Estas considerações de saúde não se destinam a aconselhamento médico e não é sugerido que qualquer pesquisa termine aqui. Também não é sugerido que quando for considerado seguro amamentar que seja, Portanto, seguro para doar leite.

Please consult with a healthcare provider with any questions about sharing leite materno, especially when donating to a premature baby.

No espírito da escolha informada, this section of health considerations is provided as an investigation tool to research topics and questions that may arise while exploring the suggestions for addressing donors, blood tests for milk donation, and other topics related to the sharing of human milk.

Quando os pais e cuidadores procuram informações sobre o compartilhamento seguro do leite humano, é importante que todas as informações disponíveis sejam apresentadas. O padrão não deve ser a única informação fornecida e o desvio do padrão é e deve ser uma escolha pessoal.

Poluição do ar

A amamentação pode diminuir os efeitos adversos da poluição do ar e apesar dos riscos associados à contaminação química do leite materno, os pais lactantes devem ser encorajados a amamentar seus bebês. Breastfeeding benefits outweigh the potential health risks. Moreover, breastfeeding has a limited ecological footprint and its contribution to sustainability and food security should be considered in environmental goals and policies.¹

Alcohol consumption

After alcohol consumption in moderate amounts, breastfeeding can generally be resumed as soon as someone feels neurologically normal.²

Alcohol is not a galactagogue; it may blunt prolactin response to suckling and negatively affects infant motor development. Thus, ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor, 8 oz wine, ou 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk.³ Dr.. Gideon Koren of the Canadian Motherisk Program provides a table with times from the beginning of drinking until the clearance of alcohol from breastmilk for people of various body weights.

It is important for the full informed choice process to divulgar any alcohol consumption to a recipient family.

Drogas, medicamento, álcool, e a decisão de descartar o leite materno

Anesthesia

If planning to donate breastmilk after being administered anesthesia, please consult with a healthcare provider for clearance and disclose this information to the recipient.

Older research on anesthetic agents indicates that a single use of anesthesia medication is nearly undetectable in breastmilk. Once someone is awake enough after the procedure to nurse a baby, there is very little anesthesia medication left to have any effect.⁴

More specific studies on breastfeeding outcomes for breastfeeding parents after surgical anesthesia is needed. Prolonged fasting times, frequent expression, or breastfeeding in the immediate perioperative period need to be more rigorously explored in controlled settings. Breastfeeding-friendly policies in hospitals and outpatient surgery centers should be prioritized. Much of the literature on systemic opioid use during labor, especially fentanyl and remifentanil, does not include breastfeeding outcomes. A more comprehensive evaluation of common postpartum opioids postdelivery and their occurrence in breastmilk is also needed.^{5 6 7 8}

Por favor, veja também Informações gerais sobre medicamentos.

Bactérias

Breastmilk contains antimicrobiano componentes that fight bacteria. The protective properties of breastmilk have been well established.⁹

When breastmilk is heat-treated, bacteria are generally destroyed even if the different methods of heat treating affect the milk differently.^{10 11}

It can be important to know that some bacteria form esporos quando exposto ao calor. Bacillus cereus é uma bactéria formadora de esporos e é conhecida por causar cerca de 2% do total de casos de intoxicação alimentar. É amplamente encontrado na natureza (solo, plantações, agua).¹²

Bacillus food poisoning usually occurs because heat-resistant endospores survive cooking or pasteurização and then germinate and multiply when the food is inadequately refrigerated.¹³ While Bacillus cereus bacterium is easily controlled by proper handling,¹⁴ this bacterium is not reduced by heat-treating. B. Cereus can be of special concern to sick and premature babies¹⁵ because of their compromised immune systems.

Milk banks screen for this and other bacteria before and after pasteurization. Casa triagem of bacteria is technically possible, but expensive and/or elaborate. Proper handling is important in avoiding contamination by bacteria.

When donating to a premature baby, special considerations may need to be taken into account. Por favor, veja E os bebês prematuros? for more information and consult with a specialized healthcare provider when planning on donating to a premature baby.

Controle de natalidade

Cerca de seis semanas após o parto, uma vez que a oferta de leite esteja firmemente estabelecida, contraceptivos à base de hormônios sintéticos são considerados seguros para tomar.¹⁶

No entanto, abastecimento ainda pode ser afetado. Discutir o desejo de usar contraceptivos orais e quaisquer consequências potenciais que possam ter na produção de leite¹⁷ with a healthcare provider.

Inform prospective recipients if taking hormonal contraceptives.

There are also other, non-hormonal forms of contraceptives that can be looked into, such as the Lactational Amenorrhea Method (LAM),¹⁸ and Natural Family Planning (NFP).¹⁹

Please contact a primary healthcare provider and/or other local resources Para maiores informações.

Blood products (update coming soon)

Donors should disclose to recipients if they have or will be receiving blood products. Please also consult a healthcare provider to discuss donating milk in this case.

The wait time for donating blood after having received a blood transfusion from another person in the United States is 3 meses. You may not donate if you received a blood transfusion since 1980 in France, Irlanda, Inglaterra, País de Gales, Escócia, Irlanda do Norte, Ilhas do Canal, Ilha de Man, Gibraltar, or the Falkland Islands. This requirement is related to concerns about variant CJD, or ‘mad cow’ disease.^{20 21 22}

Those who received Rh Immune Globulin (RhIG –brand names: Rhogam/WinRho)²³ are restricted from blood donation for 6 weeks. No entanto, there are no contraindications for breastfeeding one’s own babies after receiving Rhogam.²⁴

Caffeine

It is considered safe for someone to consume caffeine while breastfeeding. No entanto, a small amount of caffeine does get into breastmilk.²⁵ It is suggested to limit caffeine while breastfeeding to 3-4 cups per day.²⁶ And, our apologies for breaking this news to chocolate lovers: Since the recommendation is to keep caffeine intake under 300mg,²⁷ we are sad to report that you should consider limiting your chocolate consumption to about half a pound per day.

Cancer

While cancer itself is not contra-indicado para amamentação, the use of chemotherapy, radiation with radioactive isótopos,^{28 29} e certos medicamentos relacionados ao câncer são.³⁰

UMA 2014 relato de caso sobre o efeito da quimioterapia na microbiota e metaboloma do leite humano descobriram que a quimioterapia causou um desvio significativo de uma microbiota saudável e perfil metabolômico.³¹

It is advised to speak to a healthcare provider about concerns regarding breastfeeding while undergoing cancer treatment, doação de leite materno após tratamento de câncer, e recebendo leite de um ex-paciente com câncer. Muitos bombeiam durante o tratamento e descartam o leite para que a amamentação possa continuar após o término do tratamento.

Informações gerais sobre medicamentos

Varreduras de diagnóstico (raios X, mamografias, ressonância magnética, e CT/CAT)

In her article Breastfeeding and Cancer,³² Diane West, BA, IBCLC, writes that radiation from diagnostic procedures using x-rays, mamografias, ressonância magnética, and CT/CAT scans are all safe during lactation. While this kind of radiation does have the ability to mutate DNA in live cells, it does not collect in the milk and is therefore compatible with uninterrupted breastfeeding. Radiopaque e radiocontrast agents typically used in ductogram, CT/CAT, ressonância magnética, MIBI scan, or PET scan diagnostic tests are extremely inert and virtually unabsorbed when taken orally, so they do not pass into the milk and it is not necessary to interrupt breastfeeding when they are used. Additionally, O livro de respostas da amamentação³³ reports that nursing may safely resume immediately after X-rays. Lactating people who receive iodinated contrast or gadolinium can continue breastfeeding without interruption.³⁴

Although the vast majority of circumstances do not require interruption of breastfeeding, certain exceptions do exist.³⁵ More information on the safety of radiocontrast dyes can be found in Thomas Hale’s Medications and Mothers Milk.^{36 37} Radioactive isotopes are not safe while breastfeeding, and breastfeeding should be temporarily interrupted when having a procedure requiring these isotopes. Generally, a short interruption of breastfeeding is necessary and a baby should be fed previously pumped milk.³⁸

Please disclose any diagnostic scans you may undergo to a recipient family in order to allow for their full informed choice process.

For more information also see the sectionMedicamento.

Direct contact between donor and recipient families

Direct contact between donor and recipient is an important aspect of safe milksharing. No one but a donor or a parent/legal guardian/medical provider can assume responsibility for a child and make informed decisions about the milksharing processes. For donors, knowing how their milk and personal information will be used and by whom is important as well. Direct contact between donor and recipient allows for proper screening and is a layer of safety when it comes to human milksharing via private arrangement.

The only way to safeguard the facilitating of these processes on our network is with transparency and therefore we cannot accommodate offers and requests made by third parties who are not legal or medical representatives.

To support the full informed choice process and self-determination of all families practicing private arrangement milksharing, for the safety of babies, and for network transparency, we only accept offers and requests from legally or medically responsible parties.

come nos pés

Legal and medical representatives are a parent(s) of the child, someone with custody, legal guardianship, or power of attorney, a foster parent, donors donating their own milk, parteiras, and anyone legally allowed to prescribe medication, including the nurse practitioner.

Irmãos, crianças, avós, amigos, aunts, sister-/brother-in-law, etc., are not legally nor clinicamente responsible parties. IBCLCs, enfermeiras, and doulas are also not clinically responsible parties and they cannot request milk for their clients.

For screening suggestions, Vejo Questions for addressing recipients e Questions for addressing donors.

Donor testing

Milk banking guidelines³⁹ in most countries require donors to be tested every 3-6 meses (depending on the bank) or sooner if there has been any risk of exposure or significant change of health status.

Previous records can be requested if blood work was done recently. Testing for some infectious diseases⁴⁰ is often done routinely during pregnancy⁴¹ or as part of annual checkups.

If not covered by insurance or public healthcare, becoming a blood donor may provide free screening in certain areas. It is usually possible to request a copy of any testing done. Recipients may also accept proof of regular blood donations with the same agency as evidence of good health. Por favor, check local blood donor requirements to see qualification requirements and procedures.^{42 43 44}

If pregnant, there is a waiting period of 6 weeks after birth before being allowed to donate blood in the US and up to 6 months in other countries. It should be noted that the blood donation process can vary by region. It is therefore important to always check with your local agency.

Vale ressaltar que muitas clínicas gratuitas fornecem testes anônimos. Como esses resultados de laboratório não conterão o nome do paciente, é importante pedir para adicioná-lo ao solicitar uma cópia.

Para exames de sangue, please visit your healthcare provider, ou você pode solicitar testes por conta própria através de determinados laboratórios.⁴⁵ Veja estas sugestões teste de tela for milk donors.

Drogas, medicamentos, álcool, and post-consumption discarding of breastmilk

There are few substances that can make their way into the breastmilk, some in more significant quantities than others.

Although the presence of a small quantity of medication and/or alcohol in breastmilk may be allowable for a healthy term baby, exposure to these products to a sick baby or preterm baby may be moredetrimental.

It is very important that all medication, álcool, and drug consumption be disclosed to recipients.

Donors can either discard the milk pumped after such consumption or note the type and amount on the bag to allow recipients to make an informed decision. A lactating recipient who is supplementing with donor milk may be fine with certain medications if they are using the same or similar medication for instance, while someone else may prefer not to use this donor milk.

The donor should be aware that some medications and drugs remain in their system at measurable levels for longer periods of time.

For more information see the sectionsAlcohol eMedicamento.

Exposure to needles

Unsafe exposure to non-sterilized needles (i.e. accidental needle stick, body piercing, tattoo, eletrólise, acupuntura) can lead to infections and diseases. Fulldivulgação of any needle exposure, even if deemed safe, is very important to allow for informed decision-making.

Please consult with a healthcare provider regarding donating breastmilk in case of exposure to non-sterilized needles. It may also be wise to have a complete round of blood work done after exposure and within three months.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? para obter mais informações sobre tratamento térmico epatógenos.

Herbs, vitaminas, and other supplements

Milk banks exclude⁴⁶ donors who ‪regularly use most medications and herbal supplements. This may include vitamin-herb combinations, megavitaminas‬, vitamin drinks, weight loss supplements, and cleanses including all shakes, drinks, and pills. Most ingredients in these products have not been researched well enough to know whether or not they are safe during breastfeeding. Milk bank guidelines are to protect premature and sick infants, but mega amounts of vitamins, high vitamin drinks, herbs, etc. can also affect term infants.

Please consult a healthcare provider if taking herbal supplements and/or megavitamins and planning on donating to a (premature) infant in need. Please disclose any supplements to the recipient family so that they can also make an informed decision.

Also see Medicamentos

Hormone replacement

Certain health issues and life experiences, for example, transmasculine individuals,⁴⁷ may require the use of hormone replacement therapy and these may or may not have an effect on breastmilk and breastfeeding. If receiving hormone replacement of any kind, please consult with a healthcare provider.

