January 15, 2011,
N.E. asks from Palm Coast, FL on February 12, 2008
Breastfeeding with Crohn's
Hi, I am curious if anyone breastfed while having Crohn's disease. My OBGYN/Peditrican think it isn't a good idea b/c of the medication that I am taking. Supposably it is okay to take Lialda while pregnant but not breastfeeding. I was just curious if anyone did and the name of the doctor that ok'd it.
B.M. answers from Orlando on February 13, 2008
Consider getting in touch with your local La Leche League. They are mothers who help you get in touch with the right reasources for breastfeeding as well as a support system. I don't have Crohn's, but I am on other medications for high blood pressure. I was on diff. meds during pregnancy, but it didn't control well enough after I gave birth. I was very concerned since the stuff I take now I wasn't supposed to take while pregnant. The doctor ok'd the meds, but my husband and I were very nervous about the effects on our baby. The La Leche League leader in my area helped me find resources to make an informed decision that made me feel comfortable for my baby's well-being even after my doctor ok'd the meds.
J.I. answers from Gainesville on February 13, 2008
Dear N., congratulations on your pregnancy and desire to breastfeed. Unfortunately there is a lot of misinformation and misconceptions about breastfeeding and medications. I have had clients who were told they could not nurse when taking medications that are safe for use by the infants themselves! Many times health care professional mistakenly tell moms they cannot breastfeed when taking a particular medication. This is partially due to a global lack of understanding and appreciation for all the benefits of nursing to both mom and baby. There are many risks with formula feeding of infants. Most drugs pass through breast milk only in very small amounts.
Contacting your local LLL group was an excellent suggestion. LLL has professional liaisons, who are leaders trained to address and research medical and legal issues. A good resource book for any health professional to use when considering medication issues is by Thomas Hale. It is called Medications and Mother's Milk and actually cites studies on individual drugs, not just inserts from pharmaceutical companies (which is what is published in the Physicians Desk reference (PDR) and used by most doctors). If your doctors say certain medications are contraindicated, ask them what sources they are using to support their opinion.
I am a lactation consultant, not a doctor, so can't really comment on your meds. According to Hale, prednisone is acceptable. I can't lay my hands on my copy of Hale now, so can;t share information on Lialda. But your LLL leader will be able to find the information for you. Another possible source is the lactation consultant where you plan to give birth. make sure she is an IBCLC, the highest credential in the field.
A.M. answers from Daytona Beach on February 13, 2008
I am an advicate of breastfeeding ~ It is the best for the baby. But in your case I would not recommend breastfeeding while on medications. Anything you put into your body goes into your breastmilk and can directly affect your child. My best advice ~ If a doctor would not prescribe the medication you are taking to your newborn I would use formula. Ask the doctors what side effects this medication would have on an infant.
I understand the desire to breast feed. My son was breastfed/bottle feed at first because I could not produce enough milk for him but 7 weeks post I had a gallbladder attack that required me to have it surgery. I tried "pumping and dumping" because I wanted to be able to breastfeed again once off the medication and this would help me maintain my supply. If you haven't heard this term before ~ You simply use a pumping machine to extract the milk (fooling your body so it will continue producing milk) but because the milk is not safe for the infant to consume you "dump" it (down the sink).
The best advice is to get thoroughly informed about the medication you are taking, side effects, and the WHY your doctors do not recommend you breastfeeding and then make an informed decision yourself.
Maybe see if there is an herbal supplement that would do the same thing as the medication and not have the effects on the baby - contact a health store or holistic company.
M.J. answers from Jacksonville on February 14, 2008
I would talk to a IBCLC (International Board Certified Lacation Consultant) about this. Your primary dr or OB usually aren't the experts on breast feeding. I'm sure if it's dangerous in BF, you can take something else.
I did find this: Nursing Mothers: Low concentrations of mesalamine and higher concentrations of its N-acetyl metabolite have been detected in human breast milk. While there is limited experience of lactating women using mesalamine, caution should be exercised if LIALDA is administered to a nursing mother, and used only if the benefits outweigh the risks.
M.M. answers from Daytona Beach on February 12, 2008
u r due 2 days after my lil guys 2nd birthday. i honestly do not think it would be a great idea. any kind of medication is not good to breast feed. i personally do not have crohns but my mother n law does. im sorry and i hope this helps and congrats on ur soon to be arrival.
R.M. answers from Orlando on February 28, 2008
Lialda is a newer medication so there may not be as much research available. It is a category B for pregnancy which means "presumed safety based on animal studies". However, it is a " question mark" category for breastfeeding which is regarded as safety unknown or controversial. Olsalazine and sulfasalazine are considered to be unsafe in terms of breastfeeding. Hope this helps.
M.H. answers from Fort Walton Beach on February 12, 2008
Have you thought about treating your Crohn's naturally? I don't have it, but HAVE HEALED MY ULCERATIVE COLITIS OF 34 YEARS DESPITE MY DOCTORS and I have a friend who NO LONGER has Crohn's disease because she treated it naturally as well.
Medication is dangerous to a baby whether you are pregnant or nursing. In a document published by the Breast Cancer Fund, they found an average of 40 toxic chemicals passed from mother to child in umbilical cords studied. As long as you are on medication I would not breast feed. If you could come of the medication it would be good for you and baby :). If you'd like to talk feel free to call my cell ###-###-####(verizon).
S.B. answers from Orlando on February 13, 2008
I have ulcerative colitis, but I take the same meds as someone with Crohn's. I was on Asacol the entire time I was pregnant and breast feeding; I breast fed for a year. I switched to Lialda about a year ago, and was told it was the same as Asacol but a larger dose so I only had to take them once a day. My advice to you would be to ask your gastroenterologist (sp?) the breastfeeding/meds question, becuase he or she would know more about the medicine and its effects than your Ob or the Ped. My gastroenterologist is Dr. Harry Shepherd with Digestive Disease Consultants. I would highly recommend him, I had to switch to another doc when I found out I was pregnant and he is one of the only ones who will take pregnant women. He is fantastic! Hope this helps, and good luck with everything!
Ps: I would like to point out that since I started a workout regimen and a healthier lifestyle I haven't taken the Lialda or any other meds. Its been 4 months since I've had to take anything for my colitis. I would however also like to point out that I am not pregnant, and pregnancy can do crazy things to your body. Now would not be the time to stop taking your meds! Talk to your doctor about your options before you do anything!
M.M. answers from Gainesville on February 13, 2008
This drug is too new to trust, and it impairs renal function, and sometimes CAUSES colitis. Besides, there are SO MANY better ways to treat Chrone's Disease.
In "The Fourfold Path to Healing," Tom Cowan says:
"Digestive disorders represent nature's plea for us to return to real, whole foods, foods grown in healthy soil and from animals that graze on healthy pasture. When we eat processed and imitation foods, we are, in essence, polluting the finely tuned ecosystem of the gut. Fermented foods, such as sauerkraut and cultured milk, are vital to any treatment of digestive disorders. Grains--either refined or whole--should be kept to a minimum until the condition resolves and then eaten only after proper preparation... Beet kvass, lacto-fermented ginger ale and other enzyme-rich beverages should accompany every meal. Bone broths make digestion easier, and Celtic sea salt provides trace minerals needed for enzyme structure. ...
"Finally, for all digestive orders, I have found Dr. Price's high-vitamin butter oil therapy to be useful, particularly for digestive tracts that have been badly damaged from celiac disease or treatment with chemotherapy and radiation."
Also, read Gut and Psychology Syndrome by Natasha Campbell-MNcBride MD for an even more elaborate explanation of bowel disorders.
If this sounds foreign to you, start with the Nourishing Traditions cookbook by Sally Fallon.
I would take a hefty probiotic like BioKult (one half the first day, then one, then two, then three, work your way up slowly, stop when you feel it, and start over when you are ready to).
In addition, cold-pressed organic coconut oil (1/2 to 1 tsp 4 times a day between meals) and high-vitamin cod liver oil (1 tsp once or twice a day) and as Tom Cowan MD advises, a teaspoon of butter oil daily.
Drugs do not cure the disease, they just treat it. You have to find the underlying cause of your problem and remedy the deficiency or expel the toxicity that is the cause, so your body can heal as it is naturally inclined to do. This nutrition mentioned above will do all of these beneficial things for you, with wonderful benefits for your baby.
Contrast this with what the drug will do:
INDICATIONS AND USAGE
LIALDA tablets are indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis. Safety and effectiveness of LIALDA beyond 8 weeks has not been established.
LIALDA is contraindicated in patients with hypersensitivity to salicylates (including mesalamine) or to any of the components of LIALDA.
General: Patients with pyloric stenosis may have prolonged gastric retention of LIALDA, which could delay mesalamine release in the colon.
The majority of patients who are intolerant or hypersensitive to sulfasalazine can take mesalamine medications without risk of similar reactions. However, caution should be exercised when treating patients allergic to sulfasalazine.
Mesalamine has been associated with an acute intolerance syndrome that may be difficult to distinguish from a flare of inflammatory bowel disease. Although the exact frequency of occurrence has not been determined, it has occurred in 3% of patients in controlled clinical trials of mesalamine or sulfasalazine.
Symptoms include cramping, acute abdominal pain and bloody diarrhea, sometimes fever, headache and rash. If acute intolerance syndrome is suspected, prompt withdrawal is required.
Mesalamine-induced cardiac hypersensitivity reactions (myocarditis and pericarditis) have been reported with other mesalamine medications. Caution should be taken in prescribing this medication to patients with conditions predisposing to the development of myocarditis or pericarditis.
Renal: Reports of renal impairment, including minimal change nephropathy, and acute or chronic interstitial nephritis have been associated with mesalamine medications and pro-drugs of mesalamine. For any patient with known renal dysfunction, caution should be exercised and LIALDA should be used only if the benefits outweigh the risks. It is recommended that all patients have an evaluation of renal function prior to initiation of therapy and periodically while on treatment. In animal studies with mesalamine, a 13-week oral toxicity study in mice and 13-week and 52-week oral toxicity studies in rats and cynomolgus monkeys have shown the kidney to be the major target organ of mesalamine toxicity. Oral daily doses of 2400 mg/kg in mice and 1150 mg/kg in rats produced renal lesions including granular and hyaline casts, tubular degeneration, tubular dilation, renal infarct, papillary necrosis, tubular necrosis, and interstitial nephritis. In cynomolgus monkeys, oral daily doses of 250 mg/kg or higher produced nephrosis, papillary edema, and interstitial fibrosis.
Hepatic Impairment: No information is available on patients with hepatic impairment, and therefore, caution is recommended in these patients.
Information for Patients: Patients should be instructed to swallow LIALDA tablets whole, taking care not to break the outer coating. The outer coating is designed to remain intact to protect the active ingredient, mesalamine, and ensure its availability throughout the colon.
Drug Interaction: No investigations have been performed between LIALDA and other drugs. However, the following are reports of interactions between mesalamine medications and other drugs. The concurrent use of mesalamine with known nephrotoxic agents, including non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of renal reactions. In patients receiving azathioprine or 6-mercaptopurine, concurrent use of mesalamine can increase the potential for blood disorders.
Carcinogenesis, Mutagenesis, Impairment of Fertility: In a 104-week dietary carcinogenicity study in CD-1 mice, mesalamine at doses up to 2500 mg/kg/day was not tumorigenic. This dose is 2.2 times the maximum recommended human dose (based on a body surface area comparison) of LIALDA. Furthermore, in a 104-week dietary carcinogenicity study in Wistar rats, mesalamine up to a dose of 800 mg/kg/day was not tumorigenic. This dose is 1.4 times the recommended human dose (based on a body surface area comparison) of LIALDA.
No evidence of mutagenicity was observed in an in vitro Ames test or an in vivo mouse micronucleus test.
No effects on fertility or reproductive performance were observed in male or female rats at oral doses of mesalamine up to 400 mg/kg/day (0.7 times the maximum recommended human dose based on a body surface area comparison). Semen abnormalities and infertility in men, which have been reported in association with sulfasalazine, have not been seen with other mesalamine products during controlled clinical trials.
Teratogenic Effects: Pregnancy Category B
Reproduction studies with mesalamine have been performed in rats at doses up to 1000 mg/kg/day (1.8 times the maximum recommended human dose based on a body surface area comparison) and rabbits at doses up to 800 mg/kg/day (2.9 times the maximum recommended human dose based on a body surface area comparison) and have revealed no evidence of impaired fertility or harm to the fetus due to mesalamine. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Mesalamine is known to cross the placental barrier.
Nursing Mothers: Low concentrations of mesalamine and higher concentrations of its N-acetyl metabolite have been detected in human breast milk. While there is limited experience of lactating women using mesalamine, caution should be exercised if LIALDA is administered to a nursing mother, and used only if the benefits outweigh the risks.
M.C. answers from Fort Walton Beach on February 13, 2008
I have Crohn's, but I wasn't diagnosed with it until after I had both of my children. I lived a long time with DRs just telling me that it was all stress related and in my head. Until a year ago I just suffered until symptoms were so bad I couldn't do anything for my kids. All that to say, treatment came down to two options: medication or a complete lifestyle change. It took a lot of prayer and a giant leap of plus a hugely supportive husband, but I decided to make a complete lifestyle change. Our family went vegan. We cut out meat, dairy and sugar all things that trigger episodes of Crohn's. I'm living proof that the things we eat directly effect our bodies and the things that we have to deal with physically.
It's been a year since we changed everything. I have absolutely NO pain now. Which is something I lived with for so long. And an added bonus is that I lost 50lbs in the process. I have the energy now to play with my children. It was hard at times we when first made the change. so many people just couldn't understand why I just didn't take the meds and run. But, I wouldn't change anything I did. And now I know that my intestines will stay safely in my body cancer free for a good long time.
So, my advice is change your diet, save your life, breastfeed you baby med free.
If you want to know more about how I did it just give me a call at ###-###-#### or email me at ____@____.com a blessed day!
K.C. answers from Barnstable on January 15, 2011
I know this post is old, but I have had Crohn's for 27 YEARS (since I was 8). I was on Remicade while pregnant with my son and am still nursing him (he is 2.5 years old). Remicade is VERY SAFE to nurse on due to it's molecular weight and it is not orally viable at all.
He is a beautiful, healthy baby :)