There are many issues to consider during pregnancy and breastfeeding.
What is the risk: benefit ratio to the mother and the fetus of treating versus not treating the infection? In some cases - for example, if the woman has a trichomoniasis infection during pregnancy - the morbidity can severely impact on the pregnancy's outcome, so that it would be imperative to treat the infection.
Which trimester of pregnancy is it? Drugs can have a different effect and/or impact on the fetus depending on the stage of pregnancy. For example, non-steroidal agents such as ibuprofen may be harmful to the fetus when given in the final few weeks of pregnancy, as they can cause fetal ductus arteriosus in utero.
How long has the drug been on the market? Generally, the longer a product has been licensed, the more data there are available on its safety profile. Many drugs will not be licensed for use in women who are pregnant or breastfeeding, as companies cannot ethically study this, so that most prescribing is based on clinical experience and data from accidental exposure. However, it is a requirement for licensing that potential teratogenicity is studied in animal models, although this does not always correlate with toxicity in humans.
What is the excretion profile of the drug? Not all drugs are excreted in breast milk. For some drugs it may be possible to predict how long after dosing before a drug appears in the breast milk. In this case, the mother may be able to express milk for the infant during the 'safe window'.
What is the age or health of the infant? The same drug may affect the infant differently depending on their age. Infants that are born prematurely may be more sensitive to a drug's effects.
What is the proportion of feeding that is breastfeeding? It is best practice to use drugs that are licensed in pregnancy or lactation where possible, and to always inform the mother of the issues concerned.
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For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.