Table 2 Publications (in chronological order) on women's knowledge, attitudes and practices towards medication use and safety in breastfeeding

Questionnaire mailed to random sample of 20% (n = 1131) of women who gave birth in Oslo in 1985. No details were provided on how participants were selected for the study and how their details were obtained; however, readers are referred to a previous publication (not in English) by the authors for a more detailed description of the study.

To investigate the extent of and predictors of medication use in women during the first months after birth, and to identify those symptoms in women that led to medication use during this time. The general attitude to medications was tested by asking about medication taking behaviour when suffering from a strong headache.

RR = 78% (885/1131). Fewer of those women who were breastfeeding at 4 months after birth (n = 645) were using medications than those who had stopped breastfeeding before 4 months (n = 240). The average number of doses was 166 and 307 respectively in that period. The number of doses was significantly associated with the use of oral contraceptive agents (p < 0.005) and young maternal age (p < 0.05). Most commonly reported conditions for which medications had been used in the 4 month period were dyspepsia, haemorrhoids, mastitis, rash/eczema, cracked nipples, headache, allergy and constipation. Analgesics/antipyretics (31%), dermatologicals (19%) and haemorrhoidals (15%) were most commonly taken at least once during the 4 months after birth, and vitamins and iron preparations were taken more frequently by those still breastfeeding. Long-term medication in breastfeeding women included many medications for which there was incomplete or no data about safety at the time of the study (e.g. cromoglycate, topical corticosteroids, salbutamol, insulin and thyroxine). 35% of breastfeeding women smoked daily, as did 65% of those not breastfeeding at 4 months, and there was no difference between breastfeeding and not breastfeeding women with regards to abstinence from alcohol (17 and 16%), but significantly more of those non breastfeeding were abstainers from coffee. 36% of women had less, 33% had similar, and 17% had more doubts about medication use during lactation than in pregnancy. 13% could not assess the perceived risk of medication use during lactation in relation to that in pregnancy. An association between the number of medications per woman and doubts about medication use during breastfeeding was found (p < 0.001).

Prospective cohort study by telephone follow-up of 203 breastfeeding women who were prescribed antibiotics as monotherapy and consulted the Motherisk Program between January 1990 and July 1991. Telephone interviews were conducted by Motherisk counsellors or trained toxicology students. The program was a consultation and follow-up service at a tertiary care, paediatric hospital in Toronto, for healthcare professionals and women with concerns about exposure to medications, chemicals and radiation during pregnancy and breastfeeding.

To determine the incidence of antibiotic prescription failure in breastfeeding women, and to characterise breastfeeding patterns during antibiotic therapy.

62% (125/203) of breastfeeding women who consulted the Motherisk Program for information about the safety of antibiotics during breastfeeding were followed up within 32 weeks. 15% (19/125) of these women did not initiate therapy and Category* A antibiotics (e.g. metronidazole, chloramphenicol, tetracycline, doxycycline) were associated with the highest rate of non-use in this group of women, all of whom continued breastfeeding during the treatment period. 7% of the remaining 106 women who started taking a prescribed antibiotic stopped breastfeeding during therapy. In this group of women, Category A and B (e.g. norfloxacin, ciprofloxacin, spiramycin) antibiotics were associated with a significantly higher incidence of breastfeeding interruption (p < 0.01) than those in Category C (e.g. penicillins and cephalosporins). This means that 21% of women (26/125) eventually avoided exposing their infant to the medication. Despite reassuring advice from the program's staff (based on data from available texts, the recommendations of the American Academy of Pediatrics, case reports, and the authors' own experience), it was estimated that 1 in 5 women did not initiate therapy or did not continue breastfeeding.

204 women interviewed by a neonatologist (specially trained in teratology) at discharge from a maternity ward (assumed to be located at Rabin Medical Center), two to three days after delivery. No details were provided on how participants were selected for the study.

To examine the rate of pharmacist counselling of women who use medications during pregnancy and/or breastfeeding.

63% (129/204) of women reported that they were counselled by their physician, compared with 9% (18/204) who indicated that they were counselled by the pharmacist. 8% (16/204) of women had read the information leaflet accompanying the medication and in many instances, no leaflet was provided at all.

Mail questionnaire sent to 967 breastfeeding women in the South and West NHS Executive region of Hampshire, Wiltshire, Dorset and the Isle of Wight. The women were not a random sample of the study area population as they were systematically selected from the National Childbirth Trust and on a proportional basis to represent all of its branches across the geographical area.

To assess what information mothers were given or wished to be given on medication safety and whether professionals provided this.

RR = 85% (820/967 women). 57% of women reported taking medication after birth, but just over half of the women (51%) recollected being asked if they were breastfeeding. 42% did not recall receiving any medication after birth. The majority of women (279) who were prescribed medication (mostly analgesics and oral contraceptives) recalled being asked by their GP if they were breastfeeding, 29% (131) stated they were not asked, and 30 did not remind their GP that they were breastfeeding. 54% of women said they had bought OTC medications from a pharmacy but only 11% recalled being asked if they were breastfeeding, and of the 82% who said they weren't asked, 34% reminded the pharmacist that they were breastfeeding. 28% were satisfied with the advice given by GPs and pharmacists and 31% felt dissatisfied with the quality of information given. 6% said that they received conflicting advice. 48 women were advised to discontinue breastfeeding, 28 refused the medication, 25 requested an alternative medication, 24 expressed breast milk temporarily, 17 discontinued breastfeeding and 10 sought a second opinion.

See publication 22 in this table.

As for publication 22 in this table.

