High-Dose Methotrexate Treatment in a Breastfeeding Mother with Placenta Accreta: A Case Report.

Methotrexate is a rather dangerous drug and must be used really cautiously, particularly in pregnant and breastfeeding mothers.  We get this call all the time in breastfeeding mothers using this drug.  Fortunately we found  this mother who was willing to give milk samples following high dose therapy for Placenta Accreta.   This mom received 92 mg methotrexate following delivery.  Interestingly,  milk levels were really low.  This is an antifolate drug used in many diseases,  and is quite risky around pregnant women and previously I thought in breastfeeding mothers.  This data suggests that milk levels of methotrexate, even following this high dose,  are quite low (RID= 0.11%).  This was one of those questions I always hated to answer,  because we had NO data on its transmission into human milk, and its relatively dangerous.   Seems its levels in milk are very low.  We still need to be cautious,  but I can rest a bit easier now.   TWH

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Transfer of Inhaled Cannabis Into Human Breast Milk.

First, you must know that doing research with Cannabis products is virtually impossible in the USA today.  The effect of all the governmental legal restrictions, virtually stops all research.  We were most fortunate to find a wonderfully supportive group of lactation consultants and cannabis using moms in Colorado,  who helped us find breastfeeding mothers who were using this product while breastfeeding.  Nine of these moms followed our directions, and provided milk samples.  This is one of the first really accurate assessments of THC transfer into human milk.  W

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Estimation of Riluzole Levels in Human Milk and Infant Exposure During Its Use in a Patient With ALS.

This drug is a rather unusal compound that is ONLY used thus far for treating  Amyotrophic lateral sclerosis.  I was moved that a patient with ALS called and was continuing to breastfeed her infant, and wanted information about this drug in breastfeeding.  We found that levels of Riluzole were quite low.  Thanks to this heroic mom for providing milk samples during this difficult period of her life.  TWH

 

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Minimal to no transfer of certolizumab pegol into breast milk: results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study.

Certolizumab is an interesting IgG molecule,  that is used to treat various autoimmune disorders, ulcerative colitis, Crohn's disease.   This product is rather unique, in that the transporter piece of the molecule that binds to various transporter receptor sites in humans, was clipped off.  Thus certolizumab is not readily transferred via the placenta in the last trimester to the fetus.  Its transfer into the milk compartment is blunted as well.  This appears to be a good product to use in pregnant and breastfeeding mothers.  (Disclaimer:  I was involved in the d

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Transfer of Low Dose Aspirin Into Human Milk.

The InfantRisk Center gets lots of calls on aspirin, both 81 mg and 325 mg/day doses.  We who work in Pediatrics, have for 50 years worried about the risk of Reye syndrome,  that occurred many years ago following the use of aspirin in infants and childern while treating fever in viral syndromes.  This was an interesting study for us, because we were totally unable to find ANY acetylsalicylic acid in the breastmilk of mothers consuming aspirin.

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Transfer of Montelukast into Human Milk During Lactation.

Montelukast is a commonly used drug in allergies,  and as you know, eveyone has allergies.  This data shows that levels in milk are really quite low (RID = 0.68)  and there is no obvious risk to a breastfeeding infant.  TWH

 

Title: Transfer of Montelukast into Human Milk During Lactation.

Authors: Datta P, Rewers-Felkins K, Baker T, Hale TW.

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Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis.

I always worry about HIGH doses of any drug.  We frequently receive calls from mothers undergoing 1000 mg IV doses of methylprednisolone for MS.

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Transfer of natalizumab into breast milk in a mother with multiple sclerosis.

Natalizumab is a monoclonal antibody that is only used in humans with multiple sclerosis.  It is somewhat toxic, and we were interested to see if this large monoclonal antibody transfers into human milk.  Levels in milk appear low,  but I made a mistake in the timing of the study, and should have drawn milk levels several mosts longer.  I need to redo this study and go out to about 120 days.   However, at this point, I still think milk levels are subclinical.   TWH

 

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Transfer of linezolid into breast milk.

This is one of the InfantRisk Centers studies.  We found that levels of linezolid in human milk are really low.  Good news if a mom needs this drug.   TWH

 

Title: Transfer of linezolid into breast milk.

Authors: Rowe HE, Felkins K, Cooper SD, Hale TW.

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Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism.

All of us who work in pediatrics know that adequate thyroid function in a newborn is absolutely critical for the infants development.  Nothing is worse than hypothyroidism in a newborn infant.  While the infant needs low to modest levels of potassium iodine to make all the thyroxin it needs,  TOO MUCH iodine basically shuts the infant thyroid down.  Remember,  there is a pump in the human breast that collects all iodine molecules that pass the mothers breast and transfers that iodine molecule into the milk.  This was nature's way to make sure the baby could make

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