Por favor, veja a seção Medicamento Para maiores informações.

Hospitalization

As a part of the screening process, donors may be asked if they have been hospitalized. While hospitalization alone does not rule out the donation of milk, hospital-acquired infections are common and may cause some concern for exposure to various pathogens.^{48 49} The risk of exposure is not limited to the donor (who was hospitalized), but the recipient is also at risk of being exposed to anything that may pass through breastmilk. If there is a possibility that the reason for hospitalization may impact breastfeeding, this should be disclosed to the recipient.

In addition, donors may have required certain medications depending on their treatment needed, see section discussion Medicamento.

More information in Surgery and the Breastfeeding Infant.

Please see also the section Anesthesia.

Por favor, veja Como o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Infections

Introduction to infectious diseases

Quando os bebês nascem, eles adquirem flora intestinal from their parent’s microbiota. A composição desta microbiota é afetada pelo modo de entrega, bem como pela genética, o ambiente, e o modo de alimentação. O ato de amamentar influencia a flora intestinal do lactente por causa da transmissão dos organismos da pele do genitor. Breastmilk also contains components that allow for the growth of some beneficial microbes while offering protection from harmful ones. Breastmilk also directly influences the development of the infant’s immune system.

While human milk can be a source of normal microflora as well as harmful pathogens, there are very few infectious diseases for which breastfeeding needs to be stopped or interrupted.⁵⁰ In developed countries, HIV-1, HIV-2, HTLV-I, and HTLV-II are the only infectious diseases that are considered absolute contraindications to breastfeeding.^{51 52}

According to the CDC, someone with these conditions should not breastfeed or feed their expressed milk:⁵³

• If diagnosed with the human immunodeficiency virus (HIV)⁵⁴
• If infected with human T-cell lymphotropic virus type I or type II⁵⁵
• If using an illicit street drug, such as PCP (phencyclidine) or cocaine⁵⁶
• If suspected or confirmed to have Ebola virus disease⁵⁷

Temporary contraindications to breastfeeding and/or feeding expressed milk are certain medications, diagnostic imaging with radiopharmaceuticals, anyone with active lesões from diseases like HSV, Hepatitis, Sífilis, Chickenpox, and Monkey Pox), and Brucellosis.⁵⁸

When someone is diagnosed with an doença infecciosa, they have already exposed their infant to the pathogen. The interruption or the stopping of breastfeeding does not prevent exposure, and it may instead decrease the infant’s protection that comes through the protective factors found in breastmilk. Portanto, common bacterial, fungal, and viral infections in which someone’s health is not compromised are not contraindications to breastfeeding.

No entanto, while certain infectious diseases are not transmitted through breastmilk, pathogens can be transmitted via handling, by the donor or by the recipient. Someone could have minor lesions and not know that they are a sign of an infectious disease. Someone may be in an open relationship and not know the status of their partner. Regular testing for certain infectious diseases is recommended by milk banks, and it is important to fully disclose any past or potential present exposure to infectious diseases. Por favor, veja também Pasteurização caseira when the donor status is not (fully) known.

Brucellosis

Brucellosis can be contracted by touching, eating, drinking, or breathing in Brucella bacteria. This can happen through the consumption of raw dairy products, breathing in the bacteria while working in a meat-packing plant or a laboratory, and through open skin wounds by direct contact while working in a slaughterhouse, meat-packing plant, veterinarian office, while field dressing game or generally handling a sick or dead animal.^{59 60}

Person-to-person transmission is very rare but the bacteria can be passed to a breastfeeding child. The infection is treated with a combination of two or more different antibiotics, such as doxycycline with gentamicin or doxycycline with rifampicin.⁶¹

Por favor, veja Informações gerais sobre medicamentos for more information on breastfeeding safety and commonly used antibiotics.

If it becomes necessary to interrupt breastfeeding, in order to maintain supply, milk can be pumped and discarded during the treatment period. If you have been diagnosed with brucellosis, please consult with your healthcare provider for healthy nursing options.

Candida Albicans (thrush/yeast infection)

Breast and nipple pain when someone is breastfeeding is sometimes caused by thrush, an infection from Candida albicans, which can cause issues if left untreated.^{62 63} Breastfed babies can also develop thrush in their mouths.

If thrush develops in a baby or their parent, there are several healing protocols that someone can follow.⁶⁴ Please consult a healthcare provider and/or other local resources for more information about treatment options.

If a lactating person has a Candida infection it is suggested that they wash clothes that come into contact with the affected areas, like bras, reusable nursing pads, etc., in very hot water.^{65 66 67 68 69}

A Candida infection can also be transmitted via skin-to-skin contact, unclean hands, shared towels, and sexual contact.⁷⁰ This does however not mean that the other person will develop thrush.⁷¹

Using expressed milk
Keeping breastfeeding or feeding expressed milk while under treatment is considered safe. When expressing milk, it is suggested to thoroughly clean supplies in order to prevent cross-contamination.

Some recommend that milk that has been expressed and stored (frozen) should not be used once treatment is done so as to avoid re-contamination. This is probably based on the fact that in food science, freezing does not eliminate Candida but only slows down its growth. Other sources suggest pasteurizing, scalding, or boiling expressed milk to avoid re-contamination with Candida after treatment because food safety shows that heating foods destroys yeast to temperatures of ≥ 60ºC/140°F.⁷²

We can however find no evidence that suggests that Candida in expressed milk can cause a new infection. Literature has suggested candida can be a problem in milk because it can be passed from person to person, and can live in fabrics and porous materials. But yeast found in human milk is exposed to lactoferrina, which inactivates it.^{73 74} The amount of yeast needed to cause infection is also high, so recommendations for dilution with fresh milk introduce both dilution and even more exposure to lactoferrin.

If one were to heat treat expressed milk out of Candida concerns, sources either say that Candida is killed at 50ºC/122ºF,⁷⁵ or by boiling, (100ºC/212ºF),⁷⁶ scalding (82-85ºC/180-185ºF), which heats milk just until it begins to steam,⁷⁷ or pasteurizing (62.5°C/145°F para 30 minutes or 72ºC/161.6ºF for 15 segundos).⁷⁸ As you can see these temperatures are vastly different, with the first one not meeting food safety standards.

If someone plans to heat-treat milk due to a Candida infection it is important to note that heat-treating human milk reduces lactoferrin as well as important anti-infeccioso factors and enzymatic activities. Portanto, combined with the lack of evidence that Candida in milk causes a new infection, heat treatment does not seem to be the most logical route to take. Heat treating can also activate spores.⁷⁹

If a candida infection develops while being a donor, disclose this information to the recipient, especially when donating to a premature or immuno-compromised baby. Families may choose to continue to receive milk if their child is otherwise healthy and the donor is under treatment. If choosing to accept milk from a donor who has thrush, recipients should educate themselves on how to treat thrush should it develop in their child due to contamination from improper handling.

Chickenpox (Varicella)/Shingles

Chickenpox and Shingles are caused by a group of viruses in the Herpes family.

Newborn children (<1 mês) whose breastfeeding parent is not immune may suffer severe, prolonged, or fatal chickenpox. Any person with a weakened immune system, including those with cancer, human immunodeficiency virus (HIV), or taking drugs that suppress the immune system, may have an increased risk of developing a severe form of chickenpox or shingles.⁸⁰

Detection of HSV in human milk is rare.⁸¹ No entanto, those who are breastfeeding and have contracted chickenpox or shingles and have active lesions (particularly on the nipples, areolae, breasts, and/or hands) should refrain from breastfeeding and donating breastmilk in case of handling contamination until the lesions are gone. Disclose any recent exposure or outbreak to the recipient.

Donors and recipients should disclose whether or not they have been exposed earlier in life or have been vaccinated. For more information also see the section on Vaccines.

For more information also see sections on open sores and blisters e Herpes.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Cholera

Keeping the lactating parent and infant together in times of cholera yields the best results for nutritional status. The organism that causes cholera (vibrio) is not transmitted through breastmilk. The vibrio is in the gastrointestinal tract and the route of transmission is by fecal-oral contamination. Exclusively breastfed infants rarely develop cholera, unless the vibrio is introduced through the infant’s mouth, which is prevented by exclusive breastfeeding. The Infant Feeding in Emergencies (IFE) Core Group states that lactating parents with cholera should continue to breastfeed their child as long as the parent is conscious (even when getting IV fluids).⁸² Breastfeeding does not make cholera worse due to its protective properties.^{83 84} It is rarely in the best interests of the lactating parent or the child to cease breastfeeding in case of disease outbreaks or illness affecting lactating parents or children.⁸⁵

Tratamento térmico breastmilk remains an option in any affected area if necessary.

Doença de Creutzfeldt-Jakob (CJD) (update coming soon)

Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, and fatal brain disorder that leads to a rapid decrease in mental function and movement.⁸⁶

There is no test for this rare disease and therefore, in the United States, contamination is addressed with screening.⁸⁷

You are not eligible to donate if:

• A partir de janeiro 1, 1980, até dezembro 31, 1996, você gastou (visitou ou viveu) a cumulativo time of 3 meses ou mais, em qualquer país do Reino Unido (Reino Unido), Ilhas do Canal, Inglaterra, Ilhas Malvinas, Gibraltar, Ilha de Man, Irlanda do Norte, Escócia, País de Gales
• A partir de janeiro 1, 1980, apresentar, you had a blood transfusion in any of the countries listed below: França, Irlanda, Ilhas do Canal, Inglaterra, Ilhas Malvinas, Gibraltar, Ilha de Man, Irlanda do Norte, Escócia, País de Gales
• Você gastou (visitou ou viveu) um tempo acumulado de 5 anos ou mais a partir de janeiro 1, 1980, até dezembro 31, 2001, na França ou na Irlanda
• If you have received a dura mater (brain covering) transplant;
• If you received an injection of cadaveric pituitary human growth hormone (hGH) (before 1985)
• If you have first-degree blood relatives who had Creutzfeld-Jacob disease

It is important to note that 85-90% of the cases acquired so-called ‘sporadic’ CJD, meaning that the disease appears even though the person has no known risk factors for the disease. This is by far the most common type of CJD.⁸⁸ This sporadic disease occurs worldwide, including in the United States, at a rate of approximately one case per 1 million population per year, although rates of up to two cases per million are not unusual. The risk of CJD increases with age, and in persons aged over 50 anos de idade, the annual rate is approximately 3.4 cases per million.⁸⁹

In theory, CJD can be transferred between humans through injection or, heaven forbid… consumption of brain tissue. Atualmente, no information suggests CJD has been transmitted to an unborn child or through breastmilk.^{90 91 92}

Complete inactivation of CJD requires a combination of chemicals and heat treatment.⁹³

For information on the blood donor protocols of various countries see Viajar para vários países em relação à doença de Creutzfeldt-Jakob (CJD)

Milk banks follow blood bank guidelines. No entanto, it is not the general recommendation for parents to not breastfeed their own child if they have spent a cumulative time in the above-mentioned areas or received a blood transfusion there since 1980.

Please disclose any traveling or past abroad residence to prospective recipient families for their full informed choice process.

Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is one of the Herpes viruses. It is usually harmless and 50-80% of adults are carriers by the time they are 40 years old. CMV can be transmitted in utero and while breastfeeding. Transmission through breastmilk seems to be the reason for the rapid and common acquisition of cytomegalovirus that occurs among breastfed infants. It must be viewed as a form of natural immunization.^{94 95} Infections that occur from breastfeeding usually do not cause symptoms or disease in the infant and there are no recommendations against breastfeeding.⁹⁶

When preterm babies acquire CMV postnatally via breastmilk, they are at greater risk than term infants of exhibiting symptoms of the disease. In the extremely low birth weight (birth weight <1500 g) preterm infant, there is a possibility that CMV acquired from human milk may be associated with a late-onset sepsis-like syndrome. No entanto, the value of routinely feeding human milk from seropositive mothers to preterm infants outweighs the risks of clínico disease, especially because no long-term neurodesenvolvimento abnormalities have been reported. Freezing of milk reduces but does not eliminate CMV. Heat treatment eliminates the viral load from the milk but also affects bioactive factors and nutrients. Fresh mother’s own milk is preferable for routinely feeding all preterm infants.^{97 98 99 100}

While babies who contract CMV from their own CMV+ parent through breastfeeding do not get sick, babies of those who are CMV- and who receive milk from a CMV+ donor are not protected against the virus through existing anticorpos and could get sick, especially if they are premature or immuno-compromised. Com triagem adequada, a recipient can avoid donor milk from a CMV+ person if they themselves are negative or they may decide to freeze or pasteurizar the milk to avoid contamination if needed and the donor status is unknown.¹⁰¹

Como o leite materno pode ser pasteurizado em casa?

