Mituri in alaptare

06 aprilie 2015
Mihaela Drilea
10 comentarii

“NU ALAPTEZ, PENTRU CA NU AM AVUT LAPTE.”

Toate mamele pot alapta daca au informatii corecte si daca sunt sprijinite de catre familie, comunitate si personalul medical. Primele doua saptamani de lactatie sunt cruciale pentru succesul alaptarii. Initierea alaptarii trebuie sa se faca corect in orice fel de conditii, pentru ca alaptarea este un drept fundamental al femeii si al nou-nascutului. Nou-nascutul trebuie pus pe pieptul mamei,piele pe piele imediat dupa nastere, cand copilul este inca activ avand un reflex puternic de supt. Caldura corpului mamei ii asigura conforul termic, iar hormonii care se produc in corpul mamei la atingerea copilului (prolactina si oxitocina) se produc intr-o concentratie atat de mare ca nicioadata mai tarziu si ajuta la expulzia placentei si la o lactatie suficienta si de durata.

Dupa un timp, daca nu este deranjat, incepe sa se “catere” (engleza: crawling) spre san, atras fiind de mirosul areolei mamare, miros pe care il recunoaste din viata intrauterina. Acum va suge cel mai corect, nestingherit de o posibla confuzie intre mamelon sau tetina de la biberonul cu lapte praf si nu va avea dificulatati de supt mai tarziu.

“PLANGE BEBELUSUL. INSEAMNA CA LAPTELE MEU NU E SUFICIENT.”

După 2 ore de la naştere copilul este somnoros, greu de trezit. Perioada durează 2 – 4 ore la unii copii chiar mai mult (24 ore). Dacă nu se trezeşte atunci colostrul trebuie muls si administrat bebelusului la trezire cu linguriţa, seringa sau cana.

Urmează perioada de “reactivitate” ( Brazelton), când copilul se trezeşte şi vrea să sugă frecvent, la 1– 1 ½ ore (mai ales a doua zi după naştere). Chiar dacă mama are lapte (colostru) puţin, acesta este de ajuns pentru nou-născut, dacă acesta suge frecvent (8-12 ori pe zi).

Primele supturi pot fi fără succes , dar nou-născutul în prima zi are rezerve energetice din viaţa intrauterina. Plânsul frecvent după primele 24 de ore , mai ales în cursul serii este normal şi mama trebuie să ştie că nou născutul trebuie să fie pus la sân des, la cerere. Copilul va beneficia de efectele miraculoase ale colostrului (imunologice, stimularea peristaltismului, digestiei şi funcţiei intestinale)

“TREBUIE SA-TI PREGATESTI SFARCURILE DIN TIMPUL SARCINII.”

Mameloanele NU trebuie pregătite din timpul sarcinii pentru a nu se răni la supt. Cercetările au arătat că nu este nevoie de o pregătire prealabilă a mameloanelor ci doar de evitarea spălării cu săpun. Mai mult, orice stimulare a sanilor poate provoca contractii si o nastere prematura!!!

“SUPTUL LA SAN DOARE SI PROVOACA RAGADE.”

Mama NU trebuie să se aştepte la durere în mamelon în timpul suptului. Dacă suptul doare mamelonul va fi rănit. Suptul nu trebuie să doară! Ragadele NU se produc pentru că copilul este lăsat pre mult timp la săn. Dacă este ataşat corect la sân poate sta la sân cât timp doreste. Întreruperea suptului înainte ca nounascutul sa dea drumul sânului fără să ne întroducem degetul in guriţa lui poate cauza răni!

“CANTITAEA DE LAPTE SE POATE SIMTI DUPA PLENITUDINEA SANULUI”

Nu se poate stabili cantitatea de lapte după senzaţia “cât” de plini sunt sânii. După 3 săptămâni de la naştere sânul revine aproape la dimensiunea dinainte de naştere, lactaţia se stabilizează trece “umflarea” sau angorjarea sânului din primele săptămâni, sânul va produce atâta lapte cât are nevoie copilul. Deoarece cantitatea de lapte este egala cu cerinta nou-nascutului. Adica cu cat il punem mai des la san, cu atat corpul nostru va produce mai mult lapte, ca sa acopere cerintele bebelusului.

“LAPTELE MEU ESTE PREA SLAB, SAU NU ESTE BUN.”

Fiecare mama are lapte adecvat copilului ei! Nu există lapte slab. Laptele matur este mai subţire, alb-albastru faţă de primul lapte (colostru – care are culoare portocaliu galbuie) dar are toate substanţele nutritive si imunologice necesare pentru copil!

