Photo: UGC Hormonal imbalance, stress and constant lack of sleep accompany every young mother after childbirth. Unfortunately, such mood swings can harm not only the woman, but also the newborn. It is not surprising that mothers begin to think about taking sedatives. Is there any harm from sedatives while breastfeeding (BF)? What sedative can you safely take for breastfeeding? We will answer the questions in the article.
Contact a specialist
If you feel unwell, the first thing you should do is assess your condition.
If your health has really deteriorated, be sure to consult a doctor. Not all diseases can go away on their own, without medical help.
When consulting with your doctor, tell him or her that you are breastfeeding. Unfortunately, many medications (except most homeopathic ones) are incompatible with feeding. Even proven and well-known medicines for colds or headaches during breastfeeding may be prohibited. In this case, you will have to switch to artificial feeding for the duration of treatment. In this case, you should definitely check with a specialist how long after stopping the medication you can return to breastfeeding.
Sedative for hepatitis B: is it possible or not?
If you directly ask whether it is possible and necessary to take a sedative while breastfeeding, the specialist will always say: “No.” As practice shows, nothing helps a young mother cope with stress more than timely help from loved ones.
Let's find out what causes nervousness and why mothers begin to choose a sedative for nursing. First of all, the reason should be sought in constant employment. No matter how hard a woman tries to maintain the usual rhythm of life, it is almost impossible with a baby in her arms. Therefore, it is imperative that family members understand this and help either with housework or child care.
In addition, after the baby is born, the new mother faces a sharp surge in hormones. The level of endorphin, the hormone of happiness, increased during childbirth, instantly returns to normal, which causes a feeling of depression and anxiety.
Photo: Diane Wissinger and others. The art of breastfeeding. - M.: Eksmo Publishing House, 2011: UGC
G.A. Kulakova, N.A. Solovyov and E.A. Kurmaev conducted a study using Spielberg’s method and found that the postpartum period, even for no apparent reason, is characterized by a high level of anxiety. Of 176 breastfeeding women, 47% experienced occasional anxiety, and 57% suffered from trait anxiety. Surely many of them took a sedative during lactation in order to return to normal.
However, experts urge not to panic. Komarovsky, an outstanding pediatrician and my colleague, advises replacing sedatives with hepatitis B with simple relaxation methods. A warm bath, good sleep and a positive attitude are the key to the psychological stability of a young mother.
Why then do some nursing mothers take sedatives without fail? In my practice, there have been cases when women began to notice that the child was eating much worse. Typically, this occurs because adrenaline is produced in a stressful situation, which does not allow breast milk to be expelled freely during feeding.
This, of course, caused even greater concern for the baby’s health. This created a vicious circle in which mothers could no longer relax without special means.
Do not self-medicate. If you feel that your nerves are on edge, then be sure to consult a doctor who will select the appropriate sedative for women who are breastfeeding.
read carefully
Use common sense when taking any medications. Carefully read the instructions for the drug, especially the “contraindications” section. It will definitely indicate whether the medicine can be taken while breastfeeding. If a specialist has prescribed the drug to you, and the instructions state that feeding is a contraindication, you should trust the instructions more, since doctors do not always remember by heart the subtleties of prescribing a particular drug and all the medications allowed for breastfeeding.
Any doubts?
If you have the slightest doubt about whether you can take this or that medicine, consult a professional. Don't risk your child's health! Remember that you are not alone with the problem. You can get advice not only from your friends, but also from professionals - lactation consultants.
A mammologist at a clinic or a doctor at a antenatal clinic can give you contact information for such a consultant. Perhaps you were given the contact details of a breastfeeding consultant when you were in the maternity hospital.
You can ask for help at e-lactancia.org. This is the online directory of the Marina Alta Hospital "Compatibility of Breastfeeding with Pharmaceutical Drugs and other Products". APILAM (Association for the Promotion and Cultural and Scientific Research of Breastfeeding) is responsible for the information posted there. However, to use this resource it is advisable to know English.
In Russia there is an organization with similar goals - the Association of Consultants on Natural Feeding (AKEV). She has been working for about 10 years. Their website is located at: https://akev.info. Here you can also find the coordinates of specialists in your region.