Hepatitis A (HAV), B (HBV), and C (HCV)

Hepatitis A
HAV is mainly transmitted through the fecal-oral route, which includes ingesting contaminado food or water, engaging in oral-anal sex, and other incidences where fecal matter can be passed from person to person. Como tal, good hygiene, including proper handwashing practices, is considered essential to prevent the spread of HAV. HAV, even during the acute infectious period, is not a contraindication to breastfeeding. ¹⁰² No evidence of HAV has ever been found in human breastmilk.

Proper handling during any illness is important, as is labeling bags with any pertinent information, especially in case of a donor getting sick, so that recipients can be notified and exercise their full informed choice. When in doubt, expressed milk can be pasteurized at home.

Hepatitis B
HBV is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected. It is safe for those infected with the hepatitis B virus (HBV) to breastfeed their infant immediately after birth. Even before the availability of the hepatitis B vaccine, HBV transmission through breastfeeding was not reported. There is no need to delay breastfeeding until the infant is fully immunized. Those who breastfeed should take good care of their nipples to avoid cracking and bleeding. Someone who is HCV-positive and has cracked and bleeding nipples and/or surrounding areola is advised to stop breastfeeding temporarily. Instead, expressing and discarding the breastmilk should be considered until the nipples are healed in order to not compromise the milk supply. Once the breasts are no longer cracked or bleeding, breastfeeding may be fully resumed.¹⁰³

Hepatite C
HCV is transmitted via blood. It is safe for someone infected with HCV to breastfeed their infant. There is no documented evidence that breastfeeding spreads Hepatitis C nor are there current data to suggest that HCV is transmitted by human breastmilk. Hepatite C (HCV) is spread through infected blood. Someone who is HCV-positive and has cracked and bleeding nipples and/or surrounding areola is advised to stop breastfeeding temporarily. Instead, expressing and discarding the breastmilk should be considered until the nipples are healed in order to not compromise the milk supply. Once the breasts are no longer cracked or bleeding, breastfeeding may be fully resumed.¹⁰⁴

Those with substance use disorders are at high risk for HBV. Despite the many factors that may make breastfeeding a difficult choice for someone with a substance use disorder, a drug-exposed infant, who is at high risk for medical, psychological, and developmental issues, as well as the breastfeeding parent, stand to benefit significantly from breastfeeding. With careful monitoring, treatment, postpartum care, and lactation support the dyad can be supported in their breastfeeding.¹⁰⁵

❆✼❆

Each hepatitis virus carries its own risk of illness. The risks of breastfeeding with maternal hepatitis should be weighed against the known risks of NOT breastfeeding in each individual case and environment. Por favor, veja também Open sores, blisters and/or bleeding cracks on the skin, Manipulação de Leite, e Introdução às Doenças Infecciosas for more information.

In the case of milksharing, both donors and recipients can infect expressed milk by improper handling. Donors should disclose their hepatitis status and any past illness to prospective recipients and be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks. Please consult a healthcare provider for more information.

Como o leite materno pode ser pasteurizado em casa?

Herpes Simplex (HSV)

The risk of transmission of many infectious diseases, including Herpes Simplex, is increased when infants are exposed to blood products from open sores, bolhas, and/or cracked and bleeding skin that enter the breastmilk. Precautions need to be taken especially with infants under one year of age.¹⁰⁶

If you have sores on your nipple, you should not breastfeed your baby on that breast. Pump or express your milk by hand from that breast until the sore is gone. Be sure the parts of your breast pump that touch the milk do not touch the sore while pumping and are thoroughly cleaned after usage. ACOG suggests that if this happens, the milk should be thrown away.¹⁰⁷ Otherwise, expressed milk can be used because there is no concern about these infectious organisms passing through the milk.¹⁰⁸

Please disclose any open lesions to the recipient and see a healthcare provider if there are any concerns and/or if this is a primary outbreak. Donors should also be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks. Recipients should be aware that they, too, can contaminar donor milk if they have any lesions on their bodies.

Por favor, veja também medication and breastfeeding e Feridas abertas, bolhas, e/ou rachaduras na pele.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Vírus da imunodeficiência humana (HIV)

HIV is spread through direct contact with bodily fluids.¹⁰⁹ In North America, those who test positive for any type of HIV are advised not to breastfeed (or donate breastmilk of course) by the CDC.¹¹⁰

No entanto, HIV is easily killed by heating and this effectively mitigates the risk of transmitting HIV through human milk.¹¹¹ This poses the question as to whether the recommendations of the CDC for those who are HIV-positive to not breastfeed their own baby, without qualifying and allowing for the opportunity to make informed decisions with the guidance of a healthcare provider, is in the best interest of the parent/child in all situations.

Extensive research in the context of HIV in low-resource countries supports the claim that the human immunodeficiency virus is very easily destroyed and that this can be done so at home. Amamentação, and especially early breastfeeding, is one of the most critical factors for improving child development, health, and survival. Human milk also has many benefits other than reducing the risk of child mortality. The risks of not breastfeeding are not negligible, even where clean water and sanitation are accessible.^{112 113}

Donors should avoid high-risk behaviors –i.e. I.V. drug use, unprotected sex with someone of unknown status, etc. that may lead to an HIV infection. Donors should also be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks.

Nos E.U.A, as well as in many other countries, HIV is part of routine testing during pregnancy or during labor. A copy of the results can be obtained through your healthcare provider. Há 3 methods for HIV testing available depending on which one is appropriate in someone’s circumstances.¹¹⁴

Nos E.U.A, the risk of HIV transmission by mistakenly feeding a child human milk from another child’s bottle is believed to be low because women who are HIV positive are advised NOT to breastfeed their infants.¹¹⁵ Transmission of HIV from single breastmilk exposure has never been documented.

If there is any doubt regarding the donor’s HIV status or for added protection, it is possible to flash-heat breastmilk at home in order to deactivate HIV.

Please consult with a qualified healthcare provider with any HIV-related issues.

HIV e o contexto global da alimentação infantil

Update in progress with the 2016 guidelines.

Investing in improving infant feeding practices in the context of HIV, a Organização Mundial da Saúde believes that “Governments, other stakeholders and donors should greatly increase their commitment and resources for the implementation of the Global strategy for infant and young child feeding.”

Regulations on how or whether someone with HIV should breastfeed their child vary between countries.¹¹⁶ In their 2010 publication, the WHO has made specific recommendations to minimize the transmission of HIV to nursing offspring. Recognizing that every nation has unique responsibilities and circumstances to consider, the WHO recommends that “national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding, will be primarily promoted and supported by Maternal and Child Health services.”

As the strategy that will most likely give infants the greatest chance of HIV-free survival, each country’s health authority¹¹⁷ will decide whether to principally counsel and support parents known to be HIV-infected to either breastfeed and receive ARV interventions, –or– avoid all breastfeeding.¹¹⁸

The WHO recommends that those “known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding should then only stop once a nutritionally adequate and safe diet without breastmilk can be provided.”

Furthermore, the WHO states that when those known to be HIV-infected decide to stop breastfeeding at any time, infants should be provided with safe and adequate replacement foods to enable normal growth and development.

For infants less than six months of age, alternatives to breastfeeding include:

• Commercial infant formula milk as long as home conditions (outlined below) are fulfilled,¹¹⁹
• Expressed, heat-treated breastmilk (Veja abaixo).

“Home-modified animal milk is not recommended as a replacement food in the first six months of life.” ¹²⁰

Those known to be HIV-infected may consider expressing and heat-treating breastmilk as a temporary feeding strategy:

• Em circunstâncias especiais, como quando a criança nasce com baixo peso ao nascer ou apresenta alguma outra doença no neonatal período e incapaz de amamentar;
• When the parent is unwell and temporarily unable to breastfeed or has a temporary breast health problem such as mastite;
• To assist parents to stop breastfeeding;
• Se medicamentos antirretrovirais estão temporariamente indisponíveis.

Dentro ‘HIV and Infant Feeding,’ the WHO supports heat-treating for temporary feeding¹²¹ during an emergency and when no other safe options are available. In a 2008 training package, the CDC also stated that “HIV is killed by heating the milk and ends the risk of transmitting HIV through breastmilk.” It may be argued that, if a recipient receives milk from a donor of unknown HIV status, heat-treating the breastmilk is a viable short-term solution.¹²²

Atualmente, não há evidências claras sobre se o tratamento térmico do leite materno deve ser usado como uma solução permanente.

Por favor, veja Como o leite materno pode ser pasteurizado em casa? for more information on heat-treating.

Human T-lymphotropic virus Type I and II (HTLV-1, HTLV-2)

Vírus T-linfotrópico humano (HTLV) é um vírus que pode causar doenças no sangue ou nos nervos. The AAP recommends that those who are HTLV I or HTLV II positive should not breastfeed or use expressed human milk as the primary route of HTLV-1 infection seems to be through human milk.^{123 124 125}

Devido a opções de tratamento inadequadas e à falta de vacinação eficaz, atualmente, a prevenção só é possível restringindo a transmissão, incluindo o uso de preservativo nas relações sexuais ou evitar a amamentação se soropositivo para HTLV. Se por motivos socioeconômicos, A amamentação não pode ser evitada, aleitamento materno de curta duração por um máximo de até 6 meses é sugerido.¹²⁶

Bebês nascidos de pais com HTLV-1 parecem adquirir alguma imunidade limitada no útero que pode protegê-los nos primeiros meses, mas poucos estudos examinaram o impacto da infecção por HTLV-1 na fertilidade ou na gravidez ou na suscetibilidade da mãe à infecção. durante a gravidez e lactação. A amamentação está fortemente associada à transmissão e evitar a amamentação uma intervenção comprovada, but little is known about the mechanism of transmission from the milk to the infant and there have been no clinical trials of antiretroviral therapy (ARV) para evitar esta via de transmissão.¹²⁷

O HTLV não é comum nos EUA, mas é encontrado regularmente em algumas partes do Japão, o caribenho, e África Central.¹²⁸ Any concern about HTLV should be discussed with a qualified healthcare professional. Receiving a positive result from the initial blood test does not confirm positive HTLV status. Testes adicionais serão necessários para descartar resultados falso-positivos.¹²⁹

A maioria das pessoas com HTLV I ou II não desenvolve a doença ao longo da vida.^{130 131} É claro que não estamos sugerindo que uma pessoa HTLV+ doe seu leite para o filho de outra pessoa. As informações abaixo podem, Contudo, ser útil caso a saúde completa de um doador não seja conhecida:

• O HTLV-1 é destruído dentro 20 minutos a 56°C (ou 10 minutos a 90°C), ou congelando a -20°C para 12 horas.¹³²
• O processamento por congelamento-descongelamento pode eliminar a infectividade do leite humano pelo HTLV-I e os portadores do HTLV-I podem alimentar indiretamente seus bebês usando leite expresso e descongelado como forma de prevenir a infecção pelo HTLV-I.¹³³

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Influenza

Influenza is not spread to infants through breastmilk and those who are breastfeeding should continue to do so. A mother’s breastmilk contains antibodies and other immunological factors that can help protect her infant from flu and is the recommended source of nutrition for the infant, even while the mother is ill.¹³⁴

In a controlled environment, components of breastmilk have been shown to possess antibodies and antiviral properties against influenza. Human milk has significant amounts of antibodies that are directed specifically against the microbes of the parent and their environment. This results in broad defense for the infant.^{135 136 137}

Breastfeeding strengthens an infant’s immune response to influenza. Babies who are not breastfed may be more vulnerable to viral infections.¹³⁸

The influenza vaccine does not affect the safety of those who are breastfeeding or their infants. Breastfeeding does not adversely affect the immune response and is not a contraindication for vaccination.¹³⁹

Donors should discuss any illness with their recipient and consult a healthcare provider in case of influenza infection.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Doença de Lyme

Reasons to suspect that you have Lyme disease include:

• You live in a region where Lyme disease is common
• Fever, chills, headache, fadiga, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash
• Erythema migrans (EM) rash¹⁴⁰
• While there are no reports of Lyme disease being spread to infants through breastmilk, a antigenic material of the bacteria that causes Lyme disease, Borrelia burgdorferi, is transferred into human milk. While there has yet to be a case in which an infant was infected through human milk, it is not known if that genetic material is infectious or not. Thus, it is recommended that if someone is diagnosed post-partum or while breastfeeding, they should seek immediate treatment and withhold breastfeeding until beginning an appropriate antibiotic regime.¹⁴¹

It is safe to continue breastfeeding while being treated with antibiotics. Some antibiotics are safer than others while breastfeeding. Breastfeeding mothers diagnosed with Lyme disease should consult with their healthcare providers who can prescribe an antibiotic that is safe to use while breastfeeding.¹⁴²

Milk banks do not test for Lyme disease and rely on autoexclusão, physician letters for confirming health, and the Holder pasteurization process to address any possible contamination of donor milk.¹⁴³ Families using private-arrangement donor milk can screen their donors and use the Holder method of pasteurizing can be done at home when in doubt.