“SANII SUNT GOI DUPA ALAPTARE.NU MAI AM LAPTE SUFICIENT”

Producţia de lapte este un proces continuu şi întotdeauna mai vine lapte pe canale. Oricum deobicei copilul nu suge decat 60-80% din laptele disponibil.

“AM MAI PUTIN LAPTE SEARA. TREBUIE SA SUPLIMENTEZ CU LAPTE PRAF.”

Este normal ca spre seară copilul să nu se liniştească la sân (suge, apoi după puţin timp iar vrea, fără să poată adormi). Producţia de lapte continuă normal, agitaţia copilului nu este legată de producţia “insuficientă” de lapte. Mama trebuie să ştie de posibilitatea apariţiei acestei perioade, să aibă răbdare, să alăpteze relaxată. Suptul în exces face parte din stimularea normală a lactaţiei.

“TREBUIE SA BEAU MULTE LICHIDE CA SA FAC LAPTE.”

Mama trebuie să bea atâta lichide cât îi este sete. Dacă nu bea lichide laptele nu scade, ci ea va urina mai puţin şi mai concentrate….se va deshidrata!!

“TREBUIE SA MANANC MULT CA SA AM LAPTE.”

Mama trebuie să mânănce dieta ei obisnuită (un pic hipercalorică/hiperproteica la fel ca în timpul sarcinii) şi echilibrată, nu în cantităţi exagerate! Subnutriţia mamei afectează prima dată corpul ei cu mult înainte de a-i afecta laptele.

“NU AM VOIE SA CONSUM ANUMITE ALIMENTE CARE PROVOACA COLICI COPILULUI.”

Mama poate consuma orice fel de aliment în cantitate moderată, dar trebuie să observe care aliment în consum repetat produce discomfort copilului şi pe aceastea să-l evite. Mamele cu antecedente de alergie trebuie să evite alimentele alergizante ( ouă, nuci, peşte, căpşuni).

“COPILUL ARE NEVOIE DE APA, ATUNCI CAND ESTE PREA CALD.”

Laptele de mamă este atât o băutură cât şi un aliment. Copilul poate să sugă mai frecvent pentru a-si stinge setea (suge primul lapte care iese din sân, cel apos si suge puţin dar des).

“COPILUL VA DEVENI UN RASFATAT DACA IL IAU IN BRATE SI IL ALAPTEZ CAND PLANGE.”

Bebeluşii au nevoi fizice şi emoţionale vor să se simtă în siguranţâ şi iubiţi. Este normal să necesite contactul strâns şi mângăierea. După Jelliffe copilul este un “fât extrauterin” până la 9 luni fiind total dependent de mama sa. În societăţile unde in mod normal, tradiţional mama îşi poartă în permanenţă copilul cu ea, copiii nu plâng! Copiii nu stiu sa santajeze prin plans pana la 7-8 luni, ci au nevoi fizice.

“DACA AM SANI PLATI SAU MICI NU AM LAPTE.”

Mărimea sânului nu este legată de funcţia lor de a furniza lapte la cerere. Si sânii mici pot produce mult lapte.

“AM GEMENI SAU TRIPLETI. NU ALAPTEZ PTR CA NU AM SUFICIENT LAPTE PENTRU TOTI.”

Este greu intr-adevăr …..solicitant, si poate obositor pentru mami….dar lapte va fi suficient in mod sigur, trebuie doar sa-i punem pe bebelusi la sân ori de câte ori doresc ei. La inceput o sa reusiti asta pe rand cu fiecare copilas in parte, iar ulterior dupa ceva “antrenament”o sa reusiti asta si concomitent cu amandoi. Trebuie doar sa va gasiti o pozitie confortabila cu ajutorul unor perne de alaptat.

“NU MAI ALAPTEZ PENTRU CA AM FACUT RAGADE SI MA DOR FOARTE TARE SFARCURILE.”

Orice rana din pusul incorect la san se vindeca. Exista creme naturale din plante, comprese care ajuta la vindecarea ranilor. O expunere a sanilor cat mai mult la aer ajuta si ea la o vindecare mai rapida. Un ajutor in acest caz o constituie o pompa de muls, ca sa nu se opreasca lactatia prin nestimulare sau ca sa evitam posibile infectii ale sanului prin negolirea lui. Pompatul sau mulsul manual sau electric ajuta la hranirea in continuare a copilasului cu lapte matern.

