Sometimes, new mothers – who want to breastfeed – are concerned about contraindications to breastfeeding. There is a lot of information about the benefits of breastfeeding for the baby and the mother. However, it is less known when it is not a good idea to breastfeed. In this article, I will focus on the latter question.
All the contraindications to breastfeeding can be grouped into two categories:
- Related to the infant’s condition
- Maternal contraindications
Furthermore, depending on the gravity of risks for the baby or mother, contraindications can be classified as absolute contraindications and relative ones.
Contraindications to breastfeeding due to the infant’s condition:
Galactosemia (Absolute contraindication)
One of the main ingredients of regular formula and breast milk is lactose. Lactose is a disaccharide built of glucose and galactose units. Infants with the classic form of galactosemia do not have enzyme facilitating utilization and metabolism of galactose, resulting in toxicity of unused galactose in the body.
It would be very rare to have a diagnosis of galactosemia made before birth or right after birth. In most cases, galactosemia is diagnosed on state newborn screens that are usually done at 24 hrs of life, and the results are available no sooner than 2-3 days later.
After birth, frequently baby starts breastfeeding or feeding regular formula, and once we get a call from state laboratory about the possibility of galactosemia, we change such a baby to special formulas that do not contain galactose. Examples of such formulas are soy-based formulas: ProSobee and Isomil.
It is essential to know that abnormal state screening for galactosemia is only an initial test, after which we have to do additional confirmatory testing. We should never delay switching babies to galactose free formula even we still waiting for results of confirmatory tests (More about Galactosemia here).
Inborn Errors of metabolism (Relative contraindication).
Hundreds of genetic metabolic diseases can affect an infant’s health. Fortunately, they are not very common. However, when present, they can carry a very serious or even grave prognosis. For most babies, diagnosis is made on the newborn state screen that is done in the first days of life, and results – if abnormal – are reported by the end of the first week.
We just talked about Galactosemia, which is an absolute contraindication to breastfeeding. Another example of inborn error, but which is only a relative contraindication to breastfeeding, is Phenylketonuria. In this disease, our body does not have a proper enzyme to metabolize an amino acid called phenylalanine.
Depending on the severity of this disease, frequently, it can be managed with a combination of partial breastfeeding and phenylalanine free formula. Fortunately, human milk contains lower levels of phenylalanine when compared to regular formula.
If your baby is diagnosed with genetic metabolic disease, only genetics specialists or specialists in metabolic disorders should decide if it is safe for you to continue breastfeeding, and if not, what milk you should use instead.
Hyperbilirubinemia (Relative contraindication).
Hyperbilirubinemia or newborn jaundice is a common condition affecting many full-term babies. It presents itself with yellow skin in the baby. Usually, it is a benign condition, but rarely it can be life-threatening.
Typically – if treatment is needed, jaundice is treated with phototherapy. In addition to phototherapy, one has to make sure that the baby is well hydrated. Therefore breastfeeding should be encouraged.
In situations where jaundice is severe, and baby requires super intensive phototherapy or may be a candidate for other more aggressive therapies such as immunoglobulin administration or blood exchange transfusion, breastfeeding may need to be temporarily stopped.
During that time, the mother should pump her breast milk, so her body does not stop producing it, and she is ready to resume breastfeeding when her baby gets better.
Maternal contraindications to breastfeeding:
HIV infection and T-Cell Lymphotropic Virus Infection in mother (Absolute contraindication).
In the USA, women who were diagnosed with HIV infection or infections caused by T-cell lymphotropic virus type 1 or 2 (HTLV 1 and 2) should not be breastfeeding due to the risk of transmission to the baby.
In countries where infant mortality is very high and is due to malnutrition and other “simple” viral and bacterial infections, the risk of transmission of HIV and HTLV infections has to be assessed against the benefits of breastfeeding to the baby.
For those countries, one solution could be to continue breastfeeding and place a woman on antiretroviral therapy, if available. Another choice could be to advise against breastfeeding if a formula is available, and such an option is acceptable to the family.
