by Anne Eglash MD, IBCLC, FABM
Is there evidence that breastfeeding reduces the severity of Neonatal Abstinence Syndrome (NAS) and the duration of hospitalization for infants born with NAS? This is the topic of a recent study that reviewed research published in the last 10 years.
The authors found 10 studies that evaluated the effect of breastfeeding on NAS among babies born to mothers who were on methadone or buprenorphine during pregnancy. The studies reported on whether breastfeeding had an effect on the severity of NAS, the amount of pharmacologic treatment needed, and the duration of time the infants were in the hospital after birth.
What do you think is the effect of breastfeeding on neonatal abstinence syndrome, and the duration of time spent in the hospital after birth?
- Higher maternal methadone levels during pregnancy lead to more intense neonatal abstinence syndrome symptoms, requiring more pharmacologic treatment, and longer length of stay.
- If the mother continues to take methadone or buprenorphine postpartum, her infant will take longer to go through the neonatal abstinence symptoms, and take longer to go home from the hospital.
- Mothers who are taking methadone or buprenorphine during pregnancy should be counseled about not breastfeeding postpartum, in order to not expose the newborn to these opiates after birth.
- 2 & 3
See the Answer
Abstract
Cirillo C, Francis K.
Does Breast Milk Affect Neonatal Abstinence Syndrome Severity, the Need for Pharmacologic Therapy, and Length of Stay for Infants of Mothers on Opioid Maintenance Therapy During Pregnancy? Advances in Neonatal Care 16(5) p. 369-378
ABSTRACT Background: The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS. Purpose: The question guiding this brief is: “Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?” Search Strategy: CINHAL/MEDLINE Complete and PubMed databases were searched using key words—NAS and breastfeeding—and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy. The search yielded 10 studies addressing these concerns. Findings: Breast milk may be beneficial for decreasing NAS severity, pharmacologic therapy, and length of stay. Implications for Practice: Strategies should be developed to support individualized plans based on maternal history, safety, and mother’s choice. Implications for Research: Further research is needed utilizing matched case-controlled studies regarding breast milk and the influence on severity of NAS, need for pharmacologic therapy, length of stay, and neurologic outcomes. In addition, other factors should be investigated including abrupt weaning, polysubstance use, and readmissions.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This research study found that most published research on this topic involves small studies that were primarily chart reviews, limiting our knowledge on this topic. In addition, we have sufficient long term data on the effects of high maternal methadone doses during pregnancy and lactation on long term neonatal outcomes. So even though breastfeeding can help reduce Neonatal Abstinence Syndrome (NAS) severity and duration, what about the effect of long term exposure of opiates on the infant through breastfeeding?
At this point, it is good practice to encourage mothers on methadone and buprenorphine to breastfeed. The babies are expected to have less intense Neonatal Abstinence Syndrome (NAS), a shorter duration of NAS, and a greater likelihood of maternal-infant bonding. From personal experience I find that many of these mothers struggle with their milk supplies, especially if they smoke cigarettes. I suggest educating this group of mothers on the risks of combining methadone or buprenorphine with any other sedating medications, to reduce the risk of respiratory depression or death in the infant. In addition, they need to know that abrupt weaning can increase the risk of NAS in the infant, so if such a mother plans to wean, she should be given guidance on doing this slowly, watching for symptoms of NAS.
Mothers who are actively abusing substances, such as other opiates and/or other drugs of abuse, should refrain from breastfeeding.