Botox Treatment During Lactation
by Anne Eglash MD, IBCLC, FABM
Is Botox safe during lactation?
Botox, botulinum toxin from the bacteria Clostridium botulinum, is a substance that causes nerve paralysis. Botulism results from exposure to this bacterial toxin from contaminated food or in an open wound. Infants may develop botulism from contaminated food and infected dust particles. Twenty percent of infantile botulism cases come from ingesting raw honey. Symptoms of infantile botulism include weakness, poor feeding, droopiness of facial muscles and excess drooling due to a weak suck reflex.
Botox, the medicinal form of botulinum toxin, is used in various medical treatments such as wrinkles, neck spasms, headaches, and overactive bladder. Botox injections rank as the most popular minimally invasive cosmetic procedure, and among women receiving Botox in 2020, 19% were 20-39 years old. It is no wonder why we receive many questions about the safety of Botox during lactation.
This week’s article is the first study to measure transmission of Botox into breastmilk. The researchers studied breastmilk samples from 4 lactating women who underwent cosmetic injections with 40-92 units of Botox. Milk samples (60 ml) were collected at 2 hours and days 1, 3, 5 after treatment, for a total of 4 samples each.
They found that 8 of the 16 samples had varying levels of botulinum toxin ranging from 85.24 to 746.82 pg/ml, while 8 samples had no toxin detected. Based on an average intake of 670ml of breastmilk/day, a breastfed infant would ingest 0.499µg of Botox toxin in 24 hours. The lethal dose, based on primate studies, is considered 1µg/kg. For a 10 lb (4.5kg) infant the lethal dose would be 4.5µg. Therefore, the amount of Botox exposure in this study was much less than the lethal dose.
What else? See the question!
- Each mother had measurable botulinum toxin in their milk 2 hours after the procedure.
- Each mother had no detectable botulinum toxin in their milk on day 5 after the procedure.
- The amount of botulinum toxin in the milk samples decreased over the course of the 5 days.
- The subject with the least amount of injected Botox had the lowest levels of botulinum toxin in their milk.
See the Answer
Abstract
Background
There are little data on the risk to a breastfeeding infant after facial botulinum toxin injections to the mother.
Objective
To detect the presence of botulinum toxin in breast milk from lactating subjects treated with facial botulinum toxin injections, as measured by enzyme-linked immunosorbent assay (ELISA).
Methods
For this pilot study, lactating women were injected with standardized facial botulinum toxin type A (BTXA) (range 40–92 U). Collected breast milk samples over 5 days were analyzed for the presence of botulinum toxin. Exclusion criteria included (1) lactating women still using their breast milk for their infant, (2) muscular disorders, (3) any medication that could interfere with neuromuscular function, (4) uncontrolled systemic disease, (5) pregnant, and (6) neuromodulator injection in the past 90 days.
Results
Four lactating women were recruited. Eight samples had no BTXA detected, whereas 8 of the 16 total had detectible amounts, which were well below the reported lethal oral dose for an infant.
Conclusions
Although the exclusion of lactating women from receiving cosmetic botulinum toxin injections is out of an abundance of caution to the theoretical risk to the infant, this study helps support the notion that facial botulinum toxin injections do not warrant an interruption in breastfeeding. Further studies with larger sample sizes are needed.
The researchers found that 2 of the 4 women had no detectable botulinum toxin in any of their samples. The other 2 women had botulinum toxin detected in every milk sample. In one woman, the highest milk botulinum toxin levels occurred on day 5, while in the other, they peaked on day 3. The 2 women in this study who received the highest doses of cosmetic Botox had no botulinum toxin detected in any of their milk samples.
The authors highlighted the lack of clarity regarding the precise pharmacokinetics of botulinum toxin in human milk, suggesting that individual physiological factors, such as metabolism, might influence toxin transmission into breastmilk.
It is unnerving to know that botulinum toxin is expressed into human milk. Information from Lactmed uggests that Botox is likely safe during lactation. This is partially based on a case of maternal botulism where botulinum toxin was undetectable in the mother’s milk or infant. E-lactancia.org suggests that Botox is low risk.
Breastmilk is thought to be protective of infant botulism. A 1982 California study of infantile botulism found that infants who were fed human milk had better outcomes, with marked reduced risk of sudden death and older age at presentation.
Based on this first study of botulinum toxin levels in breastmilk after cosmetic Botox injections, caution is warranted when nursing a very young or premature infant, as the relative infant dose could be much higher, depending on their volume of breastmilk intake. Conversely, Botox is likely safer when nursing an older infant such as over 10 lb (4.5kg).
We need more research on the use of Botox during lactation. Lactating parents who undergo Botox injections should be educated on symptoms of infant botulism.
angela
It seems at this point there is not enough data to confidently say Botox is safe for breastfeeding mothers.
We do know Botox is passed into the breastmilk and for babies that are premature or under 10 pounds, Botox is a contraindication for breastfeeding mothers.
Audrey
The answers to the question is very ambiguous. We definitely need more research and study to support either safe or not safe to use Botox during Lactation. It would probably be wise to have our client evaluate the pros and cons of using Botox during breastfeeding. Hopefully, for the premature infant, those mother would be more concern about protecting their breast milk for her infant vs. taking care of wrinkles! But I do understand each circumstance needs to be treated individually.
Robin
While Botox is most connected with treating wrinkles, it actually has many more uses- https://www.ncbi.nlm.nih.gov/books/NBK557387/
I personally know women who have had it to treat migraines and overactive bladder with urinary incontinence. The quality of life for each of them was drastically improved.
Who knew?!
Jennifer Scales
if 20% of cases of botulism is from direct exposure to honey, what is the source of the of the other 60%? Contaminated food and dust particles? Also, curious how prevalent botulism is among infants.
IABLE
YOu are correct, the rest of the botulism cases are due to contaminated food and dust particles. The rates of infantile botulism vary by state. Here is a CDC report on the incidence of infantile botulism in 2019 https://www.cdc.gov/botulism/surv/2019/index.html#:~:text=Infant%20botulism%20cases&text=Cases%20were%20reported%20from%2032,(1%2C%20%3C1%25).
Jennifer Scales
meant to say 80% not 60 🙂
Anna
That’s great to know that Botox injection is much less than the lethal dose. However, that is not enough. Is it safe? As a breastfeeding mom I want to know if it is harmful to my baby or not, not only if it is lethal. Definitely more research is needed.
Suplementy odporność
Thanks for making this topic easier to understand. Great post!