Whaites Heinonen Essi, Johnson Diana L, Todd Alec, Chambers Christina D
Center for Better Beginnings, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
J Hum Lact. 2025 Aug;41(3):412-422. doi: 10.1177/08903344251337384. Epub 2025 May 27.
Exclusive breastfeeding for 6 months is recommended, but breastfeeding safety data is insufficient for several medications.
To determine if mothers treated with chronic medications are less likely to breastfeed.
For this secondary analysis, 6383 pregnant women in the MotherToBaby cohort recruited from the United States and Canada between 2010 and 2022 were included. Participants treated with antirheumatic medications (ARM), selective serotonin reuptake inhibitors (SSRIs), and asthma medications during pregnancy were divided into two groups based on their medication use: continuers and discontinuers. Breastfeeding initiation, supplementation with commercial milk formula, and discontinuation of breastfeeding before 6 months were compared between those exposed and unexposed to medication use. Adjusted risk and hazard ratios (aRR, aHR) and 95% Confidence Intervals (CI) were calculated with modified Poisson and Cox regressions adjusted for year, parity, socioeconomic status, body mass index, smoking, illicit drug use, race and ethnicity.
The sample included 799 (12.5%) continuers and 475 (7.4%) discontinuers of ARM, 293 continuers (4.6%) and 63 (1.0%) discontinuers of SSRIs, and 217 (3.4%) continuers and 97 (1.5%) discontinuers of asthma medications. There were 4,439 (69.6%) participants who were unexposed to the study medications. Both ARM continuers and discontinuers were more likely to not breastfeed (aRRs 95% CI: 3.92 [3.03, 5.07] and 3.08 [2.19, 4.33]), to supplement (aRRs 95% CI: 1.12 [1.01, 1.26] and 1.25 [1.10, 1.43]) and stop breastfeeding before 6 months (aHRs 95% CI: 1.72 [1.29, 2.31] and 1.41 [0.92, 2.15]). SSRI continuers were more likely to supplement (aRR 95% CI: 1.26 [1.08, 1.47]).
Participants treated with chronic medications, primarily ARMs, were less likely to breastfeed. Targeted lactation support for mothers with chronic illnesses is recommended along with development of breastfeeding safety data for these medications.
建议纯母乳喂养6个月，但关于几种药物的母乳喂养安全性数据不足。
确定接受慢性药物治疗的母亲进行母乳喂养的可能性是否较低。
在本次二次分析中，纳入了2010年至2022年间从美国和加拿大招募的母婴队列中的6383名孕妇。孕期接受抗风湿药物（ARM）、选择性5-羟色胺再摄取抑制剂（SSRI）和哮喘药物治疗的参与者根据其用药情况分为两组：持续用药者和停药者。比较用药组和未用药组在母乳喂养开始情况、补充商业配方奶以及6个月前停止母乳喂养方面的差异。采用改良泊松回归和Cox回归计算调整后的风险比和风险比（aRR，aHR）以及95%置信区间（CI），并对年份、产次、社会经济地位、体重指数、吸烟、非法药物使用、种族和民族进行了调整。
样本包括799名（12.5%）ARM持续用药者和475名（7.4%）停药者，293名（4.6%）SSRI持续用药者和63名（1.0%）停药者，以及217名（3.4%）哮喘药物持续用药者和97名（1.5%）停药者。有4439名（69.6%）参与者未使用研究药物。ARM持续用药者和停药者不进行母乳喂养的可能性更高（aRRs 95% CI：3.92 [3.03, 5.07] 和3.08 [2.19, 4.33]），补充配方奶的可能性更高（aRRs 95% CI：1.12 [1.01, 1.26] 和1.25 [1.10, 1.43]），并且在6个月前停止母乳喂养的可能性更高（aHRs 95% CI：1.72 [1.29, 2.31] 和1.41 [0.92, 2.15]）。SSRI持续用药者补充配方奶可能性更高（aRR 95% CI：1.26 [1.08, 1.47]）。
接受慢性药物治疗的参与者，主要是接受ARM治疗的参与者，进行母乳喂养的可能性较低。建议为患有慢性病的母亲提供有针对性的哺乳支持，并开展这些药物的母乳喂养安全性数据研究。