Mastitis

The presence or absence of mastitis does not appear to have a significant impact on bacterial levels in breastmilk.¹⁴⁴

Mastitis occurs on a spectrum of a variety of conditions: ductal narrowing or plugging, inflammatory mastitis, bacterial mastitis, pockets of fluid collection, abscess, galactocele, and subacute mastitis. Management of each condition addresses the general spectrum as well as each specific condition to not only treat it but also prevent reoccurrence.¹⁴⁵

Breast infections should be dealt with promptly and may require antibiotics. It is important to keep breastfeeding/expressing while having mastitis since frequent nursing helps drain the breasts and prevents the infection from spreading.¹⁴⁶ Babies will not be harmed by drinking breastmilk from breasts with mastitis. Please see the WHO publication for more information, including treatment options for Mastitis, and consult with a healthcare provider with any concerns.¹⁴⁷

Donors should inform recipients if they are being treated with antibiotics. For more information on medication use while breastfeeding, por favor, vejaInformações gerais sobre medicamentos.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Monkey Pox

The Monkey Pox virus (MPX) is transmitted through body fluids and close contact. Monkeypox is a viral infection that requires special consideration during pregnancy and breastfeeding: it is expected to transfer into human milk, and fetal infections have been reported (vertical transmission).¹⁴⁸

Atualmente, the CDC strongly recommends against breastfeeding with monkeypox. It is believed that the monkeypox virus will transfer into human milk, and more importantly, close contact can transmit the disease to the infant.¹⁴⁹

When the breastfeeding parent recovers and the lesions are healed (scabbed overe covered by normal skin), the infant could return to breastfeeding. No entanto, it can easily take 4 weeks to reach this phase.

Donors should discuss any illness with their recipient and consult a healthcare provider in case of an infection.

Por favor, vejaHow can human milk be pasteurized at home? for more information on heat-treating and pathogens.

Rubella

Rubella is a form of German measles, a disease that is less severe than typical measles but that can harm an unborn child if a parent gets the disease when they are pregnant.¹⁵⁰

Most have blood screens done when they are pregnant and the Rubella antibody status will be known via this screening. Because the Rubella vaccine should be avoided during pregnancy, it is also recommended to have a blood test before getting pregnant so that a vaccine can be given before pregnancy in case of no or low antibodies.¹⁵¹ Even if you have had a rubella immunization, or have had a rubella infection, there is still a small chance that your body has not made enough antibodies against the rubella virus to protect you. The only way to check whether the immunization has worked is to have a blood test to check for rubella antibodies. Porque congenital rubella syndrome is so important to avoid, if you are thinking about becoming pregnant for the first time, you should have a blood test to check that you are protected.”¹⁵²

Breastfeeding does not appear to be a common mode of transmission for Rubella.¹⁵³ Transmission of rubella is via coughing and sneezing.¹⁵⁴ The Measles, Mumps, and Rubella (MMR) vaccine is not contraindicated for breastfeeding.¹⁵⁵ It is theoretically possible for the rubella vaccine virus to be transmitted through breastmilk, Contudo, an infection in a term infant is without symptoms.¹⁵⁶

In the spirit of full disclosure, please discuss any illness and/or vaccination with a recipient and consult with a primary care physician.

SARS-CoV-2 (Covid-19)

The Covid-19 pandemic raises many questions with regard to human milk e feeding with (doador) leite humano. Current recommendations change regularly depending on local situations and occurrences.^{157 158}

In short
As always, follow the Four Pillars of Safe Breastmilk Sharing. Lavar as mãos com frequência, enfrentar, objetos, and surfaces that come into contact with milk before and after handling.

During Times of Social Distancing, consider:

• Donors to follow official guidelines and refrain from transporting human milk.
• Recipient to follow official guidelines and cite baby food as a vital need.

During Times of Quarantine
If a member of a donor household has been quarantined due to infection, suspected infection, or exposure, milk should not be donated.

If a member of a recipient household has been quarantined, these recipient suggestions still apply.

Destinatários
It is incumbent upon the recipient family to communicate and ensure that safety guidelines are followed to the extent needed to meet their baby’s needs. As always, use donor milk at your discretion. If your baby is immuno-compromised or has underlying health conditions, it is extremely important that you give serious consideration to the most appropriate food for your baby.

• Wash high-traffic areas in your home at least once per day.
• Wash your hands before leaving your home.
• Wash doorknobs of home and car.
• Communicate with the donor to leave donations at a safe distance from the front door.
• Place a clean towel on the seat of the car where you plan to place the milk. Do not set the milk on the floor of the car.
• Once home, use light soapy water to wipe off the bags of milk, and rinse with water.
• Store as you normally would.
• Consider pasteurizing the breastmilk using the Holder method before feeding it to the baby.¹⁵⁹
• Studies have documented complete heat inactivation of genetically similar viruses. We closely follow milk bank releases for the latest information.

Donors: 

• Wash high-traffic areas in your home at least once per day.
• Wash the baby’s hands and face prior to breastfeeding if pumping at the same time.
• Wash your breast prior to pumping.
• Wash hands and equipment prior to pumpings.
• Wash hands and equipment after pumping.
• Wash down milk bags and transport carriers (paper bags or cardboard boxes preferred).
• Wipe handles of doors and doorbells (better: text your donor upon arrival).
• Place the transport container 6ft from the door, on a clean cloth.

Until we have a greater understanding, consider: 

• Not breast/chestfeeding someone else’s child, ie wetnursing, unless this regards a live-in situation and healthy wetnurse.
• Not offering to transport/meet for milk exchange but have the recipient family pick it up outside of your house.
• Wiping down the container or bag before putting it in their car.
• Refraining from milksharing if you have any of the following symptoms: cough, difficulty breathing, chest pain, fever, flu-like symptoms such as chills, headache, and muscle aches.

If there have been no reports of Covid-19 or no social distancing has been required, consider:

• Asking if the donor has traveled to an area affected by Covid-19 within the past 4 meses.
• Asking if the donor has, directly or indirectly, been in contact with a suspected or confirmed case of Covid-19.
• Asking if the donor or recipient has any of the following symptoms: cough, difficulty breathing, chest pain, fever, flu-like symptoms such as chills, headache, and muscle aches.

Without having any evidence to the contrary and no virus having been detected in human milk, it is our current position that breastmilk-sharing during this COVID-19 pandemic can be done safely when proper procedures are used.

We trust in the informed-choice process of milk-sharing families who are dedicated to the safety of their children and we trust that community-based milksharing allows for swift action in order to flatten the curve of the COVID-19 spread. Milksharing involves fewer individual human touchpoints than formula or milk and milk-type products, even when using a delivery service.

Clinical Management
HMBANA – Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting

Sexually transmitted infections (DSTs)

While many STIs are not a contraindication to breastfeeding,¹⁶⁰ it is very important to disclose to the recipient any infections and their treatment, as well as any potential risk factors. Donors can infect expressed milk by improper handling, as can recipients. Donors should also be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks.

Human Papillomavirus (HPV), which is also an STI, is not transmitted by breastfeeding nor by expressing milk unless there is contact between vaginal/seminal fluids and the breast/nipple. Proper handwashing and expressing techniques are recommended after sexual activity.

Please also, Vejo Sífilis e Herpes. Please consult a healthcare provider if there is a reason to suspect an STI.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Sífilis

A sífilis é uma doença tratável, passado de pessoa para pessoa através do contato direto com feridas de sífilis ou por atividade sexual.¹⁶¹ A sífilis não é transmitida pelo contato com assentos sanitários, maçanetas, piscinas, banheiras quentes, banheiras, roupas compartilhadas, ou talheres.^{162 163}

Se alguém tiver um surto de sífilis ativo no peito, mamilos, ou aréolas, sugere-se que parem de amamentar. Para manter o suprimento de leite durante o tratamento de um surto de sífilis, it is recommended to express breastmilk and then discard it. After being treated and lesions have healed, é considerado seguro retomar a amamentação.

Please see a healthcare provider in case of any unfamiliar/unknown lesions and open sores and disclose any outbreaks to a recipient. Tanto as doadoras quanto as receptoras podem infectar o leite ordenhado por manuseio inadequado se tiverem sífilis. Também, Vejo DSTs para informação.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

West Nile Virus (WNV)

Infection with WNV can be without symptoms or can lead to West Nile fever or severe West Nile disease.¹⁶⁴ It is usually transmitted by mosquito bites,¹⁶⁵ and there is limited evidence of transmission through breastmilk.¹⁶⁶ According to the CDC, there is no need to routinely screen people who breastfeed or to interrupt breastfeeding if they have been diagnosed with the West Nile virus.

Consult a physician when planning on donating breastmilk, especially if to a premature and sick infant. If concerned about the West Nile virus, donors can request a simple blood test from a healthcare provider.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Tuberculosis (tb)

Someone who has active tuberculosis (tb) can breastfeed if they have received 2 weeks of appropriate anti-TB therapy. Infants can be fed expressed breastmilk during the 2-week period by someone else.¹⁶⁷ The risk of TB transmission through breastmilk is negligible and, although the most commonly used anti-TB drugs are excreted into breastmilk in small amounts, there is no evidence that this induces drug resistance.¹⁶⁸

As with most infectious diseases, by the time nursing parents present with symptoms, they have already exposed their infant to the pathogen. Cessation of breastfeeding does not prevent exposure, and may instead decrease the infant’s protection that comes through specific maternal antibodies and other protective factors found in human milk. Portanto, common maternal bacterial, fungal, and viral infections in which the mother’s health is not compromised are not contraindications to breastfeeding.¹⁶⁹

Please refer to a primary healthcare provider with more TB and breastmilk-related questions, especially with regards to past donations or becoming a donor.

Read our introduction to infectious diseases here.

Por favor, veja Como o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Marijuana

Marijuana has not been proven safe to use during breastfeeding. Data on the effects of marijuana and CBD exposure to an infant through breastfeeding are limited and conflicting.

Chemicals from marijuana can pass to your baby through breastmilk.¹⁷⁰ In addition to possible adverse effects from cannabinoids in breastmilk, smoking marijuana is not advised in the vicinity of infants because the infants may be exposed by inhaling the smoke.¹⁷¹

Possible risks of using marijuana include but are not restricted to:

• Long-term unknown exposure to Tetrahydrocannabinol (THC) in an infant since THC is stored in body fat
• Some products may contain contaminants like pesticides, heavy metals, bactérias, e fungo
• Federal and local policies can trigger the involvement of child protective agencies in the lives of families who would otherwise have no reason to interface with these agencies

Limited and variable evidence on infant development:¹⁷²

• Growth delay
• Slight and dose-dependent reduction in motor development
• Sedation in infants, leading to low tone and poor sucking

To limit potential risk to the infant, the CDC, AAP, and ACOG advise against marijuana use or marijuana-containing products in any form, including those containing CBD while breastfeeding.^{173 174 175}

It is important for the full informed choice process to disclose any marijuana consumption to a recipient family.

Also see: Drogas, medicamento, álcool, e a decisão de descartar o leite materno

Medicamento

General information on medication

Please disclose all medications, drugs, and vaccinations to recipients and discuss concerns with a healthcare provider.

A common reason for stopping breastfeeding is the use of medication by the breastfeeding parent and advice by their physician to stop nursing. No entanto, most drugs likely have no effect on milk supply or infant well-being.¹⁷⁶ When termination of breastfeeding is recommended, the risks of not breastfeeding also need to be considered.¹⁷⁷

For more information, see also Vaccines e Herbs, vitaminas, and other supplements.

Resources for medication and breastmilk:

• Breastfeeding Network (Reino Unido)
• InfantRisk Phone App
• Lactmed, a toxicology data network
• e-lactantia (Spanish)
• Lareb (Dutch)

Antidepressants (coming soon)

Immunomodulatory drugs (coming soon)

Immunosuppressant drugs (coming soon)

Insulina

Insulin is not passed into breastmilk and is considered safe¹⁷⁸ para uso durante a amamentação. A gliburida às vezes é prescrita para o tipo 2 Diabetes. Dados limitados¹⁷⁹ indicam que os níveis de gliburida no leite são insignificantes.

Aqueles com diabetes que estão amamentando e usando insulina podem amamentar seus bebês. A insulina exógena é excretada no leite materno, incluindo insulinas biossintéticas mais recentes (por exemplo., como parte, degluteco, detemir, glargina glulisina, lispro), mas a insulina é um componente normal do leite humano e pode diminuir o risco de 1 diabetes in human milk-fed infants.¹⁸⁰

Os doadores dependentes de insulina são encorajados a fazer escolhas de estilo de vida saudáveis ​​e manter uma comunicação próxima com seus profissionais de saúde.