Tuberculosis (Relative contraindication).
Tuberculosis is a very dangerous bacterial disease affecting mostly the poor and homeless, but anybody can get infected. The infection passes from person to person through air droplets created during, coughing, speaking, or singing.
Thus, close contact with an infectious person by an unprotected individual like a baby can be dangerous and poses a high risk of infection.
When a mother has active pulmonary tuberculosis, she should pump her breast milk. Since bacteria causing tuberculosis does not pass into breast milk, her milk can be given to the baby.
However, the mother should have no or minimal contact with her baby until she has received at least two weeks of appropriate antibiotic therapy and has been cleared by her physicians to be with her baby.
Herpes Simplex Virus (Relative contraindication).
Women with genital herpes can breastfeed. However, they must ensure good personal hygiene, such as hand washing.
Women with oral herpes lesions can breastfeed, but they should not be kissing their babies. Remembering about washing hands and not touching their lesions and later their baby is vital.
Women with herpetic breast lesions should not be breastfeeding on that breast. If they decide to breastfeed using unaffected breast, they must cover lesions and ensure that the baby never comes in contact with lesions.
Hepatitis B and C (Relative contraindication).
It is considered safe by most to breastfeed a baby if a mother has a Hepatitis B infection. Newborns of mothers who tested positive for Hepatitis Bs – antigen routinely receive Hepatitis B vaccine and immunoglobulin. Those two measures protect them from risk of transmission of the virus through breast milk.
Interestingly, even though Hepatitis C can be detected in human milk, maternal infection with this virus is not a contraindication to breastfeeding.
Alcohol and substance abuse (Relative contraindications).
Women who are abusing alcohol or opioid substances should be advised not to breastfeed until they can abstain from those toxic substances. Uncontrolled use of opioid illicit drugs and alcohol can negatively affect an infant’s health.
Interestingly, if a mother has been treated with methadone or buprenorphine for her addiction to opioid substances, she would be encouraged to breastfeed her baby after birth. Research shows that babies with neonatal abstinence syndrome (NAS) who receive breast milk after delivery go home sooner and need less medication for their withdrawal symptoms.
If you are interested to know more about NAS, you can read my article on this topic here.
Mother taking medications (Relative contraindications).
There are literally hundreds of medications and herbs in use now. Their effects on the breastfed baby are not very well known. In general, most drugs are compatible with breastfeeding because they do not pass into breast milk, or their concentrations are insignificant and do not affect a baby in any recognizable way.
Historically, doctors were most concerned about chemotherapy drugs and radiopharmaceuticals. To avoid radio exposure to your baby, you need to discard all breast milk until it is free of radiation.
Sometimes, women receiving antimetabolite chemotherapy drugs are allowed to breastfeed. After each chemotherapy session, they can pump and dump their milk until harmful substances are not anymore in the milk. A pharmacist can predict the needed amount of time for the medications to clear out of the body and milk.
Whenever you are using any medications, herbs, or chemicals, you should discuss with your doctor what is known about their effects on breastfeeding baby.
If you want to learn more about the potential effects of any particular medication on your baby, you can try using the LactMed Database.
Drugs and Lactation Database (LactMed) is a publicly available database on the internet and in the form of a smartphone App. It contains information on medicines and chemicals to which breastfeeding mothers may be exposed. (You can find LactMed here).
This database provides information on transmission into breast milk, levels of chemical substances in breast milk, and potential and proved effects on the baby if those are known.
Parents who are worried about contraindications for breastfeeding can take comfort that there are very few absolute ones. The most commonly cited absolute contraindications are a diagnosis of galactosemia in a baby and HIV or HTLV infections in a mother.
Additional resources on contraindications to breastfeeding:
This article is only for general information purposes. It should not be viewed as any medical advice. There is a small chance that information here may be inaccurate. You should always discuss all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.