“SUNT DISPERATA! NU MAI AM LAPTE. AM MULS / POMPAT DOAR 10 ML DINTR-UN SAN.”

Daca vei pune copilul la sanul din care tocmai te-ai muls, vei vedea ca copilul va produce din nou lactatia. Suptul copilului este incomparabil mai eficient decat o pompare electrica sau mulsul manual. O pompa nu reuseste sa extraga decat laptele de la suprafats, cel de la periferie, din profunzime va ramane in san, o pompa poate sa extraga in medie 40% din laptele pe care il producem.

“DUPA CE MANANCA, SANII TREBUIE GOLITI CU POMPA SAU MULSI.”

Sânii nu trebuie goliti după ce mănâncă bebe…..decât dacă simtiti disconfort, durere in profunzime, zone tari, sau tensiune… Lactatia se stabilizeaza si veți produce atât lapte cât ii va trebui copilului, deci cu cât goliti mai des sânii după alaptare cu atât mai mult lapte veți produce si ajungeti la hiperlactatie!

“DUPA 6 LUNI LAPTELE MEU NU MAI E BUN SAU NUTRITIV.”

NU exista lapte matern care sa nu fie bun! Culoarea sau consistenta laptelui matern nu este un factor esential sau hotarator in a afirma ca laptele nu ar mai fi bun. Academia Americană de Pediatrie susține ca laptele matern este principala sursa de nutrienti pt copil pana la vârsta de 6luni mergand chiar si pana la 1 an si sprijină alaptarea pana la DOI ani si peste. Sistemul imunitar al bebelusului poate fi considerat aproape de maturitate doar după varsta de 2ani!

“COPILUL MEU NU VREA SA SE DIVERSIFICE LA 6 LUNI. NU MAI ALAPTEZ CA SA MANANCE MANCARE.”

Diversificarea alimentatiei începe de regula după 6 luni DACA bebe este interesat de altfel de mancare decat laptele matern. Pana la 6 luni stomacul bebelusului nu este pregatit ptr a digera altceva decat lapte matern. Semne ca puteti incepe diversificarea sunt: poate sa stea singur in fundulet, duce la gura obiecte pe care le apuca între degetul mare si cel aratator !

“INTARC COPILUL PENTRU CA LAPTELE DUPA 1 AN NU MAI E NUTRITIV”

Bebelusul alaptat la cerere de la naștere pana peste 1an se va întarca singur de cele mai multe ori între 18-24 luni! Este o prostie sa fiti indrumate sa intarcati copilul pentru ca cineva afirma ca laptele nu ar mai fi nutritiv dupa o anumita perioada de timp.

“ALAPTATUL IN TANDEM = IMPOSIBIL ”

O femeie produce in mod normal lapte care ar fi suficient pentru 2 copii, iar dacă realizam ca alaptatul este un mecanism mamar, adică este reglat prin control autocrin……totul funcționează pe baza legii “cerere si oferta”. Nu o sa suferiti de angorjarea sanilor, deoarece copilul cel mare o sa fie cea mai buna “pompa” din lume. Nici de furia laptelui nu o sa suferiti, si nici de celelalte probleme care pot apărea in alaptat gen obstructii de canal….mastite……De câte ori simtiti disconfort puneti copilul cel mare sa suga ca sa mai goleasca sanul tare. Puteți alapta copiii:gen fiecare cu sanul lui sau sa aveți grija ca întâi sa mănânce cel mic.

10 comentarii Adauga un comentariu

  1. Andreea spune:

    Buna, mie mi-a spus stomatologul ca daca vreau sa alaptez in continuare, sa ii dau lui bebe sa suga numai dupa 4-6 ore dupa anestezie si sa mulg primul lapte, pe care sa-l si arunc.

    • Buna, atunci cum de te lasă după ce naști prin cezariana si ti se face o anestezie tip rahie sa alaptezi imediat după naștere? Nu cumva Concentrațiile sunt mai mari decât la o anestezie locală făcută de stomatolog?
      Ti-am răspuns cu o întrebare :)
      Nu exista nimic pe lumea aceasta care sa nu prezinte si riscuri….dar dacă pui in balanța riscuri vs beneficii, ajungi sa poți lua o decizie înțeleapta!
      La mult mai multe aspecte legate de aceste mituri in alaptare gasesti răspunsuri in cartea dr Jack Newman.
      Si nu uita! Ai încredere in instinctul tau

      • Andreea spune:

        Buna, din nou! Am fost la stomatolog, mi-a facut anestezie, apoi am alaptat, ce-i drept, cu niste emotii. Bebeloiu’ nu a avut absolut nimic. Niciun stres, nici stare de somnolenta, nici iritatii … nimic! Si da, ai dreptate in ceea ce priveste anestezia pt nastere. Merci de ajutor!

