Contraindications to breast feeding. Dr. Ahmed Isam

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1 Contraindications to breast feeding Dr. Ahmed Isam

2 When should a mother avoid breastfeeding? Health professionals agree that human milk provides the most complete form of nutrition for infants, including premature and sick newborns. However, there are rare exceptions when human milk is not recommended. Under certain circumstances, a physician will need to make a caseby-case assessment to determine whether a woman's environmental exposure or her own medical condition warrants her to interrupt or stop breastfeeding.

3 Breastfeeding is NOT advisable if one or more of the following conditions is true: infant diagnosed with galactosemia, The infant whose mother: Has been infected with the human immunodeficiency virus (HIV) Is taking antiretroviral medications Has untreated, active tuberculosis infected with human T-cell lymphotropic virus type I or2 Is using or is dependent upon an illicit drug

4 Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding Relative The presence of a herpes simplex lesion on the breast infants may feed from the opposite breast if it is free of lesions

5 TB and breast feeding According to the Center for Disease Control (CDC), breastfeeding mothers receiving treatment with first line anti-tuberculosis drugs can continue breastfeeding. The concentrations of first line anti-tuberculosis drugs in breast milk are too small to be toxic to the child.

6 Human Immunodeficiency Virus (HIV), and Acquired Immunodeficiency Virus (AIDS) Should a woman infected with HIV breastfeed her baby? The CDC policy continues to be that HIV-infected women in the United States should not breastfeed their infants. Should a woman who has been exposed to HIV during her pregnancy or around the time of delivery breastfeed her baby? No. CDC recommends that infected women in the United States refrain from breastfeeding to avoid postnatal transmission of HIV-1 to their infants through breast milk.

7 Until recently, (WHO) advised HIV-positive mothers to avoid breastfeeding if they were able to afford, prepare and store formula milk safely. But research has since emerged, that shows that a combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmitting HIV to babies through breastfeeding. On 2009, WHO released new recommendations on infant feeding by HIV-positive mothers, WHO is recommending that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old. This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV.

8 human T-cell lymphotropic virus type I or2 Human T-lymphotropic virus type I (HTLV-I), a causative agent of adult T-cell leukemia, (ATL) is transmitted from mother to child. ATL cells originate from the CD4 subset of peripheral T cells. The main route of mother-to-child transmission is postnatal breast-feeding. Refraining from breast-feeding or limiting the duration of breastfeeding can reduce the risk of mother-to-child transmission. Other than postnatal breast-feeding, there seem to be two routes of HTLV-I transmission from mother to child. One is intrauterine transmission, and the other is via saliva. Intrauterine transmission is rare,

9 Babies with galactosemia. Galactosemia is a rare genetic disease. Babies with galactosemia are unable to digest galactose, a sugar found in breast milk, and must be fed galactose-free formula. Knowing that early diagnosis leads to early treatment, babies are screened for galactosemia at birth. Although galactosemia is a permanent condition, it is easily managed with a galactosefree diet.

10 Babies with phenylketonuria. Phenylketonuria (PKU) is a metabolic disease. Babies with PKU cannot digest the amino acid, phenylalanine, and must be fed phenylalanine-free formula. Unlike babies with galactosemia who must be formula-fed, babies with certain types of PKU can partially breastfeed. However, the amount of phenylalanine in the baby s blood must be periodically measured to ensure that it is below a certain level.

11 Lactose intolerance in babies Primary (or true) lactose intolerance This extremely rare genetic condition is incompatible with normal life unless there is medical intervention. A truly lactose-intolerant baby would fail to thrive from birth (ie not even start to gain weight) and show obvious symptoms of malabsorption and dehydration. This is a medical emergency and the baby would need a special diet from soon after birth.

12 Secondary lactose intolerance Because the enzyme lactase is produced in the very tips of the microscopic folds of the intestine, anything that damages the gut lining can cause secondary lactose intolerance., for example: Gastroenteritis. Food intolerance or allergy. In breastfed babies, this can come from food proteins, such as in cows' milk, wheat, soy or egg, or possibly other food chemicals that enter breast milk from the mother's diet, as well as from food the baby has eaten. Parasitic infection such as giardiasis or cryptosporidiosis. Coeliac disease (intolerance to the gluten in wheat and some other grain products). Following bowel surgery.

13 Secondary lactose intolerance is temporary, as long as the gut damage can heal. When the cause of the damage to the gut is removed, for example by taking the food to which a breastfed baby is allergic out of the mother's diet, the gut will heal, even if the baby is still fed breast milk. If your doctor does diagnose 'lactose intolerance', continuing to breastfeed will not harm your baby as long as she is otherwise well and growing normally.

14 Rare metabolic diseases methylmalonyl-coa mutase deficiency, ornithine carbamoyltransferase deficiency, propionic acidaemia, isovaleric acidaemia, maple syrup urine disease glutaric acidemia type I Breastfeeding of infants with inborn errors of protein catabolism is feasible, but it needs close monitoring with attention to such clinical parameters as growth, development and biochemistry, including amino acids, organic acids and ammonia.

