Table 1 Extent of medicine use in women during postpartum period or lactation

Chaves et al., 2011 [33]

Brazil, cohort study, n = 246

12 months

98 %

Quality score: Abstract: 88 %, Paper: 77 %

 Pregnant women were recruited between June and Sept 2003. Nursing mothers were followed up after hospital discharge by telephone contact or home visits up to 12 months postpartum or until breastfeeding ceased.

 Analgesics/antipyretics 24.7 %

 Iron salts 13.7 %

Limitation(s): Commonly used medicines were reported as % of total number of prescriptions. ATC classification was not used.

 NSAIDs 12.8 %

 (% based on total number of prescriptions)

Stephansson et al., 2011 [34]

Sweden, cohort study, n = 102,995

3 months

51 %

Quality score: Abstract: 75 %, Paper: 64 %

 Women using prescription medicines during pregnancy and 3 months postpartum in 2007, collected from Swedish Medical Birth Register and the Prescribed Drug Register.

 Sex hormones 21.91 %

 Systemic antibacterials 13.77 %

Limitation(s): Actual drug intake bias as data source was register. No breastfeeding information was available

 NSAIDs 7.06 %

Engeland et al., 2008 [36]

Norway, cohort study, n = 106,329

3 months

57 %

Quality score: Abstract: 75 %, Paper: 64 %

 Women using prescription medicine during pregnancy and 3 months postpartum, collected from Medical Birth Registry of Norway and Norwegian Prescription Database of 2004–2006.

 Sex hormones 26.7 %

 Systemic antibacterials 16 %

Limitation(s): Actual drug intake bias as data source was register. No breastfeeding information was available

 Posterior pituitary lobe hormones 8 %

 Dermatologicals 6.9 %

Stultz et al., 2007 [37]

USA, cohort study, n = 45 breastfeeding women

12 months

96 %

Quality score: Abstract: 50 %, Paper: 77 %

 Women after delivery filled out a prenatal questionnaire and were followed up monthly by telephone for 12 months postpartum or until cessation of breastfeeding or until the close of the study in Jan 2007. They were also instructed to keep a diary regarding use of medicine.

 Vitamins 73 %

 NSAIDs 71 %

Limitation(s): Very small study. ATC classification was not used. Detail breastfeeding information was not available. The impact of medicine use on breastfeeding was not studied.

 Acetaminophen 58 %

 Progestins 24 %

 Antimicrobials 22 %

Bakker et al., 2006 [38]

Netherlands, cohort study, n = 5.412 postpartum women

3 months

68 %

Quality score: Abstract: 88 %, Paper: 68 %

 Pharmacy records of women giving birth between 1994 and 2003 were collected from the InterAction database which contains prescription drug information from community pharmacies.

 Iron preparations 30.4 %

 Systemic antibacterials 13.3 %

Limitation(s): Actual drug intake bias as data source was register. No breastfeeding information was available

 Laxatives 6.9 %

 NSAIDs 5 %

Schirm et al., 2004 [39]

Netherlands, cross-sectional study, n = 549

<6 months

66 % of 451 breastfeeding women

Quality score: Abstract: 88 %, Paper: 70 %

 Questionnaires were handed out to women with a child < 6 months through 85 Well-Baby Clinics over a 6 week period in 2002. 549 women responded and 451 of them breastfed and 297 of them used medicine.

 Vitamins 40.8 %

 Oral analgesics 36.8 %

Limitation(s): ATC classification was not used . The impact of medicine use on breastfeeding was not studied statistically.

 Antiinfectives 14.6 %

 Gastrointestinal drugs 6.9 %

Lamounier et al., 2003 [42]

Brazil, cross-sectional study, n = 2,173

Immediate postpartum period

96 %

Quality score: Abstract: 75 %, Paper: 60 %

 2,173 women giving birth in four hospitals of Belo Horizonte city in Brazil between July 1998 and July 1999 were interviewed using questionnaire. Medical records were also checked.

 Anti-inflammatory 77.8 %

 Analgesics 75.5 %

Limitation(s): ATC classification was not used. Detail breastfeeding information was not available. The impact of medicine use on breastfeeding was not studied.