  2. mihai mihaela spune:

    Eu am o fetita are 2 ani si imediat o luna nu reusec sa o intarc este bine sa o alaptez in continuare ? Am incercat toate metodele dar fara succes

    • Draga mea este bine si chiar recomandat sa o alaptezi in continuare! keep on going :)
      II oferi in continuare un laptip foarte bogat in anticorpi si foarte multa dragoste si siguranta!

  3. Daniela Gruia spune:

    Alaptez de 10 luni si pana acum ,cei din jurul meu mi-au dat toate “sfaturile” intalnite mai sus, plus multe altele…mai mult ,in familie mi se spune acum ca “daca nu se satura la o luna,acum nici atat” sau “copilul meu ,la 3 luni manca un bol intreg de ciorba!!”
    Multumesc cerului de incapatanarea mea si de faptul ca am crezut in natura (si in informatie valida) astfel incat copilul meu sa poata beneficia de toate avantajele alaptarii ! Este o munca titanica si ingrata aceea de a te justifica in fata familiei pentru ceva ce-ar trebui privit ca fiind perfect natural! Fetelor, fruntea sus,aveti incredere in voi si in micuti…ei stiu cel mai bine “cand” (alaptam,intarcam,diversificam…etc)

  4. ioana spune:

    Am un copil de 15 luni si inca il alaptez. Sunt sub un tratament cu lamotrigina 200 mg pe zi. In maternitate mi s-a spus ca pot sa il alaptez la 4 ore dupa ce am luat pastila. Este f atasat de san si nu stiu daca sa il intarc. Imi este frica sa nu il afecteze pastilele pe care le iau avand in vedere perioada lunga in care l-am alaptat. Ce ma sfatuiti sa fac?

    • Draga Ioana, uite ce am gasit despre mediactia pe care o iei tu, sincer eu nu consider ca trebuie sa renunti la alaptare!
      Lamotrigine
      CASRN: 84057-84-1
      Chemical structure for Lamotrigine

      FULL RECORD DISPLAY
      Displays all fields in the record.
      For other data, click on the Table of Contents

      Drug Levels and Effects:

      Summary of Use during Lactation:

      Breastfed infants whose mothers are taking lamotrigine have relatively high plasma lamotrigine levels, averaging 30 to 35% of maternal serum levels; infant plasma levels up to 50% of maternal levels have been reported. Neonates are particularly at risk for high plasma levels because their ability to metabolize the drug by glucuronidation is limited, plasma protein binding is relatively low, and maternal plasma and milk levels can rise dramatically in the immediate postpartum period if the dosage is not reduced to the prepregnancy dosage.[1][2] Mild thrombocytosis has been reported in some infants and withdrawal symptoms can occur if breastfeeding is abruptly discontinued. One case of severe apnea occurred in a breastfed 16-day-old whose mother was taking a high dose of the drug, and other cases of central nervous system depression have ben reported. Additionally, lamotrigine can cause rare, but potentially fatal skin reactions, although none has been reported in breastfed infants. Breastfeeding during lamotrigine monotherapy does not appear to adversely affect infant growth or development, and breastfed infants had slightly higher IQs and enhanced verbal abilities than nonbreastfed infants at 6 years of age in one study.[3] Combination therapy with sedating anticonvulsants or psychotropics may result in infant sedation or withdrawal reactions.

      If lamotrigine is required by the mother, it is not necessarily a reason to discontinue breastfeeding, because many infants have been breastfed without adverse reactions. However, breastfed infants should be carefully monitored for side effects such as apnea, rash, drowsiness or poor sucking, including measurement of serum levels to rule out toxicity if there is a concern. Monitoring of the platelet count and liver function may also be advisable. If an infant rash occurs, breastfeeding should be discontinued until the cause can be established.

      Drug Levels:

      In published reports of anticonvulsant use during breastfeeding, most women were taking a combination of anticonvulsants. Some other anticonvulsants (e.g., phenytoin, carbamazepine) stimulate the metabolism of other drugs including anticonvulsants, whereas others (e.g., valproic acid) inhibit the metabolism of other drugs. Therefore, the relationship of the maternal dosage to the concentration in breastmilk can be quite variable, making calculation of the weight-adjusted percentage of maternal dosage less meaningful than for other drugs in this database.

