Pregnancy and lactatuion

Q: What are the three phases of human milk production?

A: 1) Colostrum: first milk, thick, “liquid gold,” rich in nutrients and antibodies.
2) Transitional milk: 2–5 days to 2 weeks postpartum, bluish-white, adapts to baby’s needs.
3) Mature milk: ~10–15 days postpartum, fat content changes during feeding.

Q: What key nutrients are in mature human milk?

A: 3–5% fat, ~0.8–0.9% protein, ~7% carbs (mainly lactose), ~0.2% minerals, 60–75 kcal/100 mL.

Q: What supplements are recommended for breastfed infants?

A: All infants: vitamin D; preterm: iron from 1 month–12 months; term: iron from 4 months until iron-rich foods.

Q: List 4 benefits of breastfeeding for the infant.

A: ↓ Asthma, ↓ obesity, ↓ Type 1 DM, ↓ infections (e.g., GI infections, SIDS, necrotizing enterocolitis).

Q: List 3 benefits of breastfeeding for the mother.

A: ↓ Hypertension, ↓ Type 2 DM, ↓ ovarian & breast cancer risk.

Q: Name 3 common barriers to breastfeeding.

A: Latch/nutrition concerns, unsupportive work policies, cultural/family factors, hospital practices, concern about medication safety.

Q: Which drug properties ↑ transfer into breast milk?

A: Low MW (~300 Da), non-ionized, low protein binding, lipid soluble, weak base, high oral bioavailability.

Q: What maternal factors affect drug transfer?

A: Dose, frequency, route, metabolism, renal clearance, blood flow to breast, milk composition.

Q: Infant factors affecting drug exposure?

A: Age (preterm vs term), ADME maturity, feeding pattern, volume consumed, safety of drug in infants.

Q: Ideal drug characteristics during lactation?

A: Short half-life, high protein binding, low oral bioavailability, high MW, low lipid solubility.

Q: When should meds be taken to minimize infant exposure?

A: Immediately after breastfeeding or before infant’s longest sleep; avoid peak plasma concentrations (1–3 hrs post-dose).

Q: Is “pumping and dumping” useful for drug removal?

A: No — does not remove drug faster, but preserves milk supply if needed.

Q: What is RID% and what % is generally safe?

A: Relative Infant Dose = (Infant dose mg/kg/day) / (Maternal dose mg/kg/day) × 100; <10% is generally safe.

Q: Name 3 resources for checking drug safety in lactation.

A: LactMed, Dr. Thomas Hale’s Medications & Mother’s Milk, Briggs’ Drugs in Pregnancy and Lactation.

Q: What is the FDA Pregnancy and Lactation Labeling Rule?

A: Requires risk summary, clinical considerations (e.g., minimizing exposure, effects on milk production & infant), and data sources.

Q: List 3 drugs contraindicated during breastfeeding.

A: Amiodarone, chemotherapeutics, bromocriptine, ergotamine, isotretinoin, lithium.

Q: Name 3 medications safe or compatible with breastfeeding.

A: Penicillins, cephalosporins, acetaminophen, ibuprofen, warfarin, heparin.

Q: Which beta blockers are preferred during lactation?

A: Propranolol, metoprolol, labetalol (low milk transfer).

Q: Which antihistamine is preferred?

A: Loratadine. Diphenhydramine crosses into milk and may cause sedation.

Q: When is breastfeeding contraindicated due to maternal conditions?

A: HIV, active untreated TB (can give expressed milk), active varicella near delivery, herpetic lesions on breast, Ebola, Mpox (temporary).

Q: What is mastitis & how is it treated?

A: Breast inflammation; treat with oxacillin/dicloxacillin or 1st-gen cephalosporin for 10–14 days, pain meds, warm compress before feeding, cold compress after, keep nursing.

Q: What are galactagogues? Give an example.

A: Agents to ↑ milk supply; e.g., domperidone (not FDA approved), metoclopramide, fenugreek (herbal, limited evidence).

Q: Which vaccines are contraindicated in lactating mothers (non-emergency)?

A: Smallpox, yellow fever, HPV.

Q: What about caffeine, alcohol, and tobacco?

A: Caffeine ≤ 200–300 mg/day; alcohol: limit, wait 2 hrs per drink; tobacco not contraindicated but discouraged — NRT is compatible.

Q: AAP & WHO recommend exclusive breastfeeding for how long?

A: ~6 months, then complementary foods to ≥2 years.

Q: What is the Healthy People 2030 goal for exclusive breastfeeding at 6 months?

A: 42.4%.

Q: What caloric increase is recommended for lactating mothers?

A: +330 kcal/day first 6 months, +400 kcal/day second 6 months.

Q: Which mothers may need extra B12 or DHA?

A: Vegans, gastric bypass patients.

Q: What are the top 3 steps for safe medication use during lactation?

A: 1) Choose safest drug with data.
2) Optimize timing (post-feed/longest sleep).
3) Monitor infant for side effects, adjust or stop if needed.