Most Common Medications Dispensed During Lactation
by Anne Eglash MD, IBCLC, FABM
What are the most common medications dispensed to lactating individuals?
The United States Food and Drug Administration’s Pregnancy and Lactation Labeling Final Rule requires pharmaceutical manufacturers to include summaries of product risks during pregnancy and lactation. However, as of May 2020 only 3% of newly approved medications had lactation safety data from human studies.
The authors of this week’s study were interested in identifying the most common medications dispensed to lactating individuals, as this information might help to prioritize the medications for which safety information is needed. They used the electronic health records from a large US healthcare system in Minnesota USA that documents infant feeding type at well child visits, and analyzed infant feeding data from the 2-,4- and 6-month visits from May 2018-June 2019. They assumed that parents of infants receiving human milk were lactating, and reviewed medications dispensed to the lactating mothers within a few weeks of the 2-month visit. They did not include IUDs, contraceptive implants or medications given during hospitalization.
Among 6,099 infants with infant feeding type recorded, 4198 infants were identified as receiving human milk at the 2-month visit. The average maternal age was 31 years, and 63.2% were non-Hispanic White. Sixty-six percent had commercial insurance, and 32.4% were insured by Medicaid. They found that 20.9% of the mothers had a diagnosis of anxiety disorder and 11.6% had a mood disorder.
The researchers found that the top 3 most common medications prescribed around 2 months postpartum included oral progesterone-only contraceptives, selective serotonin reupdate inhibitor (SSRI) antidepressants, and antibiotics, in that order.
The researchers were able to track the frequency of medication use in this population over time, after verifying that they continued to provide human milk at the 4- and 6-month visits.
What else? See the question!
- The most common antidepressant dispensed was sertraline.
- 75% of the mothers were prescribed at least 1 medication around the 2-month visit.
- Prescription antifungals were among the top 10 of the prescribed medications during lactation.
- Antibiotics were prescribed more often in the first 2 months as compared to 4 or 6 months postpartum.
See the Answer
Using a novel, electronic health record (EHR)-based approach, to estimate the prevalence of prescription medication use at 2, 4, and 6 months postpartum among lactating individuals.
We utilized automated EHR data from a US health system that records infant feeding information at well-child visits. We linked mothers who received prenatal care to their infants born May 2018-June 2019, and we required infants to have ≥1 well-child visit between 31-90 days of life (i.e., 2- month well-child visit with a +/- 1 month window). Mothers were classified as lactating at the 2-month well-child visit if their infant received breastmilk at the 2-month well-child visit. For subsequent well-child visits at 4 and 6 months, mothers were considered lactating if their infant was still receiving breastmilk.
We identified 6,013 mothers meeting inclusion criteria, and 4,158 (69.2%) were classified as lactating at the 2-month well-child visit. Among those classified as lactating, the most common medication classes dispensed around the 2-month well-child visit were oral progestin contraceptives (19.1%), selective serotonin reuptake inhibitors (8.8%), first generation cephalosporins (4.3%), thyroid hormones (3.5%), nonsteroidal anti-inflammatory agents (3.4%), penicillinase-resistant penicillins (3.1%), topical corticosteroids (2.9%), and oral imidazole-related antifungals (2.0%). The most common medication classes were similar around the 4 and 6-month well-child visits although prevalence estimates were often lower.
Progestin-only contraceptives, antidepressants, and antibiotics were the most dispensed medications among lactating mothers. With routine collection of breastfeeding information, mother infant linked EHR data may overcome limitations in previous studies of medication utilization during lactation. These data should be considered for studies of medication safety during lactation given the need for human safety data.
Approximately 53.8%, not 75%, of lactating mothers were dispensed medication around the time of the 2-month visit.
Nearly 4% of the population received antifungals, either topical or fungal. They didn’t match diagnoses with the medication, so we don’t know if the antifungals were used for the dubious diagnosis of candidiasis of the breast (ie treating the wrong diagnosis), or for vaginal yeast related to antibiotic use.
The most common antibiotics, presumably for mastitis, were cefadroxil and cephalexin. At around 2 months postpartum, 4.3% of women were dispensed these antibiotics, 2.1% around 4 months, and 1.9% at 6 months, confirming other studies that found mastitis to be more common in the first few months postpartum.
It was nice to see that only 1.4% of women received contraception with estrogen vs 19.1% with progesterone only. This would indicate that physicians understand the risk of estrogen in decreasing milk production.