Postpartum Therapeutic Considerations

Source: Ward KE, O’Brien BM. Pregnancy and Lactation: Therapeutic Considerations. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7992979. Accessed June 9, 2012.

• Therapeutic issues affecting both mother and child, including time from birth through lactation.

• Medications enter breast milk via passive diffusion of nonionized and non-protein-bound medication.
• Drugs with high molecular weights, lower lipid solubility, and higher protein binding less likely to cross into breast milk or transfer more slowly.
• The higher the serum concentration of drug in mother’s serum, the higher the concentration in breast milk.
• Drugs with longer half-lives maintain higher levels in breast milk.
• Timing and frequency of feedings and amount of milk ingested by infant important considerations.

Signs and Symptoms

• Postpartum issues
  • Drug use during lactation
  • Mastitis
  • Postpartum depression
  • Relactation

• Refer to individual disorders for diagnostic considerations.

• Ensure both maternal and newborn health during months after birth

• Principles for selecting medications during pregnancy:
  • Select drugs that have been used safely.
  • Eliminate nonessential medication and discourage self-medication.
  • Avoid medications known to be harmful.

• For postpartum depression, recommend:
  • Emotional support from family and friends
  • Education about condition
  • Psychotherapy

• Drug use during lactation
  • To reduce risk to infant from drugs transferred through breast milk, select medications:
    • Considered safe for infant
    • With shorter half-lives
    • More protein bound, with lower bioavailability and lower lipid solubility.
• Mastitis
  • Usually caused by Staphylococcus aureus, E. coli, and Streptococcus.
  • Treat mother with cloxacillin, dicloxacillin, oxacillin, or cephalexin for 10–14 days.
  • Recommend:
    • Bedrest
    • Adequate oral fluid intake
    • Analgesia
    • Frequent evacuation of breast milk
• Postpartum depression
  • Sertraline first-line therapy.
  • Paroxetine and nortriptyline second-line treatments.
• Relactation
  • Metoclopramide 10 mg 3 times daily for 7–14 days recommended pharmacologic therapy. Use only if nondrug therapy ineffective.

• Refer to monitoring for individual medical disorders.