      Maternal Levels. An epileptic woman took oral lamotrigine 300 mg daily throughout pregnancy and postpartum. After 6 weeks postpartum, the dosage was reduced to 200 mg daily. Breastmilk lamotrigine levels (time with respect to the doses not stated) on a dose of 300 mg daily ranged from 2.4 to 6.5 mg/L. After reducing the maternal dosage to 200 mg daily, the milk levels were 1.95 and 1.26 mg/L at days 64 and 92 postpartum, respectively.[4]

      A woman with epilepsy was taking lamotrigine at a dosage of 300 mg daily in the last half of pregnancy and postpartum. At 2 weeks postpartum, breastmilk samples taken before the morning dose, before and after nursing, were 5.6 and 5.7 mg/L, respectively.[5]

      Thirty-four women with 35 births had breastmilk lamotrigine levels monitored. Specific dosages and milk levels were not reported in the abstract, but the authors stated that they calculated that some of the infants received a mg/kg dosage that would be expected to produce therapeutic serum levels. However, infant serum levels were not reported.[6]

      Nine epileptic mothers with 10 pregnancies taking lamotrigine in daily dosages averaging 411 mg daily (range 100 to 800 mg daily) had their breastmilk lamotrigine levels monitored between days 13 and 18 postpartum before and after nursing. (One of the mothers had her first of 2 pregnancies reported previously in reference [4]) Three of the women were also taking other anticonvulsants that induce lamotrigine metabolism; one was taking valproic acid that inhibits lamotrigine metabolism. The average prenursing breastmilk level was 7.4 mg/L (range 1 to 8.2 mg/L), 11.8 hours after the previous dose. The average postnursing level was 5.6 mg/L (range 1 to 8.2 mg/L); one mother had taken a dose during nursing. The authors estimated that these exclusively breastfed infants would receive between 0.2 and 1 mg/kg daily or about 9% (range 2 to 20%) of the maternal weight-adjusted dosage.[1][7]

      Six nursing mothers who were taking lamotrigine in an average dosage of 6.3 mg/kg daily (range 1.75 to 12.5 mg/kg daily)collected milk over 1 to 2 dosage intervals. The mean infant daily dosage of lamotrigine in breastmilk was 0.45 mg/kg daily (range 0.1 to 0.75 mg/kg daily) which was 7.6% (range 5.7 to 9.9%) of the maternal weight-adjusted dosage.[8]

      A hospital laboratory evaluated all requests for lamotrigine concentration measurements. Mothers were taking between 50 to 500 mg of lamotrigine daily in the postpartum period. Milk concentrations ranged from 0.3 to 10.3 mg/L.[9]

      Twenty-four nursing mothers taking lamotrigine had serum and breastmilk concentrations measured on several occasions. The average lamotrigine dosage was 387 mg daily (range 50 to 800 mg daily) or 5.93 mg/kg daily (range 0.99 to 14.34 mg/kg daily). The average breastmilk concentration of all samples was 3.4 mg/L (range 0.5 to 11.8 mg/L). The authors estimated that an exclusively breastfed infant would receive an average dosage of 0.51 mg/kg daily which was equivalent to 9.2% (range 3.1 to 21.1%) of the maternal weight-adjusted maternal dosage. Among 16 women who donated multiple serial milk samples, the peak milk concentrations occurred about 3 hours after the dose and averaged 2.3 times the average minimum milk concentration.[10]

      Four women who were taking lamotrigine during pregnancy and postpartum had their milk analyzed for lamotrigine twice between 1 to 12 weeks postpartum. Maternal dosages ranged from 250 to 900 mg daily and milk concentrations ranged from 2.8 to 8 mg/L.[11]

      A mother was taking 875 mg of lamotrigine daily at term and her dose was slowly reduced by 25 mg/day at weekly intervals beginning 2 weeks postpartum. On day 22 postpartum with a dose of 600 mg daily, her milk lamotrigine level was 7.68 mg/L 13 hours after a dose and on day 25, it was 10.06 mg/L 3.5 hours after the same dose. From days 28 to 64 postpartum on doses of 525 to 575 mg/day, milk samples contained 7.02 to 8.71 mg/L of lamotrigine 12 to 14 hours after a dose. The authors estimated that the infant’s daily dosage on day 22 was 1.15 mg/kg, equating to 13% of the maternal weight-adjusted dosage.[12]

