Some women stop breastfeeding following ‘overly cautious’ medication advice

Some women stop breastfeeding earlier than they wish owing to concerns around the medication they are taking, according to a review published in the International Breastfeeding Journal.

Published on 4 August 2025, the study authors said that while medication use during breastfeeding does require caution, “many instances of medication-related breastfeeding discontinuation may be avoidable, given the safety profiles of most implicated medicines”.

“Multiple factors may contribute to inaccurate or overly cautious recommendations, including limited or outdated training in breastfeeding pharmacology, time constraints during clinical consultations, concerns about professional liability, and reliance on overly conservative or non-specialist information sources,” the paper added.

The review analysed 20 studies from around the world and divided the findings between women from the general population and women with specific chronic or severe acute conditions that usually require medication.

In the general population, the proportion of women needing medication who decided to discontinue breastfeeding ranged from 2–18%, while in women with specific chronic or severe acute conditions, the proportion ranged from 2–58%, the authors revealed.

The authors said that some women stopped breastfeeding following advice from healthcare professionals, adding that “overly cautious advice remain a significant challenge”.

However, many medicines are not licensed for use during breastfeeding, because breastfeeding women are often not included in clinical trials, the authors noted.

On 4 August 2025, Rachel Pilgrim, one of the study authors, said that she was inspired to do the research because of her own experiences as a breastfeeding mother and pharmacist.

“I suspected the advice I was getting wasn’t right. I felt quite nervous challenging the doctor — even though, as a pharmacist, it’s usually part of my job to do that, it felt very different as a patient.

“But the experience made me think — what it is like for women who don’t feel able to speak up?” she added.

Speaking to The Pharmaceutical Journal, Wendy Jones, author and one of the founding members of The Breastfeeding Network, explained that she established the Drugs in Breastmilk service in 1999, following “many queries about the compatibility of medication and breastfeeding”.

The service is now run by a group of 25 pharmacists.

“Over the years, many thousands of women and healthcare professionals have sought information, having been told to interrupt breastfeeding when prescribed a medication. A study in 2019 showed this was rarely necessary,” she added.

Commenting on being asked about the use of adalimumab in a breastfeeding mother with Crohn’s disease, Jones said: “An inflammatory bowel disease (IBD) nurse had told the mother that she had to stop breastfeeding to initiate treatment.

“The drug is not orally bioavailable so cannot be absorbed by the baby from milk, and is widely used in IBD and rheumatoid arthritis. This is just one example of how access to a pharmacist and specialist sources would have altered the outcome of the consultation.

“The Breastfeeding Network, UK Drugs in Lactation Advisory Service and independently myself provide information sheets, which are free to access. LactMed and e-Lactancia are also free resources. The gold standard remains Hale and Krutsch’s Medications and Mothers’ Milk.”

“Ultimately, more research is needed, together with support from drug manufacturers to update the summary of product characteristics of their products as more information becomes available through studies and evaluation of pharmacokinetics to support breastfeeding and maternal health,” she added.

Claire Anderson, president of the Royal Pharmaceutical Society, commented: “Pharmacists are ideally placed to support women with questions about medicines and breastfeeding.

“Pharmacists can provide clear, evidence-based advice on whether a medicine is safe to use while breastfeeding, how much may pass into breast milk and any potential effects on the baby. Where needed, they can also suggest suitable alternatives.

“We’d welcome further research into women’s experiences around medicines and breastfeeding, as understanding more about the barriers and concerns women face will help healthcare professionals offer the most effective care.”