In special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply.
For the latest information on COVID-19 and breastfeeding, visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html.
Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should speak with their health care providers before considering breastfeeding:
- Antiretroviral medications (for HIV/AIDS treatment)1
- Birth-control medications containing estrogen, until breastfeeding has been well established2
- Cancer chemotherapy agents1
- Illegal drugs1
- Certain medications prescribed to treat migraines, such as ergot alkaloids3
- Mood stabilizers, such as lithium and lamotrigine4
- Sleep-aid medicines5
In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding.1
The above list of medications and other drugs is only a guideline. Before breastfeeding, you should speak with your health care provider about all medications that you are taking.5 These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.
Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed.5
Contact your infant's health care provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness.5
Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.
If you have any of the following conditions, breastfeeding your infant is NOT advised. For more information, speak with your health care provider:1
- Infection with HIV
- Infection with human T-cell lymphotropic virus type I or type II
- Untreated, active tuberculosis
If you are sick with the flu, including the H1N1 flu (also called the swine flu), you should not stop feeding your infant expressed milk. You should avoid being near your infant, however, so that you do not infect him or her. To avoid infecting your infant, someone who is not sick should give your infant your expressed milk.6
For more information on the flu, including the H1N1 flu, visit the following Centers for Disease Control and Prevention (CDC) webpage: http://www.cdc.gov/flu/.
If you have Zika virus or live in areas where Zika virus is found, the CDC recommends you continue to breastfeed your infant. Although Zika virus has been detected in breast milk, there are no reports of transmission of the virus through breastfeeding, and the benefits of breastfeeding are thought to outweigh the risks.7 NICHD is partnering with other NIH Institutes and the Brazilian research organization Fundação Oswaldo Cruz (Fiocruz) to study Zika virus transmission in 10,000 pregnant women and their infants. If possible, breast milk will be collected from the mothers. For more information on breastfeeding and Zika virus, visit the CDC's page on Zika virus transmission and its Q&A for health care providers.
In the United States, the American Academy of Pediatrics and the CDC recommend against breastfeeding if you are HIV positive; the same advice applies in other developed countries.1,8 Without any specific interventions to reduce transmission, infants breastfed by HIV-positive mothers have an increased chance of acquiring HIV through the breast milk. This rate increases if infants are breastfed longer and for mothers with newly-acquired HIV.9
Only HIV-positive mothers living in developing countries should consider breastfeeding their babies, especially if a safe and reliable source of infant formula is unavailable.9 This is because breast milk may protect against malnutrition and diarrhea, which are major causes of infant mortality in some areas of the developing world. If an HIV-positive woman decides to breastfeed her baby, research indicates that the risk of transmitting HIV to her baby is reduced if she exclusively breastfeeds (does not use a combination of formula and breast milk) and if she and her infant take antiretroviral drugs.10,11
In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding.
- Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes should monitor their blood sugar levels regularly, may need to reduce their insulin, and may need a snack containing carbohydrates before or during breastfeeding.12 Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding.
- Women who have had breast surgery in the past may face some difficulties with breastfeeding.13
- Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed.14
- Infants who have galactosemia—a rare metabolic disorder in which the body cannot digest the sugar galactose—should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.5
- Centers for Disease Control and Prevention (CDC). (2015). Breastfeeding: Diseases and conditions. Retrieved March 21, 2016, from http://www.cdc.gov/breastfeeding/disease/index.htm
- American College of Obstetricians and Gynecologists. (2016). Breastfeeding your baby. Retrieved June 1, 2016, from http://www.acog.org/Patients/FAQs/Breastfeeding-Your-Baby
- Tepper, D. (2015). Pregnancy and lactation—migraine management. Headache: The Journal of Head and Face Pain, 55, 607–608. Retrieved January 28, 2016, from https://americanheadachesociety.org/wp-content/uploads/2018/05/Pregnancy_and_Lactation_Toolbox.pdf (PDF 209 KB)
- Massachusetts General Hospital Center for Women's Mental Health. (2015). Breastfeeding & psychiatric medications. Retrieved January 29, 2016, from http://www.womensmentalhealth.org/specialty-clinics/breastfeeding-and-psychiatric-medication/
- March of Dimes. (2016). Keeping breast milk safe and healthy. Retrieved June 2, 2016, from http://www.marchofdimes.org/baby/keeping-breast-milk-safe-and-healthy.aspx
- CDC. (2009, October 23). 2009 H1N1 (swine flu) and feeding your baby: What parents should know. Retrieved April 27, 2012, from http://www.cdc.gov/h1n1flu/infantfeeding.htm
- Dupont-Rouzeyrol, M., Biron, A., O'Connor, O., Huguon, E., & Descloux, E. (2016). Infectious Zika viral particles in breastmilk. Lancet, 387(10023), 1051.
- American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841. Retrieved March 11, 2016 from http://pediatrics.aappublications.org/content/129/3/e827
- World Health Organization (WHO). (2008). HIV transmission through breastfeeding: A review of the available evidence. Retrieved March 11, 2016, from http://whqlibdoc.who.int/publications/2008/9789241596596_eng.pdf (PDF - 835 KB)
- WHO. (2010). Guidelines on HIV and infant feeding. Retrieved March 11, 2016, from http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf (PDF 1.58 MB)
- Coovadia, H. M., Rollins, N. C., Bland, R. M., Little, K., Coutsoudis, A., Bennish, M. L., & Newell, M.-L. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. Lancet, 369(9567), 1107–1116. Retrieved March 11, 2016, from http://www.thelancet.com/journals/lancet/article/PIIS0140673607602839/fulltext
- American Diabetes Association. (2007). Nutrition recommendations and interventions for diabetes. A position statement of the American Diabetes Association. Diabetes Care, 30(Suppl 1), S48–S65. Retrieved January 29, 2016, from http://care.diabetesjournals.org/content/30/suppl_1/S48.full
- BFAR. (2009). General frequently asked questions (FAQ) about breastfeeding after breast and nipple surgeries. Retrieved January 29, 2016, from http://www.bfar.org/faq.shtml
- National Institute on Drug Abuse. (2015). Substance use while pregnant and breastfeeding. Retrieved January 29, 2016, from http://www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding