Last update Dec. 27, 2021

Maternal Cystic Fybrosis

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Improvements in the treatment and management of this disease have increased life expectancy, allowing patients to reach the reproductive stage and in women, unlike men, fertility is not greatly affected. (Kroon 2018, McGuire 2016, Festini 2006)

Exclusive or partial breastfeeding should be encouraged, taking into account the health conditions of each mother (McGuire 2016, Edenborough 2008, Michel 1994, Kent 1993, Stead 1987). Partial breastfeeding of twins has been recorded. (McGuire 2016)

It requires a great deal of support, monitoring of the weight and health status of the mother with an extra daily intake of 500 calories, 11 g of protein, 500 mg of calcium, 400 IU of vitamin D and 2 litres of water. (Edenborough 2008, Michel 1994)

Respiratory physiotherapy must take into account changes in the breasts. (Edenborough 2008)

The concentration of sodium and other electrolytes and proteins in breastmilk are normal; linoleic acid, arachidonic acid and cholesterol levels are slightly decreased (McGuire 2016, Edenborough 2008, Kent 1993, Hamosh 1992, Shiffman 1989, Bitman 1987, Stead 1987, Alpert 1983, Welch 1981). Infants grow adequately with breastmilk. (Michel 1994, Smith 1992, Stead 1987, Alpert 1983, Welch 1981)

Virtually all medications used in the treatment of CF are compatible with breastfeeding (Kroon 2018): H2 antagonists (famotidine, nizatidine, ranitidine), metoclopramide, domperidone, laxatives (polyethylene glycol, senna, bisacodyl), all antibiotics except for chloramphenicol, antifungals such as fluconazole, antiviral agents such as acyclovir and valacyclovir, antidiabetics (insulin, glibenclamide, tolbutamide), pamidronate, ursodeoxycholic acid, systemic and inhaled corticosteroids, inhaled bronchodilators, pancreatic enzymes, dornase alfa, vitamins, immunosuppressants (azathioprine, cyclosporine and tacrolimus) and ibuprofen.

There is little data on the cystic fibrosis transmembrane conductance regulator (CFTR) protein enhancers, elexacaftor, ivacaftor, lumacaftor and tezacaftor, but limited data indicates that milk excretion is minimal (Terrell 2018, Trimble 2018)  and no clinical or ophthalmologic problems have been observed in more than 30 infants whose mothers were taking elexacaftor, ivacaftor, lumacaftor, or tezacaftor (Taylor 2021 and 2020, Nash 2020, Middleton 2020). Several medical societies and expert authors consider that CFTR drugs are probably safe during breastfeeding. (LactMed, Hale, Jain 2021)


See below the information of these related products:

  • (Corticosteroids) (Safe substance and/or breastfeeding is the best option.)
  • Acyclovir; Aciclovir (Safe substance and/or breastfeeding is the best option.)
  • Azathioprine (Safe substance and/or breastfeeding is the best option.)
  • Ciclosporin (Safe substance and/or breastfeeding is the best option.)
  • Domperidone (Safe substance and/or breastfeeding is the best option.)
  • Dornase Alfa (Safe substance and/or breastfeeding is the best option.)
  • Elexacaftor (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Fluconazole (Safe substance and/or breastfeeding is the best option.)
  • Glibenclamide (Safe substance and/or breastfeeding is the best option.)
  • Insulin (Safe substance and/or breastfeeding is the best option.)
  • Ivacaftor (Safe substance and/or breastfeeding is the best option.)
  • Lumacaftor (Safe substance and/or breastfeeding is the best option.)
  • Metoclopramide (Safe substance and/or breastfeeding is the best option.)
  • Pamidronate Disodium (Safe substance and/or breastfeeding is the best option.)
  • Tacrolimus (Safe substance and/or breastfeeding is the best option.)
  • Tezacaftor (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Tolbutamide (Safe substance and/or breastfeeding is the best option.)
  • Ursodeoxycholic Acid (UDCA) (Safe substance and/or breastfeeding is the best option.)

See below the information of these related groups:

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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José María Paricio, founder of e-lactancia.
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Other names

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Group

Maternal Cystic Fybrosis belongs to this group or family:

References

  1. Kroon MAGM, Akkerman-Nijland AM, Rottier BL, Koppelman GH, Akkerman OW, Touw DJ. Drugs during pregnancy and breast feeding in women diagnosed with Cystic Fibrosis - An update. J Cyst Fibros. 2018 Jan;17(1):17-25. Abstract
  2. McGuire E, Sappl PG. Breastfeeding with cystic fibrosis. Breastfeed Rev. 2016 Mar;24(1):37-40. No abstract available. Abstract
  3. Edenborough FP, Borgo G, Knoop C, Lannefors L, Mackenzie WE, Madge S, Morton AM, Oxley HC, Touw DJ, Benham M, Johannesson M; European Cystic Fibrosis Society.. Guidelines for the management of pregnancy in women with cystic fibrosis. J Cyst Fibros. 2008 Jan;7 Suppl 1:S2-32. Epub 2007 Nov 19. Abstract Full text (link to original source) Full text (in our servers)
  4. Festini F, Ciuti R, Taccetti G, Repetto T, Campana S, De Martino M. Breast-feeding in a woman with cystic fibrosis undergoing antibiotic intravenous treatment. J Matern Fetal Neonatal Med. 2006 Jun;19(6):375-6. Abstract
  5. Festini F. Ciuti R, Repetto T, Taccetti G, Neri A, Campana S, Mergni G, de Martino M. Safety of breast-feeding during an IV tobramycin course for infants of CF women. Pediatr Pulmonol Suppl. 2004;27:288-9. Poster-Abstract 291. 2004
  6. Michel SH, Mueller DH. Impact of lactation on women with cystic fibrosis and their infants: a review of five cases. J Am Diet Assoc. 1994 Feb;94(2):159-65. Abstract
  7. Kent NE, Farquharson DF. Cystic fibrosis in pregnancy. CMAJ. 1993 Sep 15;149(6):809-13. Review. Abstract Full text (link to original source) Full text (in our servers)
  8. Hamosh M, Bitman J. Human milk in disease: lipid composition. Lipids. 1992 Nov;27(11):848-57. Review. Abstract
  9. Smith PK, Tamlin N, Robertson E. Breast milk and cystic fibrosis. Med J Aust. 1992 Aug 17;157(4):283. No abstract available. Abstract
  10. Shiffman ML, Seale TW, Flux M, Rennert OR, Swender PT. Breast-milk composition in women with cystic fibrosis: report of two cases and a review of the literature. Am J Clin Nutr. 1989 Apr;49(4):612-7. Abstract
  11. Bitman J, Hamosh M, Wood DL, Freed LM, Hamosh P. Lipid composition of milk from mothers with cystic fibrosis. Pediatrics. 1987 Dec;80(6):927-32. Abstract
  12. Stead RJ, Brueton MJ, Hodson ME, Batten JC. Should mothers with cystic fibrosis breast feed? Arch Dis Child. 1987 Apr;62(4):433. No abstract available. Abstract Full text (link to original source) Full text (in our servers)
  13. Alpert SE, Cormier AD. Normal electrolyte and protein content in milk from mothers with cystic fibrosis: an explanation for the initial report of elevated milk sodium concentration. J Pediatr. 1983 Jan;102(1):77-80. No abstract available. Abstract
  14. Welch MJ, Phelps DL, Osher AB. Breast-feeding by a mother with cystic fibrosis. Pediatrics. 1981 May;67(5):664-6. Abstract

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