15 Specific Diseases and Conditions Breast Augmentation Exposure to Environmental Toxins Food-borne and Waterborne Illness during Breastfeeding Hepatitis B and C Malaria Prescription Drug Use Tobacco Use Toxoplasmosis West Nile Virus

16 Breast Augmentation Do a mother's silicone breast implants pose a risk for her breastfeeding infant? There have been no recent reports of clinical problems in infants of mothers with silicone breast implants. Therefore, in 2001, the American Academy of Pediatrics (AAP) issued a statement regarding the Transfer of Drugs and Other Chemicals Into Human Milk indicating that there was insufficient evidence to justify classifying silicone implants as a contraindication to breastfeeding. Researchers noted that silicon is present in higher concentrations in cow's milk and infant formula than in human milk expressed from mothers with silicone breast implants.

17 Exposure to Environmental Toxins While some women may have detectable levels of chemical agents in their breast milk, no established "normal" or "abnormal" levels exist to aide in clinical interpretation. Breastfeeding is still recommended despite the presence of chemical toxins. The toxicity of chemicals may be most dangerous during the prenatal period and the initiation of breastfeeding. However, for the vast majority of women the benefits of breastfeeding appear to far outweigh the risks.

18 Food-borne and Waterborne Illness In fact, a nursing mother with diarrhea believed to have been caused by food or water sources should be encouraged to increase the frequency of breastfeeding while significantly increasing her own fluid intake. In addition, (ORS) therapy for diarrhea is fully compatible with breastfeeding. Among antidiarrheal treatments, bismuth subsalicylate compounds are categorized by the American Academy of Pediatrics (AAP) as "drug[s] whose effect on nursing infants is unknown but may be of concern." These compounds contain significant levels of salicylates that could be absorbed by the infant and pose a theoretical risk of Reye's syndrome in the infant from salicylate consumption.

19 Hepatitis B Is it safe for a mother with (HBV) to breastfeed her infant after birth? Yes. Even before the availability of hepatitis B vaccine, HBV transmission through breastfeeding was not reported. All infants born to HBVinfected mothers should receive hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth. The 2 nd dose at aged 1 2 months, and the 3 rd dose at aged 6 months. However, there is no need to delay breastfeeding until the infant is fully immunized. All mothers who breastfeed should take care of their nipples to avoid cracking and bleeding.

20 Hepatitis C Virus Infection Is it safe for a mother infected with hepatitis C virus (HCV) to breastfeed her infant? Yes. There is no documented evidence that breastfeeding spreads HCV. Therefore, having HCV-infection is not a contraindication to breastfeed. HCV is transmitted by infected blood, not by human breast milk. There are no current data to suggest that HCV is transmitted by human breast milk.

21 Is it safe for the HCV-positive mother to breastfeed if her nipples are cracked and bleeding? Data are insufficient to say yes or no. However, HCV is spread by infected blood. Therefore, if the HCV-positive mother's nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. Instead, she should consider expressing and discarding her breast milk until her nipples are healed.

22 Malaria Is malaria passed to an infant through a mother's breast milk? No. However, a nursing mother who plans to travel to a geographic region where malaria is prevalent is advised to take every precaution to reduce her risk of infection. In addition, a nursing mother should thoroughly wash insect repellents from her hands and breast skin before holding and breastfeeding her infant or child.

23 Tobacco Use Should mothers who smoke breastfeed? Mothers who smoke are encouraged to quit, however, breast milk remains the recommended food for a baby even if the mother smokes. Although nicotine may be present in the milk of a mother who smokes, there are no reports of adverse effects on the infant due to breastfeeding. Secondary smoke is a separate concern regarding the child's long-term health. The American Academy of Pediatrics recognizes pregnancy and lactation as two ideal times to promote smoking cessation, but does not indicate that mothers who smoke should not breastfeed.

24 Toxoplasmosis Should a woman breastfeed her infant if she had contracted a toxoplasmosis infection during her pregnancy? Yes. Among healthy women, the possibility of breast milk transmission of Toxoplasmosis infection is not likely. While Toxoplasmosis infection has been associated with infants who consumed unpasteurized goat's milk, there are no studies documenting breast milk transmission of Toxoplasmosis gondii in humans. Perhaps, in the event that a nursing woman experiences cracked and bleeding nipples or breast inflammation within one to two weeks immediately following an acute Toxoplasmosis infection (when the organism is still circulating in her bloodstream), it is theoretically possible that she could transmit Toxoplasma gondii to the infant through her breast milk. Immune suppressed women could have circulating Toxoplasma for even longer periods of time. However, the likelihood of human milk transmission is very small.

25 West Nile Virus Can a woman who becomes infected with West Nile Virus safely nurse her infant? Scientists have found no evidence that a mother's West Nile Virus infection harms her breastfeeding infant. Therefore, CDC recommends that women with West Nile Virus illness continue breastfeeding because the benefits of breast milk are thought to outweigh the theoretical risk of harm to the infant. In the few documented cases of West Nile Virus transmission through breastfeeding (1 case in the year 2002; 3 cases in the year 2003), none resulted in recognizable illness in the infant.

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