Por favor, veja Medicamentos for more information as well.

Medicação para tireóide

Os hormônios da tireoide desempenham um papel na produção de leite materno e, assim como os hormônios da tireoide produzidos naturalmente, alguns medicamentos para a tireoide passarão para o leite materno. This is considered safe and is not contraindicated for breastfeeding.^{181 182}

Por favor, veja também Medicamento Para maiores informações.

Refer to a primary healthcare provider with any concerns regarding becoming a milk donor and disclose taking thyroid medication to potential recipients.

Nutrition

Breastmilk is perfectly designed to nourish and protect a baby. Below are just some considerations to take into account while breastfeeding.

The nutritive demands of lactation are considerably greater than those of pregnancy. No entanto, the effect that diet has on the nutritional value of breastmilk is not significant enough to warrant its replacement with artificial feeding options or animal milk. Human milk has a fairly constant composition and is only selectively affected by the diet.^{183 184}

Though a poor diet does not destroy the nutritional value of human milk, the composition can be improved by a healthy diet.¹⁸⁵

One’s health during lactation should also be taken into account. It is recommended those who are lactating eat a well-balanced diet and drink enough liquids.¹⁸⁶

For vegans and some vegetarians,¹⁸⁷ vitamin B-12 supplementation may be needed to ensure proper levels of those vitamins. General vegan pregnancy recommendations are safe while breastfeeding also.¹⁸⁸

An adequate amount of absorbable iron is also important in a vegan diet. Non-heme, the iron found in all plants is less well absorbed than heme, the iron in meat, poultry, and fish. Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron.¹⁸⁹

There are growing concerns that meat and dairy need to be consumed with discernment. Conventional farming practices can leave us with food laced with hormones and chemicals that could cause health problems in the future.¹⁹⁰ Studies on human health indicate that organic food is healthier, but eating an organic diet can be costly.^{191 192} Some foods called the ‘Dirty Dozen’ may be more important than others for avoiding chemical toxins.¹⁹³

Avoiding the consumption of trans ácidos graxos and adequate intake of essential fatty acids Omega-3 and Omega-6 are also important for healthy breastmilk and its fat content, both in quality and quantity. Maternal consumption of TFAs during lactation impairs the rate of fat metabolism in the mammary glands by increasing TFAs and decreasing the percentage of essential fatty acids in the milk, which are important for brain development, the nervous system, and future health. While the mechanisms involved are still unclear, the intake of dietary components rich in TFAs during pregnancy and lactation is known to cause cardiovascular diseases, tumors, type 2 diabetes, and inflammatory conditions, like obesity-related insulin resistance.¹⁹⁴

Assuring a healthy intake of the fatty acid DHA (O-3) is also important for the development of a baby’s brain.¹⁹⁵

One last thing to consider in regards to donating milk to a premature baby is that there is evidence that there may be a decrease in lipase activity over time in lactating parents who are malnourished.¹⁹⁶ Por favor, veja E os bebês prematuros for more information on lipase, fat absorption, and heat-treating for preterm babies.

Open sores, bolhas, bleeding cracks on the skin

Someone with chronic Hepatite C (HCV) who is having a flare-up that includes jaundice and/or develops cracked or bleeding nipples should not donate milk. This protocol should also be followed for outbreaks of Sífilis e Herpes. Even though there is no data to suggest that Hepatitis, Sífilis, Herpes, and other infectious diseases are transmitted via breastmilk itself, the risk of transmission of many infectious diseases is increased when infants are potentially exposed to blood products from open sores, bolhas, and/or cracked and bleeding skin that enter the breastmilk.

If you have lesions on a breast and/or nipples, it is recommended to not breastfeed your baby on that breast. Pump or express your milk by hand from that breast until the sore is gone. Be sure the parts of your breast pump that touch the milk do not touch the sore while pumping. If this happens, the milk should be thrown away.

Please discloseany open lesions to the recipient and see a healthcare provider if there are any concerns and/or if this is a primary outbreak. Donors should also be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks. Labeling bags of donor milk with name and date is important so that a batch of donor milk can be identified if someone develops sores and lesions. Recipients should be aware that they, too, can contaminate donor milk if they have any lesions on their bodies.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

Organ transplant (coming soon)

Pasteurização

Pasteurização caseira

When full screening is not available, estado de saúde do doador é desconhecido, or to reduce the potential risks of exposure to HIV and/or other pathogens, breastmilk can be pasteurized at home.

Pasteurização do suporte
(Longo tempo de baixa temperatura - 62,5°C/145°F para 30 minutos)

A pasteurização do suporte é considerada o padrão¹⁹⁷ para pasteurização de leite humano e de vaca. Demonstrou-se que inativa patógenos, mantendo propriedades nutritivas adequadas. No entanto, dadas suas curvas tempo-temperatura mais longas, this method damages more of the antimicrobial factors¹⁹⁸ of breastmilk than would flash pasteurization.¹⁹⁹

Este método de pasteurização pode ser feito pelos pais ou cuidadores no fogão, ou com um kit pasteurizador caseiro para leite humano. Alguns podem decidir que querem comprar pasteurizadores de nível comercial que também estão disponíveis.

Explicação de como realizar a pasteurização do Holder em casa.

Aquecimento por flash
(Tempo curto de alta temperatura - (72ºC/161,6ºF para 15 segundos)

Flash-heating is a low-tech method of pasteurizing breastmilk that was developed for those who are HIV-positive in developing countries that had no safe or affordable alternatives for feeding their infants.²⁰⁰ Estudos²⁰¹ por uma equipe de pesquisa liderada por Israel-Ballard,^{202 203 204} demonstraram que o leite materno HF inativa o HIV e 4 bactérias comuns.²⁰⁵

Explicação de como executar o método Flash-heat de pasteurização em casa.

Resfriando o leite tratado termicamente

Alimentos cozidos têm uma zona de perigo,²⁰⁶ uma faixa de temperatura de 60ºC/140ºF a 4ºC/39ºF onde as bactérias gostam de crescer. Portanto, é importante resfriar o leite rapidamente depois de aquecido. Resfriando o recipiente em água gelada)) deixando um pouco de leite muito quente por muito tempo. Por favor, saiba que nem todo vidro é adequado para aquecimento e resfriamento rápido.

Reutilizando leite tratado termicamente

No estudo sobre segurança bacteriana, K. Israel-Ballard, e outros. discutir isso depois de esfriar, flash-heat foi bem sucedido em eliminar completamente as bactérias na maioria das amostras, e impediu um crescimento substancial de até 8 h quando armazenado em temperatura ambiente.

A data, a segurança do reaquecimento do leite previamente tratado termicamente não, para nosso conhecimento, foi estudado. Deve-se notar que a maioria da literatura fala em termos de aquecimento do leite ordenhado para alimentação, mas que os pais geralmente aquecem o (descongelado) leite sob água morna corrente ou coloque-o em um recipiente em água morna por um curto período de tempo para tirar o frio dele. O aquecimento suave não deve ser considerado tratamento térmico. Para propriedades ideais do leite materno, reaquecimento (aquecimento) o leite não deve ser feito diretamente em uma panela no fogão nem em um recipiente colocado em água fervente no fogão (o que seria o tratamento térmico desnecessariamente).

O leite tratado termicamente pode ser refrigerado ou congelado seguindo protocolos comuns de segurança alimentar.²⁰⁷ Nós sugerimos, Contudo, que depois de uma primeira alimentação, leite que foi tratado termicamente não ser refrigerado e reaquecido novamente como antibacteriano propriedades podem diminuir com o aumento do manuseio.

Holder method explanation

1. Coloque o leite em garrafas de leite de vidro ou potes de conservas. Encha apenas quatro quintos para permitir a expansão do leite quando aquecido.
2. Coloque as garrafas ou frascos em um rack dentro de um grande enlatador. Encha o enlatador com água morna até que o nível da água esteja ligeiramente acima do nível do leite nos frascos.
3. Iniciar aquecimento. Mexa o leite em cada recipiente com uma colher de cabo longo para obter uma distribuição uniforme do calor. Monitore a temperatura com precisão, termômetro de haste metálica. À medida que a temperatura se aproxima de 145ºF, pare de mexer, e cubra frouxamente todos os frascos, exceto um com tampas. Cubra o frasco restante com papel alumínio. Faça um furo no centro da folha e insira o
termômetro.
4. Continue aquecendo até que a temperatura seja 145ºF ou ligeiramente acima. Ajuste o calor para manter a temperatura em 145ºF por 30 minutos. Se a qualquer momento a temperatura cair abaixo de 145ºF, reaquecer e manter a 145ºF ou acima para 30 minutos.
5. Depois 30 minutos, substituir gradualmente a água quente por água fria para resfriar o leite. Se isso não for feito gradualmente, as garrafas ou frascos podem quebrar.
6. Continue resfriando o leite até que a temperatura seja de 80ºF ou menos. A esta temperatura, água gelada pode ser usada para refrigerar. Resfrie o leite a 40ºF ou mais frio. Aperte as tampas e guarde na geladeira a 40ºF ou mais frio até usar.²⁰⁸

Flash-heating explanation

• Always wash all utensils that you will use to express and heat treat your breastmilk with clean water and soap. É melhor ferver esses utensílios após a lavagem para garantir que estejam limpos.
• Coloque todo o leite em um copo resistente ao calor (não de plástico) jarra. A quantidade de leite deve estar entre 50 ml e 150 ml. Se tiver mais leite, você pode dividir em 2 jarros.
• Coloque o pote de leite em uma panela pequena com água. Certifique-se de que a água esteja cerca de dois dedos acima do nível do leite para que todo o leite seja bem aquecido.
• Aqueça a água em fogo bem quente ou no nível mais alto do seu fogão até que ferva (quando a água tem bolhas grandes). Fique por perto porque isso deve levar apenas alguns minutos. Deixar a água ferver por muito tempo danificará alguns dos nutrientes do leite.
• Retire o pote de leite da água fervente imediatamente após a água ferver. Coloque o frasco em um recipiente com água fria, ou deixe-o descansar sozinho para esfriar até atingir a temperatura ambiente.
• Proteja o leite enquanto esfria e durante o armazenamento, colocando uma tampa limpa ou um pequeno prato sobre ele.
• Você pode alimentar seu bebê com segurança com este leite aquecido dentro de 6 horas.
• Você pode alimentar o bebê usando um copo aberto limpo. Até um bebê recém-nascido aprende rapidamente a beber de um copo. Evite usar mamadeiras e bicos. Eles são difíceis de limpar e podem deixar seu bebê doente.^{209 210}

Abaixo está Kiersten Israel-Ballard demonstrando aquecimento instantâneo no fogão.

❆✼❆

Calor instantâneo e HIV
Dados os riscos específicos para pais lactantes em países em desenvolvimento, estudos de pesquisa focados em determinar o impacto do calor instantâneo no HIV, bactérias, e elementos protetores do leite materno, such as immunoglobulins, vitaminas, and the immunoreactive proteins lactoferrin and lysozyme.

Estudos²¹¹ por uma equipe de pesquisa liderada por Israel-Ballard,^{212 213 214} demonstraram que o leite materno HF inativa o HIV e 4 bactérias comuns²¹⁵ mantendo altos níveis de vitaminas,²¹⁶ lactoferrina,²¹⁷ e imunoglobulina,²¹⁸ que são importantes para a saúde de um bebê e sua imunidade a infecções. Ver Por que o leite materno for more information on the importance of the anti-infective components of breastmilk.

Segurança do aquecimento instantâneo
Quando os pesquisadores projetaram o método flash-heat para pais lactantes em países em desenvolvimento, it was an attempt to replicate the flash-pasteurization methodology for a low-resource setting. O aquecimento flash é um processo doméstico simplificado e, como tal, não é tão controlado quanto o método real de pasteurização flash. Altitude, volumes de leite materno, volumes de água, e o erro humano pode contribuir para diferenças no processo de flash-heat. Embora os pesquisadores suponham que as temperaturas alcançadas durante o calor instantâneo tornam o leite materno seguro, it should be noted that its effectiveness to inactive all viruses and spores²¹⁹ não foi completamente pesquisado e permanece teórico.

Ao tratar o leite humano termicamente, muitas propriedades anti-infecciosas importantes são reduzidas. O método Holder afeta essas propriedades de uma maneira maior do que o aquecimento Flash. Any heat treatment deactivates lipase, uma enzima que ajuda na quebra e absorção de gorduras, e os efeitos a longo prazo da alimentação com leite tratado termicamente não foram pesquisados²²⁰ Cru (não pasteurizado), fresco (não congelado quando possível) leite humano, de um doador devidamente selecionado, e manuseado adequadamente é uma opção melhor quando disponível.

