Contraindications are factors in a person’s situation that serve as a reason to withhold a certain line of treatment or procedure; such factors make it unwise to adopt a particular line of intervention.

Contraindications to breastfeeding are those conditions or factors in a mother, that could make the consumption of breast milk from the mother hazardous to the health of their infant. The ideal path for infant feeding i.e. breastfeeding is not recommended for such mothers.

Breastfeeding is contraindicated for the following:

Infants with special health problems such as galactosemia (galactose 1-phosphate uridyltransferase deficiency), maple syrup urine disease and phenylketonuria.

In cases where mothers have untreated active tuberculosis disease or are Human T-cell lymphotropic virus type I– or II–positive. An individual with T-cell lymphotropic virus type I and II will have excessive amount of T-cell leukemia and HTLV-1. There are currently no antivirals a mother can take to reduce the spread which is why breastfeeding is not recommended

In situations where the mother uses illicit drugs (drug abuse,).

Alcohol consumption: the fat content in the breast can cause toxins from alcohol to build up. Mothers are advised to limit drinking of alcohol to one or two drinks per week to ensure that the toxins do not reach the breast. Drinking alcohol while breastfeeding can spread toxins to the infant thereby predisposing the infant to the risk of slow weight gain.

Breastfeeding may not be in the best interest of the baby when breastfeeding mothers have herpes simplex lesions on a breast (if one of the breast is free from lesion, the infant may feed from the breast)

In conditions where by radioactive exposures are used to treat mother such as receiving therapeutic radioactive isotopes,anti-metabolites or chemotherapeutic agents, medications or exposure to radioactive materials; such should refrain from breastfeeding until these substances are cleared from their breast milk.

In infants born to mothers who are HIV infected, breastfeeding is discouraged owing to the risk of transmission of HIV to the infant through human milk. The World Health Organization (WHO) recommend replacement feeding if it is acceptable, feasible, affordable, sustainable and safe (AFASS). Additionally, many studies now support the fact that HIV infected mother can breastfeed just that such must do so in an exclusive manner for the first 6 months (exclusive breastfeeding). This reduces the risk of contaminants that may cause gut inflammation allowing HIV organisms to reach the sub-mucosal tissue. Furthermore, anti-retroviral drugs can reduce the risk of breast milk route of mother to child transmission of HIV infection.

HIV AND INFANT FEEDING

In the absence of an anti-retroviral (ARV) intervention and depending on the duration of breastfeeding approximately 10%-15% of infants will become infected through breast milk. Breastfeeding can account for up to 40% of all mother-to-child transmission (MTCT) of HIV

Infant feeding options for HIV positive mothers under the current WHO guidelines (2010):

HIV-infected mothers are to breastfeed their infants for at least 12 months of age.Breastfeeding with an ARV intervention to reduce transmission from 14 weeks of gestation to one week postpartum or until one week after all exposure to breast milk has ended.

Avoidance of all breastfeeding i.e. replacement feeding: Replacement feeding should not be used unless it is acceptable, feasible, affordable, sustainable and safe (AFASS)

Infants are also to be placed on ARVs

Approach to stopping breastfeeding

HIV-infected mothers who decide to stop breastfeeding should do so gradually, over a period of 1 month. After the stop of breastfeeding; ongoing prophylaxis (maternal or infant prophylaxis) should be continued for 1 week.

Use of expressed breast milk and Heat-treated breast milk.

In a situation where the HIV-infected mother’s infant is born with low birth weight, ill or unable to breastfeed in the neonatal period; expressing breast milk and heat treating of breast milk can be used as an interim feeding strategy.

Reviewed on 11/4/2020

REFERENCES
American Academy of Pediatrics, Pediatr., 115, 496 (2005).

A., Montgomery A. and Wood J., Disease-a-Month, 54, 6, 343 (2008).

Health Service Executive, 2008. Contraindications to breastfeeding. Ireland: HSE.

Naylor A.J. and Wester R.A., Wellstart Int., 3, 1 (2009).

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