      A mother treated for epilepsy during pregnancy and breastfeeding had lamotrigine measured in several blood and milk samples during the first month postpartum. She was receiving 400 mg of lamotrigine daily which corresponded to a dose of 5.3 mg/kg daily at birth increasing to 6.5 mg/kg daily at 1 month due to postpartum weight loss. Milk lamotrigine levels ranged from 7.8 to 11.5 mg/L on 4 occasions during the first month.[13][14]

      Infant Levels. An infant was exclusively breastfed from day 2 of age during maternal treatment with lamotrigine 300 mg daily. Infant total serum level at 2 days of age was 2.8 mg/L (free drug 1.2 mg/L), reflecting transplacental passage. Serum levels taken periodically 2 to 3 hours after the morning dose and 1 to 2 hours after breastfeeding ranged from 1.7 to 2.7 mg/L (free drug 0.73 to 1 mg/L). After maternal dosage reduction to 200 mg daily and 50% formula supplementation, total serum levels on days 64 and 92 dropped to 1.54 and 0.75 mg/L (free drug 0.53 and 0.24 mg/L), respectively. Infant serum levels were undetectable (total <0.2 mg/L; free <0.1 mg/L) on days 144 and 145 with only one breastfeeding daily.[4]

      The 2-week old breastfed infant of a mother taking lamotrigine 300 mg daily had a level of 1.4 mg/L before the mother’s morning dose.[5]

      The plasma levels of 10 breastfed infants of 9 mothers taking lamotrigine during pregnancy and postpartum were monitored after birth. Most were breastfed from day 1 or 2 of age. Their transplacentally acquired plasma levels which were similar to maternal plasma levels at birth, generally dropped slightly over the first 72 hours of life. Infant plasma levels 2 to 3 weeks postpartum averaged 1.7 mg/L (range 0.5 to 3.3 mg/L) before nursing about 11.8 hours after the previous maternal dose and 1.5 mg/L (range <0.5 to 2.5 mg/L) after nursing. Infant plasma levels averaged 30% (range 23 to 50%) of their mothers’ plasma levels at that time.[1][7]

      Four infants of mothers taking lamotrigine monotherapy during pregnancy and lactation for partial seizures had their plasma levels monitored on day 10 of age (sampling time with respect to dose or nursing not reported). Maternal dosages were 200,400,750, and 800 mg and the respective infant’s serum levels were <1, 1.8, 2, and 1.3 mg/L. Repeat levels in 2 infants at 2 months of age were 1.7 and 1.9 mg/L (previously 1.8 and 1.3 mg/L, respectively). Infant plasma levels ranged from 0 to 43% of maternal plasma levels at 10 days of age and 20 and 23% of maternal levels at 2 months when they were partially breastfed, each receiving formula for 2 or 3 feedings daily.[2]

      Six infants with a median age of 4.1 months (range 0.1 to 5.1 months) were breastfed during maternal use of lamotrigine in an average dosage of 6.3 mg/kg daily. Five were exclusively breastfed and one was about 50% breastfed. Single serum levels taken at various times after the maternal dose averaged 0.6 (range 0.3 to 0.9 mg/L) which averaged 18% (range 3 to 33%) of maternal serum levels.[8]

      A hospital laboratory evaluated all requests for lamotrigine concentration measurements. Mothers were taking between 50 to 500 mg of lamotrigine daily. Infant serum concentrations averaged 88% of their mothers’ serum concentrations at delivery , and averaged 45 to 55% of their mothers’ serum concentrations at 3, 7, 14 and 30 days after delivery, although the percentage of infants who were breastfed was not stated. Infants who were breastfed (extent not stated) had serum concentrations ranging from <0.1 to 12.7 mg/L.[9]

      Simultaneous infant and maternal serum lamotrigine concentrations were obtained from 12 mother-infant pairs during maternal use of lamotrigine. Total infant serum concentrations of lamotrigine averaged 18.3% of maternal serum concentrations, but unbound infant serum concentrations averaged 30.9% of maternal levels, probably because the drug was less bound in the infants’ serum. In 4 mother-infant pairs who had simultaneous serum sampling at delivery and again during the first 4 weeks postpartum, infant/maternal serum concentration ratios averaged 12.2 (total) and 6.2 (unbound) times higher at delivery than at the second sampling. These decreases indicate that exposure to lamotrigine during breastfeeding is much less than exposure during pregnancy.[10]