Aquecimento por flash versus pasteurização por flash

Aquecimento por flash (FH) is a low-tech method of pasteurizing human milk that was developed for HIV-positive mothers in developing countries who had no safe or affordable alternatives for feeding their infants.²²¹ Estudos²²² por uma equipe de pesquisa liderada por Israel-Ballard,^{223 224 225} demonstraram que o leite materno HF inativa o HIV e 4 bactérias comuns.²²⁶ A Organização Mundial da Saúde apóia a extração e tratamento térmico do leite daqueles que são HIV positivos para alimentação temporária durante uma emergência e quando não há outras opções seguras disponíveis.²²⁷

No entanto, o aquecimento instantâneo não deve ser confundido com a pasteurização instantânea. (PF), que é um processo comercial. Both are forms of High-Temperature Short-Time (HTST) Pasteurização, mas a pasteurização rápida requer sequipamentos especiais enquanto o aquecimento instantâneo não.²²⁸ FP envolve o aquecimento a exatamente 72ºC/161,5ºF para 15 segundos. Este processo é seguido pela indústria de laticínios e é um método de pasteurização oficialmente aceito.^{229 230} Foi demonstrado que a pasteurização instantânea do leite humano inativa bactérias, bem como certos vírus patogênicos importantes, especificamente HIV, HTLV, VHB e VHC, e CMV.²³¹

Enquanto a temperatura do leite quando FH normalmente atinge 72ºC/161,5ºF,²³² isso não é tão preciso quanto com o processo FP. Em ambiente doméstico, o tempo e a temperatura não são facilmente controlados, nem os volumes de leite e água.

Por exemplo, a temperatura do leite humano ao usar FH varia muito dependendo da altitude e pressão atmosférica. A água ferve a 100ºC/212ºF ao nível do mar, mas quanto maior a altitude, quanto mais baixo for o ponto de ebulição da água.²³³ Usar FH em casa e retirar o leite do fogo quando a água ferver nem sempre fará com que o leite atinja exatamente 72ºC/161,5ºF, a temperatura segura necessária para a pasteurização instantânea. Não sabemos como o tratamento térmico do leite a 71ºC, por exemplo, afeta a carga viral, exceto HIV (Veja abaixo).

Outro aspecto é que, ao contrário de FP onde a temperatura é mantida por 15 segundos, todo o processo de FH leva cerca de 5 minutos. Manter o leite em uma temperatura precisa por um período de tempo específico não é viável em um ambiente doméstico. Tanto a temperatura quanto o tempo são importantes, no entanto, ao pasteurizar rapidamente.

Embora a HF tenha sido pesquisada e comprovadamente desative o HIV, its effectiveness on other viruses is theoretical. Nós, como uma rede de compartilhamento de leite, não pode fazer suposições e dizer à nossa comunidade que ambos os processos fazem a mesma coisa. O HIV é destruído em baixas temperaturas (57ºC/134,5ºF) e, portanto, ferver água em qualquer lugar a qualquer momento resultará em leite quente o suficiente para desativar o vírus. Embora os resultados positivos da FH possam ser comparáveis ​​aos da FP, quando se trata dos outros vírus, mais pesquisas são necessárias para abordar isso diretamente.

Atualmente, não há evidências claras sobre se o tratamento térmico do leite materno deve ser usado como uma solução permanente.²³⁴

Para mais informações sobre alimentação infantil e HIV, por favor, veja Vírus da imunodeficiência humana (HIV) e HIV e o contexto global da alimentação infantil

Pretoria method

Pretoria pasteurization is another form of low-temperature long time (LTLT) stovetop heat-treating that has been used for breastmilk from an HIV-positive lactating parents in developing countries.²³⁵ Este método, no entanto, não mostrou ser tão eficaz quanto o aquecimento por flash.²³⁶

Pregnancy

Pregnancy is not a condition that requires the cessation of breastfeeding. No entanto, research shows that while breastfeeding during pregnancy does not cause an increased risk of miscarriage, there may be some issues with maternal anemia and lower infant birth weight. It seems that good nutrition and support are important.^{237 238}

If becoming pregnant while nursing a child, the taste of breastmilk may change and cause self-weaning. In some instances, a reduction in milk supply may occur during the second trimester.²³⁹

Some may feel uterine contractions while breastfeeding. If there is a history of miscarriage or preterm labor and you are breastfeeding an older child, talk to a healthcare provider regarding any potential concerns or signs and symptoms there may be.

Silicone breast implants

Research is limited; Contudo, there have been no recent reports of clinical problems in infants of a breastfeeding parent with silicone breast implants.^{240 241}

The surgical procedure used to place the implant might disrupt the ability to breastfeed effectively. Research, Contudo, indicates that the silicone in breast implants does not appear to pose a risk of contaminating breastmilk. There is convincing evidence that infants breastfed by those with silicone gel breast implants receive no higher silicon intakes from breastmilk than infants breastfed by those without breast implants. Infants receiving cows’ milk or commercial infant formula feedings are likely to have significantly higher silicon intakes than breastfed infants. Evidence that any likely exposure to silicon or silicone has effects on infant health is lacking.²⁴²

Storage temperatures:

Low

For long-term storage, breastmilk is best kept in freezers of -20 degrees C or colder. The basic principles of freezing dictate that frozen foods at -18C (0F) are indefinitely safe from bacterial contamination, although enzymatic processes inherent in food could persist, with possible changes in milk quality.²⁴³ Viruses such as CMV and HTLV are reduced or eliminated.²⁴⁴ Hopefully, more research will be done regarding cold temperatures as milk treatment.

See the section on CMV  e HTLV for more information about the promising effect of cold treatment of viruses.

High

Holder pasteurization and flash-pasteurizing both inactivate viruses such as HIV, HTLV, HTLV, HBV, HCV, CMV, e bactérias. Each process has a different effect on the anti-infective properties and biologically active components of human milk.

Foi demonstrado que o aquecimento por flash desativa o HIV e 4 bactérias, mantendo a maioria das propriedades anti-infecciosas, but further research is needed to assess the effect on other pathogens.

É importante notar que algumas bactérias formamesporos when exposed to heat. Bacillus cereus is such a spore-forming bacterium and has been known to cause about 2% do total de casos de intoxicação alimentar. É amplamente encontrado na natureza (solo, plantações, agua). Para mais informações consulte Bactérias.

Veja issoComo o leite materno pode ser pasteurizado em casa? Para maiores informações.

Substance Use Disorder

Those who suffer from substance use disorder (recreational and/or prescription) should not donate their milk.²⁴⁵ Someone is not a suitable donor if they use illegal drugs. Donors should disclose all drug use to recipients.

Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed.²⁴⁶

Ver Medicamento Para maiores informações.

Tear gas and pepper spray

By Dr. Angie Bond, Doutorado

What is “Tear Gas” made of?
Tear gas is actually a powder that spreads in a cloud through the air when it high-pressure canister that holds it breaks. These powders have three different formulas, but all of them are designed to work the same way.

What does it do?
The chemicals are made to send pain signals in the body and cause tightening of the throat. Crying, coughing, choking, running nose, throwing up, stomach pain, diarrhea, itching, burning, rash, and breathing problems can happen from short exposures, and long exposures can result in symptoms that last up to 10 meses.²⁴⁷ People with heart or breathing problems can have life-threatening reactions to exposure to tear gas. One kind of tear gas (CS gas) causes miscarriage and development problems for the fetus in animals and may have the same effect on humans.²⁴⁸

Can it get into breastmilk?
Tear gas chemicals work because they break down in contact with skin and mucous membranes. They are not easily absorbed into the blood. No human tests for tear gas have been done for either milk or blood, but in animals, the chemicals only last in the blood for seconds. Things that are not in the blood cannot get into milk itself, but a powder that might be on the skin can get into expressed milk or expose a baby during latched feeding. Breastfeeding or milk expression is recommended to be avoided for an hour after exposure or an hour after cleaning skin and hair to ensure all possible chemicals are gone from the blood and milk, but there is no recommendation to pump and dump.²⁴⁹ To stop accidentally exposing an infant or getting residue in milk, anyone who has been exposed should use disposable cleaning towels and cool soapy water to wash skin and hair, starting with the head and working down the body toward the feet. Clothes should be removed while wearing gloves without going over the face (cut shirts off if needed) and disposed of in plastic bags. Eyes can be rinsed with milk or sterile saline or clean water.²⁵⁰

Is it safe to share milk if the donor was exposed to tear gas?
Tear gas does not cause any known short- or long-term changes in human or animal milk. After the donor has cleaned their skin and hair, there is no known risk for contamination. Informed choice means that each family will need to decide for themselves if tear gas exposure is safe for sharing milk.

What is “Pepper Spray” made of?
Pepper spray is an oil-based spray that uses the chemical oleoresin capsicum found in chili peppers in very high concentrations mixed with rubbing alcohol or other dispersing liquids.

What does pepper spray do?
Pepper spray causes pain and swelling when it touches skin and mucous membranes. It can also cause blisters and corneal abrasions, nerve damage, bleeding problems for people on blood thinners, or allergic reactions.²⁵¹ People exposed to pepper spray most often experience itching, burning, pain, rash crying, coughing, throwing up, sensitivity to pain, numbness, and swelling of the throat. Symptoms last up to several hours, and complications can last for days to weeks.

Can it get into milk?
Oleoresin capsicum breaks down to capsaicin. Capsaicin is considered safe for use during breastfeeding as a diet supplement, food, and skin ointment. The amount of active time in the blood for capsaicin is about 25 minutos. There are reports of capsaicin in human milk after eating capsaicin, but at very low concentrations. Some infants have been reported to develop a rash after exposure to capsaicin from human milk.²⁵² It is also possible for oil residue on the skin to contaminate expressed milk, or expose an infant accidentally during latched feeding if there is still oil on the skin. To avoid accidentally exposing an infant, clothing should be removed while wearing gloves and placed into a sealed plastic bag without touching the face or genitals. Cut clothing off if necessary. Eyes should be rinsed for 20 minutes with a lot of cool water. The skin should be washed starting with the face and moving from the head down the body to the feet with water and non-oil-based soap. There is no recommended wait time to express milk or feed a baby after consuming or being exposed to capsaicin, and no recommendation to pump and dump milk.

Is it safe to share milk if the donor was exposed to pepper spray?
Capsaicin is considered safe during breastfeeding for all individuals and infants who are not allergic to capsaicin, peppers, or related plants such as tomato, potato, and paprika.²⁵³ Informed choice means that each family will need to decide for themselves if tear pepper spray exposure is safe for sharing milk.

Tobacco

The AAP encourages those who breastfeed to quit smoking. The risks of smoking include sudden infant death syndrome (SIDS), decreased fetal breathing, learning problems, respiratory disorders, and heart disease as an adult. If quitting is impossible, consider making your home and car smoke-free.²⁵⁴

Nicotine secreted into breastmilk can potentially cause severe adverse effects on a newborn and there is no knowledge of the exact period when infants develop the ability to completely metabolize nicotine. Studies found that the amount of nicotine found in breastmilk is 2.9 times greater than that found in maternal blood plasma.²⁵⁵

E-cigarettes are not an FDA-approved method to quit smoking. The inhaled nicotine of e-cigarettes still enters someone’s blood through their lungs, and then easily passes into breastmilk.^{256 257}

While smoking donors are not excluded from donating breastmilk via community milksharing it is the recipient’s personal choice whether they want to receive milk from a donor who smokes tobacco. Eats on Feets requires full disclosure of all substances used.

Donors should not smoke if their milk will be given to a premature or critically ill baby.

Viagem: (update coming soon)

By air

X-rays and backscatter scanning devices used in airports are safe for breastmilk and breastfeeding parents/caretakers. No entanto, these devices do utilize low levels of radiation, which has raised some health concerns.^{258 259 260}

X-rays used in airport screenings have no known effect on breastfeeding, leite humano, or the process of lactation. Airlines typically consider breast pumps as personal items to be carried on board, similar to laptop computers, handbags, and diaper bags.²⁶¹

Prior to departure, those who will be traveling by air and expect to have expressed milk with them during their travel need to carefully plan how they will transport the milk. Please note that airport security regulations for passengers carrying expressed milk vary internationally and are subject to change.

Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling.

Insulated cooler bag

15ºC (59ºF)

24 horas

Keep ice packs in contact with milk containers

At your destination, use the milk right away, store it in the refrigerator, or freeze it. Also see, Manuseio de Leite Doador e How can human milk be transported or shipped?

