A systematic review article on anaesthesia and analgesia drug effects on Breast milk composition and lactation

Breastfeeding is one of the most important aspects of maternal and child health. It is important to understand how medications affect breast milk and lactation for mothers. The absolute dose transferred during the colostrum period is still very low; the total intake is generally less than 30–100 mL/day for the first few days postpartum. This review article presents evidence-based guidelines for pain management and anaesthesia in breastfeeding women. Various pharmacological factors determine the transmission of a drug into breast milk and its effect on the baby: the plasma protein binding, molecular weight, volume of distribution, pKA, lipid solubility, and maternal pharmacogenomics. This article synthesises perspectives on the safety of medications in situations where there is insufficient data to conclusively support ongoing breast feeding without the requirement to express and discard breast milk after undergoing anaesthesia. The article also includes the potential transfer of various pain medicines, such as NSAIDs and opioids like morphine, methadone, and remifentanil, through breast milk and their impact on the new-born. However, it is important to exercise caution while using medications due to the potential risks they pose to infants. The paper highlights the significance of professional collaboration in addressing anaesthesia issues during pregnancy and the postpartum period for parturient women. The article also examines the effects of immunosuppressants on women who have undergone transplants, emphasising the importance of careful surveillance and individualised care to safeguard the health of both the mother and the infant.