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A survey of the literature was conducted to evaluate the influence of mothers' medications on breast-fed infants with regard to the excretion of drugs into breast milk, the adverse reactions produced in breast-fed infants and the factors influencing them. The reported adverse reactions were most frequently caused by central nervous system drugs, accounting for 52% of the total. They included sedation and lethargy. On examining the times after birth that reactions occurred and the estimated maximum doses received by infants in breast milk, we found that adverse reactions frequently occurred in the infants of less than 3 months old and were particularly frequent in those less than 7 days old. Also, the estimated maximum doses in breast-fed infants having adverse reactions were significantly higher than those in infants with no adverse reactions. For half of the drugs reported to cause adverse reactions, the estimated maximum doses were less than 5% of the maternal weight adjusted doses. An evaluation of total scores for maximum drug intake through breast-feeding, existence of adverse reactions in the literature, and infant development showed that 82% of drugs reported to cause adverse reactions had scores of 10 or above while 75% of drugs for which adverse reactions were not reported had scores of less than 10. Our findings suggested that a comprehensive evaluation of such factors as mammary excretion and infant growth status could play a significant role in the prediction of adverse reactions in breast-fed infants.