The medical preparation of a traveler who is breastfeeding differs only slightly from that of other travelers and depends in part on whether the breastfeeding parent and child will be separated or together during travel. Expressed milk is not considered a biohazard²⁶² to which Universal Precautions apply. International Air Transport Authority (IATA) regulations for shipping Category Biological Substances (UN 3373) do not apply to expressed milk; it is considered a food for individual use. Travelers shipping frozen milk should follow guidelines for shipping other frozen foods and liquids. Expressed milk does not need to be declared at US Customs upon return to the United States.²⁶³

To Cameroon, República Centro-Africana, Chade, Congo, Guiné Equatorial, Gabão, Níger, ou Nigéria

Travel to these countries increases the risk of exposure to the Human T-Lymphotropic Virus (HTLV) and possibly HIV Group O.^{264 265}

Donation of blood, tissue, or breastmilk in the U.S is not allowed after traveling to these countries, especially if a person received a blood transfusion, had unprotected sex with a local resident, or exposure to needles.

HIV, HTLV and untreated active tuberculosis²⁶⁶ are the only infectious diseases that are considered contraindications to breastfeeding in North America.^{267 268} Also see Introduction to infectious diseases.

Please see a primary care physician with any concerns.

Por favor, vejaComo o leite materno pode ser pasteurizado em casa? for more information on heat-treating and pathogens.

To various countries with regards to Creutzfeldt-Jakob Disease (CJD)

Most milk banks follow blood bank guidelines and thus milk banks in various countries may exclude people from donating breastmilk when they have traveled or spent time in certain countries because of CJD.

Em muitos países, it is common for donors to be rejected if they have spent a cumulative 3-6 meses no Reino Unido, França, ou Irlanda. Os EUA têm uma política de viagem especialmente rigorosa para doadores de sangue e/ou leite. Embora os prazos específicos permitidos para morar ou visitar determinadas áreas geográficas possam diferir ligeiramente de país para país, a preocupação é a mesma. Por favor, leia a seção sobre Doença de Creutzfeldt-Jakob (CJD) para saber como isso se aplica ou não ao compartilhamento de leite materno.

Canadá
De acordo com os serviços de sangue canadenses:²⁶⁹
Qualquer pessoa que viajou para o Reino Unido de 1980 Através dos 1996 ou para França e/ou Irlanda (República da Irlanda) a partir de 1980 Através dos 2001, não é elegível para doar se eles:

• Passou um total acumulado de três meses ou mais no Reino Unido (Reino Unido) entre janeiro 1980 e dezembro 31, 1996
• Gastou um total acumulado de 5 anos ou mais na França e/ou Irlanda (República da Irlanda) entre janeiro 1, 1980 e dezembro 31, 2001

EUA
A política da Cruz Vermelha Americana não o considera elegível para doar se:²⁷⁰

• A partir de janeiro 1, 1980, até dezembro 31, 1996, você gastou (visitou ou viveu) um tempo acumulado de 3 meses ou mais, em qualquer país do Reino Unido (Reino Unido)²⁷¹
• A partir de janeiro 1, 1980, apresentar, você teve uma transfusão de sangue em qualquer um desses países: França, Irlanda, Ilhas do Canal, Inglaterra, Ilhas Malvinas, Gibraltar, Ilha de Man, Irlanda do Norte, Escócia, País de Gales
• Você gastou (visitou ou viveu) um tempo acumulado de 5 anos ou mais a partir de janeiro 1, 1980, até dezembro 31, 2001, na França ou na Irlanda.

FORA
Uma política semelhante se aplica a potenciais doadores para o Serviço de Sangue da Cruz Vermelha Australiana, excluindo pessoas que tenham passado um período cumulativo de seis meses ou mais no Reino Unido entre 1980 e 1996 e/ou receberam transfusões de sangue no Reino Unido desde 1 Janeiro 1980.²⁷²

República Checa
Na República Checa, qualquer pessoa que tenha passado mais de seis meses no Reino Unido ou na França entre os anos 1980 e 1996 ou recebeu uma transfusão no Reino Unido após o ano 1980 não é permitido doar sangue.

Dinamarca
A Associação de Doadores de Sangue da Dinamarca exclui potenciais doadores que tenham passado um período cumulativo de pelo menos doze meses no Reino Unido entre 1 Janeiro 1980 e 31 dezembro 1996.²⁷³

Alemanha
Regulamentos semelhantes estão em vigor na Alemanha, onde qualquer pessoa que tenha passado seis meses ou mais morando no Reino Unido entre janeiro 1980 e dezembro 1996 está permanentemente excluído da doação de sangue.

Cingapura
A Cruz Vermelha de Singapura exclui potenciais doadores que tenham passado um período cumulativo de três meses ou mais no Reino Unido entre 1980 e 1996.²⁷⁴

Nova Zelândia
Na Nova Zelândia, qualquer pessoa que tenha vivido no Reino Unido, França, ou a República da Irlanda por um total de seis meses ou mais entre 1980 e 1996 não é permitido doar sangue.

Polônia
Na Polônia, qualquer pessoa que cumulativamente passou seis meses ou mais entre 1 Janeiro 1980 e 31 dezembro 1996 no Reino Unido, Irlanda, ou a França está permanentemente excluída de doar.

Suíça
O Swiss Blutspendedienst SRK exclui potenciais doadores que tenham passado um tempo cumulativo de pelo menos seis meses no Reino Unido entre 1 Janeiro 1980 e 31 dezembro 1996.²⁷⁵

Visite o site da Cruz Vermelha de um país específico para obter informações sobre, atual, e listas completas.

Vaccines

Except for the Smallpox and Yellow Fever live virus vaccines, vaccines are considered safe for breastfeeding and thus for milk donors.²⁷⁶

With regard to the Covid vaccine, there is little biological plausibility that the vaccine causes harm and antibodies to SARS-CoV-2 in milk may protect the breastfeeding child.²⁷⁷

If participating in milksharing, please disclose any recent vaccinations.

Consult with a healthcare provider with questions about vaccines and donating milk.

