CBC CBC Medications & Substances in Breastfeeding 2 — Questions and Answers
Question 1: Alcohol consumption while breastfeeding is a common concern. What is the safest guidance for a CBC counselor to provide?
- Waiting 2–3 hours per standard drink before nursing minimizes infant exposure (Correct answer)
- Pumping and dumping immediately after drinking eliminates all alcohol from milk
- One to two drinks daily are considered completely safe for all infants
- Alcohol does not transfer into breast milk at detectable levels
Correct answer: Waiting 2–3 hours per standard drink before nursing minimizes infant exposure
Alcohol clears from milk at the same rate as from blood, so waiting approximately 2–3 hours per drink before nursing minimizes infant alcohol exposure.
Question 2: Which antidepressant class is generally considered most compatible with breastfeeding based on current evidence?
- Selective serotonin reuptake inhibitors (SSRIs), particularly sertraline and paroxetine (Correct answer)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- All antidepressants carry equal risk and none should be used
Correct answer: Selective serotonin reuptake inhibitors (SSRIs), particularly sertraline and paroxetine
SSRIs, especially sertraline and paroxetine, have extensive safety data showing low milk transfer and minimal adverse infant effects.
Question 3: A CBC counselor is asked about cannabis use while breastfeeding. What is the most evidence-based response?
- Cannabis use is not recommended during breastfeeding as THC accumulates in breast milk and may affect infant neurodevelopment (Correct answer)
- Cannabis is safe because it is a natural plant product
- Topical cannabis products pose no risk to breastfed infants
- THC does not cross into breast milk due to its large molecular size
Correct answer: Cannabis use is not recommended during breastfeeding as THC accumulates in breast milk and may affect infant neurodevelopment
THC is highly lipid-soluble and accumulates in breast milk; current evidence links infant THC exposure to potential neurodevelopmental concerns.
Question 4: What is the primary concern with codeine use in breastfeeding mothers?
- Ultra-rapid metabolizers can produce dangerously high morphine levels that transfer into milk, potentially causing infant respiratory depression (Correct answer)
- Codeine reduces milk supply significantly after a single dose
- Codeine is not absorbed from breast milk by infants
- The concern is only relevant for premature infants
Correct answer: Ultra-rapid metabolizers can produce dangerously high morphine levels that transfer into milk, potentially causing infant respiratory depression
Mothers who are CYP2D6 ultra-rapid metabolizers convert codeine to morphine very quickly, leading to elevated morphine levels in milk that can cause infant sedation or respiratory depression.
Question 5: Which herbal supplement has some evidence suggesting it may decrease milk supply?
- Sage (Salvia officinalis) (Correct answer)
- Fenugreek
- Blessed thistle
- Fennel
Correct answer: Sage (Salvia officinalis)
Sage contains compounds thought to have antiestrogenic and antisecretory effects, and traditionally has been used to dry up milk supply.
Question 6: When a breastfeeding mother must undergo general anesthesia for surgery, what is the current evidence-based recommendation?
- Breastfeeding can typically resume as soon as the mother is alert and stable, without a required pump-and-dump period (Correct answer)
- She must pump and dump for at least 24 hours post-anesthesia
- Breastfeeding must be permanently discontinued after general anesthesia
- She should wait a minimum of 12 hours regardless of how she feels
Correct answer: Breastfeeding can typically resume as soon as the mother is alert and stable, without a required pump-and-dump period
Most anesthetic agents are rapidly cleared from the body, and current evidence supports resuming breastfeeding once the mother is alert and recovering, as milk levels are minimal.
CBC CBC Medications & Substances in Breastfeeding 2
Alcohol consumption while breastfeeding is a common concern.
What is the safest guidance for a CBC counselor to provide?