 Antibiotics 17.8 %

Jones and Brown 2003 [41] & 2000 [44]

UK, cross-sectional study, n = 820

Within 5 days after delivery and after hospital discharge

56.5 % within 5 days after delivery

Quality score: Abstract : 38 %, Paper: 85 %

 Questionnaires were sent to postpartum women, in southern England between March and April 1995 and 820 breastfeeding women responded.

 55 % after hospital discharge

 Antibiotics 14.27 %

Limitation(s): ATC classification was not used. The impact of medicine use on breastfeeding was not studied.

 Analgesics 3.3 %

Olesen et al. 1999 [45, 46]

Denmark, cohort study, n = 15,756 to 16,001

12 weeks

34.2 % to 34.7 %

Quality score: Abstract: 88 %; Paper: 64 %

 Information about women’s prescription drug use during pregnancy and 12 weeks postpartum was collected from North Jutland Prescription Database from 1 Jan 1991 to 31 Dec 1996 and linked to Danish Medical Birth Register.

 Penicillins 20.1 %

 Opthalmologicals 15.5 %

Limitation(s): Actual drug intake bias as data source was register. No breastfeeding information was available

 Dermatological corticosteroids 5.7 %

 (% based on total number of prescriptions)

Thomas et al., 1994 [49]

India, cross-sectional study, n = 539

6 weeks

100 %

Quality score: Abstract: 38 %, Paper: 70 %

 Women who gave birth at a Southern Indian Hospital between June and Sept 1989, were interviewed using a questionnaire from the day of discharge to 6 weeks postpartum during their subsequent visits in hospital. Hospital charts were also reviewed.

 Vitamins and minerals 100 %

 Antipyretics 53.1 %

Limitation(s): ATC classification was not used. The impact of medicine use on breastfeeding was not studied.

 Anti-inflammatory 49.2 %

 Antibiotics 37.8 %

Uppal et al., 1993 [50]

India, cross-sectional study, n = 500

N/A

90 %

Quality score: Abstract: 63 %, Paper: 75 %

 200 women giving birth in Nehru Hospital, 200 attending the postpartum clinic at the same hospital, and 100 women living in a rural area were interviewed between Nov 1989 and May 1990. Hospital records were also checked.

 For hospital, postpartum clinic and community settings-

 Antibiotics: 90 %, 86 % and 13 % respectively

Limitation(s): ATC classification was not used. The impact of medicine use on breastfeeding was not studied. Very little breastfeeding information.

 Analgesics: 56 %, 70 % and 37.6 % respectively

Blomquist and Soderman, 1991[52]

Sweden, cross-sectional study, n = 195

Up to 4 months

70 % (excluding vitamins)

Quality score: Abstract: 75 %, Paper: 65 %

 Women giving birth between 12 Jan and 8 Feb 1987 were asked to answer a questionnaire after hospital discharge. 195/229 women responded.

 Vitamins 45 %

 Pituitary hormones 29 %

Limitation(s): The impact of medicine use on breastfeeding was not studied. Very little breastfeeding information

 Sex hormones 18 %

Matheson et al., 1990 [53]

Norway, retrospective survey, n = 885

3–5 months

69 %

Quality score: Abstract: 63 %, Paper: 70 %

 Women 3–5 months after delivery responded to a postal questionnaire in 1985.

 Analgesics/antipyretics 32 %

 Dermatologicals 19 %

Limitation(s): ATC classification was not used. The impact of medicine use onbreastfeeding was not studied.

 Antihaemorrhoidals 15 %

Passmore et al., 1984 [55]

Ireland, cross-sectional study, n = 2,004

Immediate postpartum period

99 %

Quality score: Abstract: 75 %, Paper: 65 %

 Medicine charts of women giving birth in three hospitals of Belfast between July to Sept 1982.

 Analgesics 78.4 %

 Antibacterials 15.5 %

Limitation(s): ATC classification was not used. Very little breastfeeding information.

 Hypnotics 36 %