The figures reported in this publication differ slightly from those in publication 22, despite being the same study. Therefore, only new results are presented here. 48% (395/820) of women continued to breastfeed at 6 months and 19% (153/820) were breastfeeding at the time of completion of the questionnaire. While 250 of the medications taken by women after birth were analgesics and 63 were antibiotics, a wide range of other medication was given, such as antiepileptics, antihypertensives, antihistamines and thyroxine. Similarly, the majority of prescriptions received from GPs once women were home were for antibiotics and analgesics, but also included antidepressants and iron supplements.

Prospective cohort, observational study. 78 women who contacted the Motherisk program between 1990-97 to enquire about foetal safety of PTU therapy were interviewed postpartum regarding their choice of infant feeding method and relevant advice received from physicians. Women who rang the program to determine its safety in breastfeeding were excluded from the study. Data for 3 groups of women were compared: group 1) women who required PTU postpartum; group 2) women who no longer required the medicine; and group 3) a control group of age-matched women who contacted the program within the same year as their counterparts and who were not taking any chronic medicines or teratogenic or toxic substances.

To determine whether there is a relationship between physicians' advice and women's initiation of breastfeeding during PTU therapy, as well as the extent of physician compliance with evidence-based data on the safety of this medicine in breastfeeding.

66/78 women identified had live births and were included in the study. 55% (36/66) of women were in group 1, 46% (30/66) in group 2, and 36 in group 3. Breastfeeding initiation rates for these groups were 44%, 83% and 83% respectively (group 1 vs group 2, p < 0.01; group 1 vs group 3, p < 0.01), however, demographic characteristics of the 3 groups were similar. In group 1, 10/36 women did not seek advice from physicians and the remaining 26 (72%) received advice from 39 physicians. 62% (24/39) of physicians advised women to breastfeed, 33% (13/29) advised not to breastfeed and 5% (2/29) gave equivocal advice. Of 18 women who received advice in favour of breastfeeding by at least 1 physician, 83% (15/18) initiated breastfeeding. Whereas of the 8/24 women who did not receive advice in favour of breastfeeding, none breastfed. 60% (12/20) of women who chose to formula feed indicated physicians' advice against breastfeeding or their concern about the medicine as the main reason for not breastfeeding. 50 women who breastfed received advice from 22 physicians regarding breastfeeding (20 in favour, 1 against and 1 equivocal), and 11 who formula fed received advice from 17 physicians (4 in favour, 12 against and 1 equivocal). Physicians' advice was the only significant predictor of the woman's choice to breastfeed during PTU treatment (relative risk: 5, 95% CI: 1-23).

Questionnaire given to all women (for completion at home) with a child not older than 6 months, who had visited a Well-Baby Clinic in the province of Friesland. If the woman visited the clinic more than once in the study period, only one questionnaire was handed out, and if someone other than the woman came to the clinic with the child, they were asked to pass on the questionnaire to the woman. This was carried out over a 6-week period in November-December 2002 across 85 Clinics.

To survey medication use by breastfeeding women, and to compare this with non-breastfeeding women. Also to explore whether medication use influenced women's decisions to breastfeed and vice-versa.

RR ≈ 43% (549 returned questionnaires). 82% of respondents breastfed their baby some time during the first 6 months after birth. 66% of all breastfeeding women had used medications, but less frequently than non-breastfeeding women (80%). Vitamins were used more frequently by breastfeeding women, whereas oral contraceptives, iron preparations, and peptic ulcer and psychotropic medications use was higher in non-breastfeeding women. 30% of women hesitated to use medications during breastfeeding, 10% stopped either breastfeeding or medication use to avoid combining the two, 5% took a measure to minimise exposure to the child, and 12% did not breastfeed because of medication use.

Questionnaire administered to 35 women, in their homes, who had a baby aged between 6 weeks and 1 year and who either scored above 12 on the Edinburgh Postnatal Depression Scale or were diagnosed with clinical depression by a psychiatrist. Women were participating in a wider study (that the authors have referenced and provides more information on how participants were identified and selected for the study) of the cost-effectiveness of services for PND.

To determine the experiences of postnatally depressed women with regards to antidepressant treatment.

RR = 43% (60/82 women fulfilled the recruitment criteria, however, only 35 were taking antidepressant medication - 5 were on SSRIs**, 25 were prescribed TCAs^#, 2 of these were subsequently prescribed SSRIs and 3 were subsequently prescribed flupenthixol. One woman was taking flupenthixol alone). All women were of white ethnicity. 13/35 women were breastfeeding and 4/13 (31%) did not want to take the antidepressant for that reason. It was also reported that the literature shows that TCAs and SSRIs are safe for infants, but should be prescribed only after the risk-benefit ratio is clearly outlined and discussed with the woman and her partner.

In-depth interviews between November 2006-June 2007 with 27 women in three UK cities, at their homes or over the telephone. Women had been diagnosed with postnatal depression and taken part in a randomised controlled trial (that the authors referenced and provides more information on how participants were identified and selected for the study), involving antidepressants versus antidepressants and non-directive counselling. A purposeful sampling approach was used to ensure interviews were held with women randomised to different treatment arms and living in different cities.

To determine the experiences and views of postnatally depressed women with regards to antidepressant treatment.

Women expressed concerns about taking antidepressants when breastfeeding, however the associated medications were not reported and comments to illustrate these concerns were also not provided. Moreover, the number of women who were breastfeeding was not given. It is not known whether women specifically discussed with their GP the issue of using antidepressants when breastfeeding. Most women were of white ethnicity (21/27).