Vitamins and minerals are not drugs
Separately, it is worth mentioning vitamin-mineral complexes. They are not medicines, but an important addition to the diet of a nursing mother. During lactation, a woman's need for nutrients increases, and some vitamins and minerals are required even more during breastfeeding than during pregnancy.
However, be careful! Not every vitamin complex is approved for use while breastfeeding. And in this case, it is important to read the instructions and look at the contraindications. Better yet, immediately choose a specialized complex for nursing mothers. For example, Pregnoton Mama, which contains essential minerals, vitamins and Omega-3. Pregnoton Mama can be taken throughout the entire period of breastfeeding.
THIS IS NOT AN ADVERTISING. THE MATERIAL WAS PREPARED WITH THE PARTICIPATION OF EXPERTS.
Treatment of insomnia during pregnancy and after childbirth
Prevalence of sleep disorders during pregnancy
According to a National Sleep Foundation survey conducted two decades ago, nearly 80% of women experience sleep disturbance at some point during pregnancy. According to some authors, from 5% to 38% of women report insomnia during pregnancy. in early pregnancy, with a prevalence in late pregnancy of up to 60%.
Snoring is more common during pregnancy and can affect up to one third of pregnant women by the third trimester. with longitudinal studies showing that the frequency of habitual snoring increases from the first trimester to the third trimester. The prevalence of objectively measured sleep-disordered breathing also increases with pregnancy progression and ranges from 4% to 70%.
Causes of sleep disturbances during pregnancy
Many pregnancy-specific changes can affect sleep continuity and structure, worsen pre-existing sleep problems, or lead to the development of de novo sleep disorders. Anatomical and physiological factors such as sprains, uterine contractions or fetal movements lead to sleep disturbance and fragmentation. The respiratory system undergoes significant physiological changes that can affect breathing during sleep; namely, functional residual capacity decreases in late pregnancy, with a more pronounced decrease in the supine position. Increased levels of reproductive hormones and increases in plasma and interstitial volume can lead to upper airway edema and nasal congestion. Together with these changes, physiological weight gain and central weight distribution during pregnancy may influence breathing during sleep. Metabolic physiological changes during pregnancy may also influence sleep disorders such as restless leg syndrome during pregnancy. For example, the need for folic acid and iron is higher during pregnancy due to the increasing demand for fertility products
Treatment of sleep disorders during pregnancy
Non-pharmacological treatment for insomnia during pregnancy includes good sleep hygiene, such as establishing regular sleep-wake cycles, controlling stimuli, minimizing fluid intake before bed to reduce nocturia, avoiding caffeine before bed, minimizing sleep restrictions, eliminating physical discomfort, cognitive behavioral therapy for insomnia (CBT-I), exercise, meditation, acupuncture. There are concerns regarding the administration of exogenous melatonin during pregnancy and its effects on the development of circadian rhythms and reproductive function in the offspring, however, exogenous melatonin may also have some potential protective effects for the fetus.
Antihistamines are widely used in pregnancy, with several studies supporting their safety profile in humans. Pregnant women randomized to trazodone or diphenhydramine in one trial had significant improvements in sleep duration and sleep efficiency compared with placebo at 2 and 6 weeks.
The benzodiazepine agonist hypnotics (zaleplon, zolpidem, and eszopiclone) are nonbenzodiazepine drugs that act on the gamma-aminobutyric acid A receptor. These are the most commonly prescribed drugs for insomnia, including in pregnant women. However, there are reports of “floppy baby syndrome” in infants born to mothers taking long-term diazepam during pregnancy, and there are concerns about neonatal withdrawal symptoms with benzodiazepines.
Sleep disturbance after childbirth
The preferred method of infant feeding is exclusive breastfeeding for at least 6 months, continued for ≥ 1 year, due to the numerous short- and long-term benefits provided to the mother and her baby. During the earliest postpartum days, more drugs pass into breast milk compared to later periods due to the wide intercellular pathways between mammary epithelial cells. In general, drugs are more likely to pass into breast milk if they have high concentrations in maternal plasma, are lipophilic, have a lower molecular weight, and are less protein bound.
Sleep disturbances are a common occurrence in women during the postpartum period. Hormonal shifts during pregnancy and postpartum, particularly during breastfeeding, alter sleep architecture, increase neural activity, affect the airway, and control fluid distribution.
