You may be breastfeeding and have a medicine to take, a new prescription or one you were already on. Many medications pass into breast milk, but most have little or no effect on milk supply or on the baby's well-being, and it is usually safe to use prescription medications while breastfeeding. A few are to be avoided while breastfeeding, and which group yours is in depends on the medicine. Two public places collect information on a medicine and breast milk. Open both, and you can pick out the lines that report a measurement, see what your health care provider still has to weigh, and have ready the two facts about your baby that only you can give.
Where the information about a medicine and breastfeeding is kept
For a medicine, information about it and breastfeeding is collected in a national database and, for a prescription drug, on its label. The database is the Drugs and Lactation Database, LactMed, which the National Library of Medicine maintains: it holds information on drugs and other chemicals to which breastfeeding mothers may be exposed, its data come from the scientific literature with a reference for each item, and a peer review panel checks the data for scientific validity and for whether they are the most current information. LactMed is linked from the CDC's page on prescription medication use while breastfeeding.
The label here means a drug's full prescribing information, the long document written for each prescription drug, not the pharmacy sticker on the box. Under the Pregnancy and Lactation Labeling Rule, whose labeling changes took effect on June 30, 2015, the breastfeeding part of a label is a subsection headed Lactation, numbered 8.2, the new name of the old Nursing mothers subsection. Not every prescription label has moved to the new format, so on an older one look for a heading called Nursing mothers instead. Prescription labels, including the Ozempic label, are posted on DailyMed, a National Library of Medicine site. Over-the-counter medicines were left out of the rule and their labels did not change, so for a medicine bought off the shelf, look it up in LactMed, and tell your health care provider and your baby's provider that you take it.
What is inside a LactMed record, and which part is a measurement
The measured part of a LactMed record is the drug level: the levels of the substance in breast milk and in infant blood, taken from published research. Alongside those levels, a record covers the possible adverse effects in a nursing infant, alternatives to the drug where appropriate, and recommendations for use while breastfeeding. Every item carries its reference, so a line you want your provider to see can be traced to the study behind it.
The wording can read as if it were meant for a clinician. Read a record for three answers, and note each one for your appointment:
- whether the drug's level in breast milk, or in a breastfed baby's blood, was measured at all
- whether any effects in nursing babies were reported, and which
- whether alternatives are listed
Why a label's breastfeeding section can say so little
On the label, the Lactation subsection gives information about using the drug while breastfeeding, such as the amount of drug in breast milk and potential effects on the breastfed infant, and the rule requires a label to be updated when its information becomes outdated. Where there are no human data, the subsection can only say so. Read both the label and the LactMed record for your medicine, and take any difference between them to your health care provider. If you have seen a drug graded with a letter, such as category C, that letter is one of the pregnancy letter categories, A, B, C, D and X, which the same rule removed.
Ozempic, a semaglutide injection for adults with type 2 diabetes, is one weekly injection whose Lactation subsection is short. According to the Ozempic label, there are no data on whether semaglutide is present in human milk, what effect it has on a breastfed infant, or whether it affects milk production. Semaglutide was found in the milk of lactating rats, a finding whose clinical relevance is not clear because lactation differs between species. The prescriber is to consider the developmental and health benefits of breastfeeding along with the mother's clinical need for the drug and any potential adverse effects on the infant, from the drug or from the mother's underlying condition.
Ozempic's patient guide, a later pregnancy and compounded semaglutide
According to the Medication Guide at the end of the Ozempic label, the part written for patients, it is not known whether Ozempic passes into breast milk, and if you are nursing, talk with your health care provider about the best way to feed your baby while you use it. According to the Ozempic label, Ozempic is to be stopped in women at least 2 months ahead of a planned pregnancy, because semaglutide takes a long time to wash out of the body. Whether a weekly weight injection affects birth control pills depends on which medicine it is (see Can a weekly weight injection make the pill less reliable?). Compounded medications, which a pharmacy prepares, are not FDA-approved, and the Ozempic label is written for Ozempic, so if your semaglutide was compounded, ask the physician who prescribed it which breastfeeding and pregnancy statements apply to yours.
What a provider weighs that a record on a screen cannot, and who has to be told
Before prescribing for a breastfeeding mother, a health care provider is to weigh the medicine's risks and benefits, taking into account seven factors from the American Academy of Pediatrics:
- the mother's need for the drug
- its potential effects on milk production
- the amount of it excreted into breast milk
- how much of it a breastfeeding baby absorbs by mouth
- possible adverse effects on the baby
- the baby's age
- the proportion of feeds that are breast milk
Two of the seven are facts about your baby, its age and the share of its feeds that are breast milk, and neither is in any database, so have both ready when you speak to the provider prescribing. Weighing all seven is that provider's job, and how best to feed your baby while you take the medicine is a question to talk through with them. What you bring is the medicine's name, your three answers from LactMed, the label's Lactation subsection, and those two facts.
Tell your own health care provider and your baby's provider about any medicine or supplement you take, including vitamins, herbs and over-the-counter products, and tell any provider you see in the year after the birth what medication you are taking or have recently taken. Some medicines, illegal drugs and alcohol can pass through breast milk and harm a baby. If you have concerns about whether to breastfeed, check with your own health care provider, and if feeding itself has become hard, contact a lactation consultant.
For a question between appointments, you can contact Mother to Baby, from the Organization of Teratology Information Specialists, in English or Spanish at 866-626-6847, about medications, vaccines, herbal products and more during pregnancy or breastfeeding.
Signs after the birth that cannot wait for an appointment
Urgent maternal warning signs can appear during pregnancy and in the year after delivery, and any one of them needs medical care immediately, ahead of any appointment; most of them still apply while you nurse a baby of a few months. For any of these, go to an emergency room or call 911:
- fainting, or dizziness that won't go away
- trouble breathing
- a headache that won't go away or gets worse
- belly pain that is severe and doesn't go away
- throwing up that won't stop
- bleeding heavy enough to soak through one or more pads in an hour
Chest pain or pressure that is severe, breathlessness so bad that you cannot wait, or suddenly being unable to see means calling 911 right away. Thoughts about harming yourself or your baby need help right away too: go to your local emergency room or call 911, or call or text 988, the National Suicide and Crisis Lifeline, which you can reach at any time.
Every other urgent maternal warning sign needs medical care immediately as well, such as a fever of 100.4°F or higher, blurred or double vision, or extreme swelling of your hands or face: call your own health care provider right away, say you gave birth within the last year, and ask at what point to go to an emergency room or call 911. If something that is not one of those signs feels wrong, or you are not sure whether it is serious, talk to your health care provider, and tell them you were pregnant within the last year.
If you are thinking about weight care through NicoCares, its eligibility check has a box for being pregnant or breastfeeding among the health-history questions, and the clinical decision on treatment belongs to a physician with a license in your state. A question about which label applies to a medicine prescribed that way is one to send your care team in Spruce; patients join that messaging app from an invitation Spruce emails them. NicoCares is not an emergency service, so none of the signs above should wait on a message.
