenting & Breastfeeding

Posted on this website is a list of drugs that have been approved by the AAP for consumption during lactation.  Prednisolone is on the list as being approved, but there is no further information.  I could not find Immuran on the list, but it does say that the list is very general.

Mommies with Experience Breastfeeding on Prednisone

‘In general, my anxiety was heightened from the prednisone and I am just so worried about my baby even more so than before. I’m breastfeeding to benefit him not to hinder him in anyway. I am so sad breastfeeding has been so wonderful so far and now with this flare it is turning into a nightmare I don’t want to give up because of fear of something that may not even be an issue. I would feel even worse then.’

‘I’m thinking if he puts me on a higher dose (of Prednisone) that could potentially be a problem I could pump and dump (formula feed) for several hours after taking the meds then breastfeed at night and in the morning before I take my dose.’

Everyone is Different –

Like with everything to do with ITP, there is no simple straight forward answer.  Everything you do while being treated for ITP and especially when you are pregnant will depend of what your Doctors and Haematologists recommend at the time.  It makes sense to look for as much information as possible online – but please remember that everyone is different.

by Meg

Meghan Brewster is a writer and blogger. She is an ITP patient and launched ITP&Me in 2011. She is a coffee lover and a try hard dancer. @meghan_brewster

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