Despite relatively frequent night awakenings, mothers experience minimal insomnia, unrefreshing sleep, anxiety, depression, daytime sleepiness, or fatigue after 2 or 6 months. The strongest relationship between maternal and infant sleep was in the number of nighttime sleep and wake episodes. Of note, none of the infant sleep parameters were associated with maternal anxiety, depression, fatigue, sleepiness, or unrefreshing sleep at any time point.
Selective serotonin reuptake inhibitors
Among the SSRIs, paroxetine, fluvoxamine, and sertraline primarily produce undetectable plasma levels. Citalopram levels can be measured in some infants, although in most cases they are relatively low. Fluoxetine and venlafaxine produce the highest plasma concentrations in infants, in some infants up to more than 80% and 30% of estimated therapeutic concentrations in adults, respectively. However, such high concentrations are rare; for example, for fluoxetine, infant plasma concentrations greater than 10% of maternal plasma levels were found in only 8 of 36 cases (22%).
Adverse effects on the infant during breastfeeding in women exposed to new antidepressants through breast milk have been suspected in some cases, and more often after exposure to fluoxetine and citalopram than after exposure to other drugs. The observed effects were largely subtle and nonspecific, and may even have occurred by chance. For example, crying, irritability, decreased feeding, and watery stools have been reported in some cases for fluoxetine. In isolated cases, hypotension, colic, decreased feeding and sleep disturbances have been reported for citalopram.
Main Factor
Because of the immature liver function of neonates and the gradual development of drug metabolizing capacity, infancy is a central factor to consider in individual risk analysis.
Agomelatine
Some evidence suggests that breastfeeding is safe after 4 hours of taking agomelatine. To minimize the risk of harm to the infant, studies involving larger patient samples, including infant plasma samples, are needed. The general lack of data on fluvoxamine, venlafaxine, duloxetine, bupropion, mirtazapine, and reboxetine suggests that they are best avoided pending further research.
Safety index
A specific safety index has been proposed for the use of antidepressants by nursing mothers. The index is expressed as the ratio of the reported number of infants with adverse effects following exposure to an antidepressant through milk and the reported total number of infants exposed to the same antidepressant, multiplied by 100. A value of ≤2 is assumed to indicate that that the drug is relatively safe; a value of 2.1-10 indicates that the drug should be used with great caution, and a value above 10 indicates that the drug should be contraindicated in nursing mothers. The index has some limitations, such as that it is less reliable when the number of cases in the literature is small, and that it does not take into account the quality of the underlying data, such as whether the suspected adverse events most likely occurred by chance. or more likely a causal relationship with antidepressant exposure.. When applying the safety index to cases reported before 2007, the estimated values were 0.68 and 0.95 for sertraline and paroxetine and 3.5 and 5.3 for fluoxetine and citalopram, respectively .
Risk and benefit?
Most reviews and guidelines recommend that the choice of specific treatment should be based on an individualized risk-benefit analysis. In such an analysis as the risk/benefit of an untreated maternal disease for the mother and infant, the risk/benefit of a specific treatment for the mother and infant, the risk/benefit of breastfeeding or not breastfeeding for the infant, possible maternal risks of not breastfeeding and the mother's desire to breastfeed chest. Exposure to medications may pose risks to the infant, but there are also risks that arise from untreated depression and from the absence of breast milk for the infant. Therefore, no clinical decision in the context of postpartum depression is completely safe.
What is better: pharmacotherapy or non-drug treatment?
Non-drug methods such as psychotherapy should be considered, especially for mild to moderate depression. For women with moderate to severe depression, and in some cases also anxiety, medication is usually the most appropriate treatment option. Moreover, for women with previous postpartum depression or women who were treated with antidepressants during pregnancy, antidepressants are the preferred treatment for prevention or new episodes/relapses.
Feeding breaks and breast milk drainage during antidepressant therapy
Avoiding breastfeeding during the peak concentration phase, such as taking the daily dose in the evening and avoiding breastfeeding at night, will only modestly reduce infant drug use.
Draining and discarding breast milk to reduce exposure does not make a big difference. First, there is no indication that there is a risk threshold that will be exceeded if infant exposure is reduced to some extent, such as 30-50%. Second, avoiding breast milk implicitly implies that the effects of medications are harmful if the baby is fed only breast milk. Third, in our experience, a routine such as 50% breastfeeding and 50% bottle feeding most often results in bottle feeding only after a relatively short period of time.
