title: Revision of Breastfeeding Guidelines in the Setting of Maternal Opioid Use Disorder: One Institution's Experience.
abstract: Breastfeeding is recommended for women with opioid use disorder who are treated with methadone or buprenorphine. Infants with neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure have unique challenges related to breastfeeding but also have significant benefits including improved NAS symptoms with a decreased need for pharmacotherapy. Poor understanding of substance use disorder and treatment, lack of evidence-based recommendations, and vague guidelines from national academies create controversy about breastfeeding eligibility for these women. Defining breastfeeding guidelines is often difficult, particularly in large institutions with multiple providers caring for the mother-infant dyad. Based on the available evidence and review of our institutional data, we revised our breastfeeding guidelines for mothers with opioid use disorder. The aims of our new guidelines are (a) to safely promote breastfeeding in all mothers with opioid use disorder who are in recovery, (b) to improve NAS outcomes through use of breastfeeding as a key nonpharmacologic treatment modality, and (c) to improve staff communication and consistency on the subject of breastfeeding in this patient population.
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA Elisha.Wachman@bmc.org.
authors.forename: Elisha M
authors.initials: EM
authors.lastname: Wachman
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Kelley
authors.initials: K
authors.lastname: Saia
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Humphreys
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Minear
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Ginny
authors.initials: G
authors.lastname: Combs
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Philipp
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D001900:Boston; D001942:Breast Feeding; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000628:therapy*; D011181:Postnatal Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: breastfeeding; breastfeeding practices; breastfeeding promotion; drug-exposed infants