krewersf's blog

Longer lactation duration is associated with decreased prevalence of non-alcoholic fatty liver disease in women.

A longer duration of breastfeeding has been associated with multiple potential health benefits for the mother including reduction in heart disease, diabetes and certain cancers. In this study we found that breastfeeding for longer than 6 months was associated with a lower risk of non-alcoholic fatty liver disease in mid-life.

Pediatric allergy to secondhand marijuana smoke

This article clearly suggests you should not smoke marijuana in close proximity to your children.


Pediatric allergy to secondhand marijuana smoke

Seattle, Washington

Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

We've known for years that Erythromycin and perhaps azithromycin can cause pyloric stenosis in infants,  but we were cautious about its use during breastfeeding, or during pregnancy in mothers.  Seems from this data that erythromycin used during pregnancy or breastfeeding may not be associated with pyloric stenosis.  This is probably dose-related, and perhaps time dependent,  since levels in milk are low. This is good news.  Thus women can potentially use macrolide antibiotics while breastfeeding.  I still think they are not the best choice early postpartum in breastfeeding mothers and physicians should choose an alternate, just in case the first few months postpartum. 

Breastfeeding Greater Than 6 Months Is Associated with Smaller Maternal Waist Circumference Up To One Decade After Delivery.

Breastfeeding studies continue to suggest that breastfed infants are lighter in body weight.  This is probably due to changes in gut microbiome, although this is not clear yet.  Good news,  breastfeed your baby and give them a lighter body weight in the future. 

Anti-TNF Exposure during Pregnancy in Crohn's Disease Patients.

The use of 'biological' drugs that are derived from the IgG antibody, are gaining in popularity.  They are used in many syndromes today and are providing major changes in lifestyle for humans.  These drugs commonly work for all kinds of rheumatic or autoimmune syndromes and provide major lifestyle changes in patients.  Fortunately,  these IgG-type products don't transfer into breastmilk very well and therefore breastfeeding mothers can commonly use these products quite safely. 

High-Dose Methotrexate Treatment in a Breastfeeding Mother with Placenta Accreta: A Case Report.

Methotrexate is a rather dangerous drug and must be used really cautiously, particularly in pregnant and breastfeeding mothers.  We get this call all the time in breastfeeding mothers using this drug.  Fortunately we found  this mother who was willing to give milk samples following high dose therapy for Placenta Accreta.   This mom received 92 mg methotrexate following delivery.  Interestingly,  milk levels were really low.  This is an antifolate drug used in many diseases,  and is quite risky around pregnant women and previously I thought in breastfeeding mothers.  This data suggests that milk levels of methotrexate, even following this high dose,  are quite low (RID= 0.11%).  This was one of those questions I always hated to answer,  because we had NO data on its transmission into human milk, and its relatively dangerous.   Seems its levels in milk are very low.  We still need to be cautious,  but I can rest a bit easier now.   TWH

Transfer of Inhaled Cannabis Into Human Breast Milk.

First, you must know that doing research with Cannabis products is virtually impossible in the USA today.  The effect of all the governmental legal restrictions, virtually stops all research.  We were most fortunate to find a wonderfully supportive group of lactation consultants and cannabis using moms in Colorado,  who helped us find breastfeeding mothers who were using this product while breastfeeding.  Nine of these moms followed our directions, and provided milk samples.  This is one of the first really accurate assessments of THC transfer into human milk.  W

Estimation of Riluzole Levels in Human Milk and Infant Exposure During Its Use in a Patient With ALS.

This drug is a rather unusal compound that is ONLY used thus far for treating  Amyotrophic lateral sclerosis.  I was moved that a patient with ALS called and was continuing to breastfeed her infant, and wanted information about this drug in breastfeeding.  We found that levels of Riluzole were quite low.  Thanks to this heroic mom for providing milk samples during this difficult period of her life.  TWH


Minimal to no transfer of certolizumab pegol into breast milk: results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study.

Certolizumab is an interesting IgG molecule,  that is used to treat various autoimmune disorders, ulcerative colitis, Crohn's disease.   This product is rather unique, in that the transporter piece of the molecule that binds to various transporter receptor sites in humans, was clipped off.  Thus certolizumab is not readily transferred via the placenta in the last trimester to the fetus.  Its transfer into the milk compartment is blunted as well.  This appears to be a good product to use in pregnant and breastfeeding mothers.  (Disclaimer:  I was involved in the d

Transfer of Low Dose Aspirin Into Human Milk.

The InfantRisk Center gets lots of calls on aspirin, both 81 mg and 325 mg/day doses.  We who work in Pediatrics, have for 50 years worried about the risk of Reye syndrome,  that occurred many years ago following the use of aspirin in infants and childern while treating fever in viral syndromes.  This was an interesting study for us, because we were totally unable to find ANY acetylsalicylic acid in the breastmilk of mothers consuming aspirin.