Breastfeeding and Medication Use in Kidney Disease

Abstract

Pregnancy in CKD is a condition fraught with challenges including multiple medications, high-risk pregnancy followed by maternal and fetal compromise such as preterm delivery, and low birth weight infant. Breastfeeding is unique in its impact on the mother and the baby, their bonding, and future health implications impacting the society. Breast milk is produced specific for the infant by the biological mother. It changes in composition with lactation stage and leads to optimal growth of the baby including establishing circadian rhythms, getting protective antibodies, and establishing a healthy gut microbiome. Multiple hormones influence the composition of the milk. Lactation is maintained by removal of the milk. Blood-milk barrier allows for the specific composition of milk by transporting different sized molecules through different mechanisms. It is safe to assume that most medications will be found in some amount in human milk; however, the impact of that is usually not enough to justify stopping breastfeeding. When the mother's milk is not available, formula or donor milk can be considered. There are resources to guide the use of medications during lactation that the providers should be aware of and use, to guide medication and breastfeeding recommendations.

Case report: Applicability of breastfeeding the child of a patient with kidney failure with replacement therapy

“…Breastfeeding in KFRT is challenging, not only due to the impact of the hemodialysis procedure but also due to the adverse effects of drugs on infants and lactation itself. Experts also raise concerns about the mother's ability to feed her baby, given her clinical condition after a complicated, high-risk pregnancy (4).…”

“…From an evolutionary and nutritional perspective, exclusive breastfeeding during the first 6 months of life has been recognized as the gold standard of infant nutrition (2). The benefits and indispensability of breastfeeding for the harmonious development of the child have been confirmed by numerous studies (3)(4)(5). Milk promotes optimal growth of the child, including the establishment of circadian rhythms, the production of protective antibodies, and the formation of a healthy gut microbiome (6).…”

Efektivitas Daun Kelor Terhadap Produksi Asi Pada Ibu Menyusui di Puskesmas Simpang Mamplam Bireuen

“…Menurut Survei Nasional 2016, tingkat pemberian ASI eksklusif di kalangan wanita selama bulan pertama setelah melahirkan mencapai 66,2%, menunjukkan hasil yang memuaskan (Chu, Sheu, Hsu, Liao, & Chien, 2019). Menyusui adalah tantangan, unik dalam dampaknya pada ibu dan bayi, ikatan mereka dan implikasi kesehatan di masa depan yang berdampak pada perilaku baik di masyarakat (Singh, 2020).…”

Excretion of Ergometrine Maleate Injection into Breast Milk and Safety Evaluation of Breastfeeding

“…Breast milk is an ideal food for the healthy growth and development of infants. Studies have shown that the bene ts of breastfeeding include but are not limited to: the reduction of childhood infections (upper respiratory disease, otitis media, and gastroenteritis) and allergies, higher cognitive function and improved neurocognitive [1][2][3] in newborns, of importance to the growth, active and passive immunity, the establishment of circadian rhythms, as well as cognitive and psychosocial development among newborns. [4] However, some drugs can affect the infant through breast milk.…”

“…Generally speaking, drugs with a short half-life period, strong protein binding capacity, low oral bioavailability to infants, high molecular weight, and relative infant dose (RID) of less than 10% are safe for breastfed infants. [3,5,6] The nal dose encountered by an infant must be determined with respect to both the milk secretion rate and the disposition of the drug in the infant. [5,6] Prolactin (PRL) is a polypeptide hormone synthesized and released from the anterior pituitary gland that regulates lactation, reproduction, metabolism, immune responses, and electrolyte balance.…”