      Four breastfed infants (extent not stated), whose mothers were taking lamotrigine in dosages ranging from 250 to 900 mg daily, had serum lamotrigine concentrations measured twice after breastfeeding between 1 and 12 weeks postpartum. The median serum concentration in the infants was 2.2 mg/L (range 1.7 to 3.3 mg/L), which was 26% of the median maternal serum concentrations.[11]

      An infant was fully breastfed by a mother taking lamotrigine during pregnancy and postpartum. The infant had a serum concentration of 7.7 mg/L at 12 hours of life and 5.8 mg/L on day 3 of life while his mother was taking 875 mg daily of lamotrigine. On day 16, 4 hours after the maternal dose and 3 hours after breastfeeding, the infant’s serum concentration was 4.9 mg/L with a maternal dose of 850 mg daily. Breastfeeding was terminated on day 17 because of an severe apneic episode in the infant; on day 22, the infant’s serum concentration was 1.3 mg/L and on day 25 it was 0.5 mg/L.[12]

      A mother treated for epilepsy during pregnancy and breastfeeding was receiving 400 mg of lamotrigine daily which corresponded to a dose of 5.3 mg/kg daily at birth and increasing to 6.5 mg/kg daily at 1 month due to postpartum weight loss. Her breastfed (extent not stated) infant had a serum lamotrigine concentration of 13.6 mg/L at birth, 12.7 mg/L at 4 days of age and then stabilized between 6.7 to 6.9 mg/L from days 6 to 32 of age. The initial high levels were probably due to transplacental transmission. The later concentrations corresponded to 44 to 49% of the maternal serum concentrations.[13][14] The same authors reported on 21 women who were taking lamotrigine during pregnancy and lactation and their infants. At 6 to 10 days postpartum, the infants’ serum lamotrigine concentrations ranged from 0% to 74% of maternal serum concentrations.[15]

      A computer simulation of 300 cases in which the mother was receiving 200 mg of lamotrigine daily estimated that a fully breastfed infant would receive an average of 2 mg of lamotrigine daily and develop average serum concentration of 1 mg/L.[16]

      Three breastfed preterm infants whose mothers were taking lamotrigine 200 mg daily had serum lamotrigine levels measured. One infant whose mother was taking no other drugs, had undetectable serum lamotrigine. The other two infants were twins whose mother was taking other unspecified medications for bipolar disorder. They reportedly had serum levels “within the therapeutic range”. Whether the infants were exposed prenatally was not stated.[17]

      Four mothers treated with lamotrigine for bipolar disorder in dosages of 100 to 300 mg daily fully breastfed their infants. Infant and maternal serum samples were obtained between 1.5 and 5 weeks postpartum. The infant serum levels averaged 32.5% (range 18 to 46%) of the maternal serum levels.[18]

      Effects in Breastfed Infants:

      One infant was exclusively breastfed from day 2 of life during maternal lamotrigine 300 mg daily, which was decreased at 6 weeks postpartum to 200 mg daily and 50% formula was introduced. Examinations every 4 weeks showed normal development and no evidence of mental retardation or neurologic deficits. An electroencephalogram at 4 weeks of age showed no signs of pathology.[4]

      A breastfed infant whose mother was taking lamotrigine 300 mg daily during pregnancy and postpartum had no observable adverse effects up to 5 months of age.[5]

      The same authors reported 9 previously unreported infants who were breastfed during maternal lamotrigine therapy (dosage range 100 to 800 mg daily) with no adverse effects.[1][7]

      Thirty-five pregnancies in 34 mothers who were taking lamotrigine during pregnancy were monitored. An unstated fraction of them breastfed their infants. No adverse effects in infants were observed.[6]

      An exclusively breastfed infant whose mother was taking lamotrigine 200 mg and levetiracetam 2.5 g daily during pregnancy and lactation appeared healthy to the investigators throughout the 6- to 8-week study period.[19]

      The breastfed infant of a woman taking lamotrigine 300 mg daily developed normally during the first 4 months of life and no adverse effects were observed.[20]

      A 6-week-old infant developed apparent withdrawal symptoms after abrupt weaning by a mother who was taking lamotrigine 200 mg daily during late pregnancy and postpartum. Symptoms included loss of appetite, neuromotor hyperexcitability and irritability. Symptoms occurred 2 weeks after weaning and were completely alleviated within 48 hours after instituting lamotrigine 1 mg/kg daily in the infant. Neuromotor development of the infant normalized 1 month after discontinuing therapy.[21] The reaction is rated as probably caused by lamotrigine in breastmilk.

