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Maternal Disease and Breastfeeding
ผศ.พญ. สาวิตรี สวุิกรมโรงพยาบาลเจริญกรุงประชารกัษ์
สํานกัการแพทย์ กรุงเทพมหานคร
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Cr. : The Telegraph
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Contraindication of Breastfeeding
• Neonatal factors : GalactosemiaMetabolic disorders
• Maternal factors : Maternal diseaseMedication during lactation
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Medication during lactation• L1 : Safest• L2 : Safer• L3 : Probably safe• L4 : Possibly Hazardous• L5 : Hazardous
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L1 : Safest
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L2 : Safer
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L3 : Probably safe
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L4 : Possibly Hazardous
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L5 : Hazardous
Contraindication in breastfeeding
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Relative Infant Dose หรือ RID
• ระดบัความปลอดภยัในการใช้ยาในช่วงให้นมลกู
ปริมาณยาที่พบในนํา้นม
RID = _______________________________________________________________________________ X 100 ปริมาณยาที่พบในกระแสเลือดแม่
RID ทีน้อยกวา่ร้อยละ ๑๐ เป็นยาที่ปลอดภยัที่สามารถใช้ได้ในชว่งที่ให้นมลกู
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Maternal Disease
Cr. : Medical Career Specialists
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Medical Illness
• Hypertension• Diabetes mellitus• Heart disease• Renal disease• Hematologic disease• Epilepsy• Hyper/hypothyroid
Safeto
breastfeed
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Asthma
Safe to breastfeed
Cr. : Imperial College London
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Asthma
Safe to breastfeed
Theophylline : infant irritability and insomnia
Cr. : Imperial College London
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Migrain• NSAIDs : Safe to breastfeed
Cr. : viminim
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Migrain• NSAIDs : Safe to breastfeed
Ergotamine alkaloids (cafergot) : contraindication inhibit Prolactin decrease breastmilk
Cr. : viminim
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Infectious disease
Cr. : www.huffingtonpost.com
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Bacterial Infection
Safe to breastfeed
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Bacterial Infection
Safe to breastfeed
High dose Metronidazole : delayed breastfeeding 12‐24 hr
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Bacterial Infection
Safe to breastfeed
High dose Metronidazole : delayed breastfeeding 12‐24 hr
Chloramphenicol : bone marrow suppression
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Bacterial Infection
Safe to breastfeed
High dose Metronidazole : delayed breastfeeding 12‐24 hr
Chloramphenicol : bone marrow suppression
Trimethoprim/sulfamethoxazole, sulfisoxazole, dapsone : Precaution in neonatal jaundice, G6PD deficiencyesp. in sick baby and preterm baby
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Fungal Infection
Safe to breastfeed
Cr. : www.microscopy‐uk.org.uk
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Tuberculosis (TB)
During treatment : Safe to breastfeed
1st diagnosis (sputum AFB+) : isolate mother for 2 wk INH prophylaxis to baby expressed breastmilk
for baby if AFB‐ return to
breastfeedCr. : www.radiologyassistant.nl
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Parasitic Infection
Malaria : Safe to breastfeed
Beware use quinine and primaquine in mother with G6PD deficiency baby
Cr. : www.wired.co.uk
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Viral Infection
Women with HIV, HTLV1, HTLV2 infection
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Hepatitis A Infection
• Safe to breastfeed• Baby should receive immunoglobulin.
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Hepatitis B Infection
• Safe to breastfeed• Baby should receive HBIG and Hepatitis B vaccine.
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Hepatitis C Infection
• Safe to breastfeed
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Varicella Zoster infection(Chicken pox)
If mother has skin lesion but baby doesn’t• separate them• give VZIG to baby• expressed breastmilk for baby except lesion around nipple
Cr. : www.md‐health.com
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Varicella Zoster infection(Chicken pox)
If mother has skin lesion but baby doesn’t• separate them• give VZIG to baby• expressed breastmilk for baby except lesion around nipple
If both of mother and baby have lesion • continue breastfeeding
Cr. : www.md‐health.com
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Herpes Simplex Infection
• continue breastfeeding• contact precaution
Discontinue breastfeeding only lesion around nipple
Cr. : www.maerakluke.com
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Cancer
• Breast cancer• Other cancer
Safeto
breastfeed
Discontinue breastfeeding while treatment bychemotherapy or radiation therapy
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Breast Condition
• Cracked nipple• Mastitis• Breast abscess• Breast mass excision• Breast augmentation• Breast reduction
Safeto
breastfeed
Cr. : LOOKGREATMD
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การคมกาํเนิดุ
ในระหว่างให้นมบตรุ
พญ. สาวิตรี สวุิกรม
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ถุงยางอนามัย
สามารถใช้ได้
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ห่วงคุมกาํเนิด
สามารถใช้ได้
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ยาเมด็คุมกาํเนิดชนิดที่มีฮอร์โมนเอสโตรเจนและโปรเจสเตอโรน (Combined pills)
จะทาํให้นํา้นมลดลง
ควรหลีกเลี่ยง
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ยาเมด็คุมกาํเนิดชนิดที่มีฮอร์โมนโปรเจสเตอโรนอย่างเดียว
(Mini‐pills)ไม่ทาํให้นํา้นมลดลง
ExlutonCerazette
สามารถใช้ได้
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ยาฉีดคุมกาํเนิดชนิดฮอร์โมนโปรเจสเตอโรนอย่างเดยีว
(DMPA หรือ Depo‐provera)ไม่ทาํให้นํา้นมลดลง
แต่ควรระวังว่าถ้าฉีดก่อนที่นํา้นมจะผลิตได้เพยีงพอ (ก่อนอายุ 1 ‐2 สัปดาห์) อาจจะไปยับยัง้การออกฤทธิของฮอร์โมนโปรแลคตนิ์ ซึ่งเป็นฮอร์โมนที่ทาํ
ให้มีการผลิตนํา้นม
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ยาฝังคุมกาํเนิด
เป็นฮอร์โมนโปรเจสเตอโรน
ออกฤทธิเหมือนยาฉีดคุมกาํเนิด์
แต่อย่ได้นานถงึู 3 – 5 ปี
สามารถใช้ได้