      Six infants with a median age of 4.1 months (range 0.1 to 5.1 months) were breastfed during maternal use of lamotrigine in an average dosage of 6.3 mg/kg daily. Five were exclusively breastfed and one was about 50% breastfed. No adverse effects were noted by the mothers or the attending pediatricians. A clinical pediatric assessment in 3 of the infants also revealed no adverse effects.[8]

      Thirty infants whose mothers were taking lamotrigine were followed during breastfeeding. None of the infants developed a rash. Among infants who were monitored by laboratory testing, no abnormalities in liver tests, electrolytes (n = 10) or hematocrits (n = 8) were noted. Elevated platelet counts were observed in 7 of 8 infants tested (average age 3.8 weeks, range 2 to 10 weeks), with no adverse clinical effects.[10]

      A mother was taking 875 mg of lamotrigine daily at term and her dose was slowly reduced by 25 mg/day at weekly intervals beginning 2 weeks postpartum. Her infant was fully breastfed and on day 16 postpartum while she was taking 850 mg daily, the infant experienced a severe apneic episode requiring cardiac compressions to maintain perfusion and was responsive only to painful stimuli. The infant’s mother was taking a high dosage and had extensive drug excretion into breastmilk, and the infant’s serum concentration was at the high end of the therapeutic range for children, but the fact that no adverse effects had occurred prior to day 16 could not be explained. Lamotrigine was assessed to be the probable causes of the apneic episode.[12]

      Three women with bipolar disorder breastfed their infants during pregnancy and breastfeeding. One took 50 mg daily at term and increased her dose to 200 mg within one month. She reportedly breastfed her infant exclusively for 12 months. An unrelated infant rash occurred at 4 months of age, but the infant’s growth and development were normal at 18 months of age. Another woman took lamotrigine 250 mg daily while she breastfed (extent not stated) her infant for several weeks. The infant’s growth and development were normal at 18 months of age. The third mother also took 250 mg daily while breastfeeding (extent not stated) for at least 15 months. At 4 months of age, the infant developed a rash on the neck that resolved spontaneously; the infant’s growth and development were normal at 15 months of age.[22]

      Five breastfed preterm infants were reported whose mothers were taking lamotrigine. Transient elevation of liver enzymes occurred in twins whose mother was taking other unspecified medications for bipolar disorder. No adverse effects were seen in the other infants.[17]

      A prospective cohort study in Norway followed infants of mothers who took antiepileptic drugs during pregnancy and lactation and compared to infants with mothers with untreated epilepsy and infants with fathers who took antiepileptics as control groups. Of the 223 mothers studied, 71 were taking lamotrigine monotherapy. Infants were assessed at 6, 18 and 36 months of age. Continuous breastfeeding in children of women using antiepileptic drugs was associated with no greater impaired development than those with no breastfeeding or breastfeeding for less than 6 months.[23][24]

      In a long-term study on infants exposed to anticonvulsants during breastfeeding, no difference in average intelligence quotient at 3 years of age was found between infants who were breastfed (n = 30) a median of 6 months and those not breastfed (n = 36) when their mothers were taking lamotrigine.[25] Breastfeeding during phenytoin monotherapy does not appear to adversely affect infant growth or development, and breastfed infants had higher IQs and enhanced verbal abilities than nonbreastfed infants at 6 years of age in one study.[3] Combination therapy with sedating anticonvulsants or psychotropics may result in infant sedation or withdrawal reactions.

      All adverse reactions in breastfed infants reported in France between January 1985 and June 2011 were compiled by a French pharmacovigilance center. Of 174 reports, lamotrigine was reported to cause adverse reactions in 6 infants and to be one of the drugs most often suspected in serious adverse reactions, such as sedation, hypotonia, weight loss and liver damage.[26]

      Effects on Lactation and Breastmilk:

      Relevant published information was not found as of the revision date.

  5. Vasii spune:

    Am nascut acum cateva zile la maternitatea de stat si am fost in salon cu o doamna de etnie rroma. Femeia mi-a zis ca ea ca sa aiba mult lapte bea bere ceea ce mie mi s-a parut fascinant, dar ma si umbrea gandul la un copil intrat in coma alcoolica. Asadar, inttrebarile mele sunt:
    -are berea efect asupra alaptarii?
    -alcoolul din bere nu afecteaza copilul?

    Mult succes in ceea ce faci si iti multumesc pentru toate informatiile publicate. Mi-ar fi placut sa te cunosc personal, dar nu am putut sa vin la Brasov sa nasc.

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