_______________

1. Monika A. Zielinska, Jadwiga Hamulga. 2019. Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms ↩︎
2. Hale, Thomas. Medications and Mothers’ Milk, 2012 edition. Hale Publishing, 2012: 417-419. ↩︎
3. Academia Americana de Pediatria. 2022. Amamentação e o uso de leite humano ↩︎
4. O. Spigset. 1994. Anaesthetic agents and excretion in breastmilk ↩︎
5. Erin Martin, e outros, Breastfeeding Medicine. 2018. ABM’s Protocol #15 Peripartum Analgesia and Anesthesia for the Breastfeeding Mother ↩︎
6. Medindia – Drugs used for general anesthesia ↩︎
7. Medindia – Drugs used for spinals and epidurals ↩︎
8. Deborah Anderson. Journal of Midwifery and Women’s Health. 2011. A review of systemic opioids commonly used for labor pain relief ↩︎
9. Por que o leite materno? ↩︎
10. Como o leite materno pode ser pasteurizado em casa? ↩︎
11. Aquecimento por flash ↩︎
12. Todar’s Online Textbook of Bacteriology. Bacillus cereus Food Poisoning ↩︎
13. New Zealand Food Safety Authority – Bacillus cereus ↩︎
14. Ecolab – What is Bacillus cereus? ↩︎
15. Nicholaus J. Hilliard, e outros. 2003. Bacillus cereus Bacteremia in a Preterm Neonate ↩︎
16. Médico de Família Americano RICHARD A. GUTMAN, M.D., e outros. 2015. Contraceptivos orais combinados para mães que estão amamentando ↩︎
17. Healthy Children – Birth Control and Breastfeeding Hormonal contraceptives with high doses of estrogen are more likely to decrease milk supply. ↩︎
18. LAM – The Lactational Amenorrhea Method ↩︎
19. ACOG – Fertility Awareness-Based Methods of Family Planning ↩︎
20. American Red Cross – Eligibility Criteria: Alphabetical ↩︎
21. Australian Red Cross – Eligibility Quizz ↩︎
22. Canadian Blood Services – Am I eligible to donate blood? ↩︎
23. Memorial Sloan Kettering Cancer Center – Immunizations & Vaccinations ↩︎
24. CDC - Vaccinations ↩︎
25. AAP. 2001. The Transfer of Drugs and Other Chemicals Into Human Milk ↩︎
26. Organização Mundial da Saúde. 2001. Healthy Eating during Pregnancy and Breastfeeding ↩︎
27. P. Nawrot, e outros. 2002. Effects of caffeine on human health ↩︎
28. Ficha informativa de mãe para bebê. Quimioterapia ↩︎
29. Mohrbacher and Stock. 2003. O livro de respostas da amamentação. Imprimir ↩︎
30. NIH National Cancer Institute – Lista de medicamentos contra o câncer de A a Z ↩︎
31. Camila Urbaniak, e outros. 2014. Efeito da quimioterapia na microbiota e metaboloma do leite humano, relato de caso ↩︎
32. Oeste, D. BA, IBCLC, Aleitamento Materno e Câncer, Amamentação hoje, Questão 10, 2011 ↩︎
33. Mohrbacher and Stock. 2003. O livro de respostas da amamentação. Imprimir ↩︎
34. University of California – UCSF Department of Radiology ↩︎
35. Katrina B. Mitchell. 2019. Protocolo Clínico ABM #31: Radiology and Nuclear Medicine Studies in Lactating Women ↩︎
36. Hale TW. Medications and Mothers Milk. 15th Edition. Amarillo, Texas: Hale Publishing; 2012 ↩︎
37. A list of generic names for contrast dyes and radiopaque agents can be found here and this 2011 poster as well. Kay Hoover, M Ed, IBCLC. 2011. Radio-Contrast Agents and Breastfeeding ↩︎
38. Mohrbacher and Stock. 2003. O livro de respostas da amamentação. Imprimir ↩︎
39. NHS - Donor Breast Milk Banks: The operation of donor milk bank services Milk bank screening is still mostly based on blood bank screening protocols. ↩︎
40. ACOG – Routine Tests During Pregnancy ↩︎
41. This testing does not cover all the diseases that milk banks test for and in most cases, these records will be almost one year old. ↩︎
42. American Red Cross – Eligibility Criteria: Alphabetical ↩︎
43. Australian Red Cross – Eligibility Quizz ↩︎
44. Canadian Blood Services – Am I eligible to donate blood? ↩︎
45. Direct Labs e Quest Diagnostics são 2 Apenas recursos dos EUA. Please let us know what is available in your country by emailing us so we can add this information. ↩︎
46. Associação de Bancos de Leite Humano da América do Norte. Arquivado. HMBANA|Doe Leite As diretrizes do banco de leite dos EUA são seguidas de perto por outros países. Wikipedia – Human milk bank ↩︎
47. Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study ↩︎
48. CDC - Hospital Acquired Infection Data ↩︎
49. CDC - Monitoring Hospital-Acquired Infections to Promote Patient Safety — United States, 1990-1999 ↩︎
50. Noni E MacDonald. 2016. Maternal Infectious Disease and Breastfeeding for a quick overview of infectious diseases and corresponding breastfeeding management. ↩︎
51. Robert M. Lourenço. 2020. Transmission of Infectious Diseases Through Breast Milk and Breastfeeding ↩︎
52. Ver Vírus da imunodeficiência humana (HIV) Para maiores informações ↩︎
53. Associação de Bancos de Leite Humano da América do Norte. Arquivado. HMBANA|Doe Leite excludes donors who have had a positive blood test result for HIV, HTLV, Hepatite B ou C, ou Sífilis, cujo parceiro sexual está em risco de HIV, que usam drogas ilegais, que fuma ou usa produtos de tabaco, que receberam um transplante de órgão ou tecido ou uma transfusão de sangue na última 12 mês, que regularmente têm mais de duas onças ou mais de álcool por dia, que estão no Reino Unido há mais de 3 meses ou na Europa por mais de 5 anos desde 1980 e que nasceram ou viajaram para Camarões, República da África Central, Chade, Congo, Guiné Equatorial, Gabão, Níger, ou Nigéria. ↩︎
54. CDC - Vírus da imunodeficiência humana (HIV) Note: recommendations about breastfeeding and HIV may be different in other countries ↩︎
55. AAP 2012. Amamentação e o uso de leite humano ↩︎
56. Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed. ↩︎
57. CDC - Ebola Virus Disease ↩︎
58. CDC - Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants ↩︎
59. CDC - Brucellosis ↩︎
60. NHS - Brucellosis ↩︎
61. NHS - Overview Antibiotics ↩︎
62. NHS - Oral thrush (Mouth thrush ↩︎
63. NHS - Breastfeeding and thrush) ↩︎
64. IBC – Candida Protocol ↩︎
65. Illinois DHS – Trush – Yeast infection ↩︎
66. Older studies seem to indicate that it takes the temperature to be over 70ºC/158ºF and hot ironing to completely eradicate Candida. Rashid, e outros. Carta para o editor. British Journal of Venereal Diseases. Survival of Candida albicans on fabric after laundering The authors add that this may be too impractical in a home setting and they suggest using an antifungal disinfectant in the laundry. ↩︎
67. Per University Midwifery Associates. 2005. Yeast and Breastfeeding using vinegar to inhibit the fungus to grow is another suggestion as thrush cannot thrive in acidic conditions. Adding 120–240ml (½–1 cup) of distilled white vinegar to baths and in final rinses in washing machines can help mitigate the fungus. No entanto, research shows that C. albicans can actively neutralize the environment from either acidic or alkaline pHs depending on need, which means that vinegar alone may not be enough Slavena Vylkova, e outros. 2011. The Fungal Pathogen Candida albicans Autoinduces Hyphal Morphogenesis by Raising Extracellular pH ↩︎
68. NHS - Thrush ↩︎
69. Some research indicates that microwaving may also inactivate Candida if the clothes are damp as most microorganisms are inactivated by moist heat (ie. steam) 121°C/252.5ºF for 15-30 min. Government of Canada – Pathogen Safety Data Sheets: Infectious Substances – Candida albicans ↩︎
70. Odds, 1981. Genital Candidosis ↩︎
71. Cleveland Clinic – Thrush ↩︎
72. University of California Cooperative Extension – Food Safety Basics ↩︎
73. Y. Andersson, e outros. 2000. Lactoferrin is responsible for the fungistatic effect of human milk ↩︎
74. Hashem Al-Sheikh. 2009. Effect of Lactoferrin and Iron on the Growth Human Pathogenic Candida Species ↩︎
75. Odds. 1988. 2nd Edition. Candida and Candidosis. Imprimir, p.14: The pathogenic Candida species usually die within minutes at temperatures above 50ºC although in one study C. albicans in a rich nutrient broth took 1h to die at 70ºC and it survived the temperatures within composted sewage. ↩︎
76. Mohrbacher and Stock. 2003. O livro de respostas da amamentação. Imprimir. ↩︎
77. UnityPointHealth – Yeast Infection ↩︎
78. Wambach and Spencer. 2021. Aleitamento Materno e Lactação Humana. p 544 ↩︎
79. Ver Bactérias ↩︎
80. NYS Dep. of Health – Chickenpox (varicella zoster infection) ↩︎
81. Riordan. 2005. Aleitamento Materno e Lactação Humana ↩︎
82. UNICEF – DRAFT – Infant and young child feeding briefing for Zimbabwe [during the time of cholera] ↩︎
83. UNICEF – Breastfeeding mothers in cholera treatment centers ↩︎
84. UNICEF – Infant and Young Child Feeding During Diarrhoea and Cholera ↩︎
85. UNICEF – Joint Statement: Infant And Young Child Feeding In Emergencies ↩︎
86. NIH - Creutzfeldt-Jakob Disease Fact Sheet ↩︎
87. American Red Cross – In-Depth Discussion of Variant Creutzfeld-Jakob Disease and Blood Donation These are blood bank guidelines. While there is no evidence that blood from people with sporadic CJD is infectious, studies have found that infectious prions from BSE and vCJD may accumulate in the lymph nodes (which produce white blood cells), the spleen, and the tonsils. These findings suggest that blood transfusions from people with vCJD might transmit the disease. The possibility that blood from people with vCJD may be infectious has led to a policy preventing people in the United States from donating blood if they have resided for more than 3 months in a country or countries where BSE is common. ↩︎
88. NIH - Creutzfeldt-Jakob Disease Fact Sheet ↩︎
89. CDC - Doença de Creutzfeldt-Jakob, Classic (CJD) ↩︎
90. NHS - Is CJD contagious? ↩︎
91. Public Health England – Information for people who have an increased risk of CJD ↩︎
92. Public Health Agency of Canada – Classic Creutzfeldt-Jakob Disease in Canada ↩︎
93. N. N. Damani, UMA. M. Emmerson. Manual of Infection Control Procedures. p.169. 2003. Imprimir ↩︎
94. Stagno, e outros. 1980. Breast Milk and the Risk of Cytomegalovirus Infection ↩︎
95. Catherine Peckhman. 1989. Cytomegalovirus in the neonate ↩︎
96. CDC - About Cytomegalovirus (CMV) ↩︎
97. AAP. 2012. Amamentação e o uso de leite humano ↩︎
98. Medela. 2012. Research Overview: The Transmission of Cytomegalovirus to Preterm Infants via Breastmilk: Evidence and Issues ↩︎
99. Freezing at -20ºC/4ºF for 3 days reduces the virus by 99%. Pasteurization at 63°C/145ºF for eight minutes resulted in no viable cytomegalovirus at all. Friis H, Andersen HK. 1982. Rate of inactivation of cytomegalovirus in raw banked milk during storage at -20ºC and pasteurization ↩︎
100. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
101. Prenatal testing does not screen for this virus. ↩︎
102. Rad Children’s Hospital San Diego – Breastfeeding and Hepatitis ↩︎
103. HBV is part of the HMBNA milk donor panel. HBV is quite prevalent in the US and is complex to properly diagnose.
     HHS – Viral Hepatitis in the United States: Data and Trends
     CDC - Interpretation of Hepatitis B Serologic Test Results
     Nos E.U.A, the vast majority of babies are vaccinated for HBV at birth which greatly reduces their chances of acquiring an infection. This information, coupled with the fact that transmission from breastmilk alone is undocumented makes the results of the study Revisão retrospectiva de testes sorológicos de potenciais doadoras de leite humano less of a concern for people participating in milksharing. The implications for a milk bank regarding testing expenses and logistics are different. Do ponto de vista de um banco de leite que testará as doadoras regularmente, faz sentido excluir qualquer pessoa com histórico de falsos positivos, pois o custo de buscar confirmações em todas as oportunidades de teste não é apenas proibitivo para uma organização sem fins lucrativos, também pode levar a problemas logísticos com o leite recebido da doadora. ↩︎
104. CDC - Mothers with Hepatitis B or C infections can breastfeed their infants. ↩︎
105. Sarah Reece-Stremtan, e outros. 2015. Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder ↩︎
106. CDC - Herpes Simplex Virus (HSV) ↩︎
107. ACOG – Genital Herpes ↩︎
108. AAP. 2012. Amamentação e o uso de leite humano ↩︎
109. Los Alamos National Laboratry – HIV and SIV Nomenclature ↩︎
110. CDC - Vírus da imunodeficiência humana (HIV) ↩︎
111. Word Health Organization. 2008. Module 6. Infant Feeding in the Context of HIV Infection, PMTCT– Generic Training Package Participant Manual ↩︎
112. Por que leite humano? ↩︎
113. HIV has created great confusion among healthcare workers about the relative merits of breastfeeding for the HIV-infected. Tragically this has also resulted in those who are known to be HIV uninfected or whose HIV status is unknown, adopting feeding practices that are inappropriate for their circumstances with detrimental effects on their infants. Infant feeding, even in settings where HIV is not highly prevalent, has been complicated by misguided messaging from the food industry and other groups with the result that parents and caretakers, who have every reason to breastfeed, choose not to do so based on unfounded fears. In these settings, the application of the International Code of Marketing of Breast-milk Substitutes (WHO. 2017. International Code of Marketing of Breast-Milk Substitutes) and subsequent relevant WHO Resolutions have particular importance. (Organização Mundial da Saúde. 2016. Guidelines on HIV and infant feeding) In the context of HIV and Covid-19, it becomes increasingly and urgently needed to support developing advocacy strategies that integrate rights-based, community-led, and inclusive approaches and includes breastfeeding into the universal health coverage (UHC) agenda to achieve health for all. (PITCH – UHC advocacy guide in COVID-19 context for HIV civil society and community partners ↩︎
114. NIH - HIV Testing ↩︎
115. Dentro 2010, the CDC also stated that chemicals present in breastmilk act, together with time and cold temperatures, to destroy the HIV present in expressed milk. Wouldn’t it be nice to know the time frame and to see the research on this to see how effective time and temperature really are? Destroy is a strong word, but if this is true, wouldn’t HIV-positive parents deserve to know? The transmission of HIV from an infected parent to their infant through continuous breastfeeding is 5-8%. Combined with ARV treatment and specific handling guidelines, the risks would be practically non-existent. We contacted the CDC back in 2010 about this information so we could refer to the research with no response to date, unfortunately. In fact, this line has since been removed from their list of reasons why the risk of accidental transmission is so low. ↩︎
116. “The [WHO] noted that governments of highly resourced countries in which infant and child mortality rates were low, largely due to low rates of serious infectious diseases and malnutrition, recommend that HIV-infected [parents] avoid all breastfeeding. In some of these countries, infants have been removed from [parents] who have wanted to breastfeed even when [they are] on ARV treatment. Authorities in these countries have taken the position that the pursuit of breastfeeding under these circumstances constitutes a form of abuse or neglect.” ↩︎
117. “This decision should be based on international recommendations and consideration of the: socio-economic and cultural contexts of the populations served by maternal and child health services; availability and quality of health services; local epidemiology including HIV prevalence among pregnant women; e, main causes of maternal and child under-nutrition and infant and child mortality.” ↩︎
118. “The systematic reviews also reported improved HIV-free survival in HIV-exposed infants when breastfed in similar settings, especially exclusive breastfeeding, compared with mixed feeding or replacement feeding (16–17).” ↩︎
119. Conditions needed to safely formula feed: Parents known to be HIV-infected should only give commercial infant formula milk as a replacement feed to their HIV-uninfected infants or infants who are of unknown HIV status when specific conditions are met: safe water and sanitation are assured at the household level and in the community, e, the parent or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant; e, the parent or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhea and malnutrition; and the parent or caregiver can, in the first six months, exclusively give infant formula milk; e, the family is supportive of this practice, and the parent or caregiver can access healthcare that offers comprehensive child health services. ↩︎
120. This is not specific to HIV-positive parents. ↩︎
121. Per Kiersten Israel-Ballard: “In practice, the term ‘In the interim’ unfortunately will encompass many HIV+ [lactating parents] who are waiting for ARVs.” ↩︎
122. Per ‘HIV and Infant Feeding’: “Laboratory evidence demonstrates that heat treatment of expressed breastmilk from [those infected with] HIV if correctly done, inactivates HIV. (42–44) […] Heat treatment of expressed breastmilk from [people] known to be HIV-infected could be considered as a potential approach to safely providing breastmilk to their exposed infants.” (See Grade profile 6, Annex 4.) ↩︎
123. (AAP. 2022. Amamentação e o uso de leite humano ↩︎
124. Renu B. Lal, e outros. 1993. Evidência de transmissão de mãe para filho do vírus linfotrópico T humano tipo II ↩︎
125. Yoshiro Tsuji, MD, Doutorado. 1990. Prevention of Mother-to-Child Transmission of Human T-Lymphotropic Virus Type-I ↩︎
126. Ioannis Mylonas. 2010. Infecção por HTLV e sua implicação em ginecologia e obstetrícia ↩︎
127. Carolina Rosadas e Graham P.. Taylor. 2019. Transmissão de HTLV-1 de mãe para filho: Necessidades de pesquisa não atendidas ↩︎
128. NORD – HTLV Tipo I e Tipo II ↩︎
129. Laboratórios ARUP - Testes de Vírus T-Linfotrópico Humano Tipos I e II ↩︎
130. NIH - Tipo de vírus da leucemia de células T humanas 1 ↩︎
131. NIH - Tipo de vírus da leucemia de células T humanas 2 ↩︎
132. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
133. Yoshiya Ando, e outros. 1989. Efeito do Leite Materno Congelado e Descongelado na Transmissão Vertical de HTLV-1 de Mães Soropositivas para Filhos ↩︎
134. CDC - Influenza (Flu ↩︎
135. Jack Newman, MD. How breastmilk Protects Newborns ↩︎
136. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
137. Hanson L. 2007. Feeding and infant development: breast-feeding and immune function ↩︎
138. Carlson A, e outros. 2009. H1N1 influenza in pregnancy: what all obstetric care providers ought to know ↩︎
139. CDC - Prevention and Control of Influenza ↩︎
140. – Occurs in approximately 70 para 80 percent of infected persons
     – Begins at the site of a tick bite after a delay of 3 para 30 days (average is about 7 days)
     – Expands gradually over several days reaching up to 12 inches or more (30 cm) across
     – May feel warm to the touch but is rarely itchy or painful
     – Sometimes clears as it enlarges, resulting in a target or bull’s-eye appearance
     – May appear on any area of the body
     – Does not always appear as a classic erythema migrans rash ↩︎
141. Infant Risk – Inaccurate Information Online Regarding Breastfeeding with Lyme Disease ↩︎
142. CDC - Lyme Disease ↩︎
143. Mothers’ Milk Bank Northeast – Donor Milk Safety and Screening. ↩︎
144. Linda J Kvist. 2008. The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment ↩︎
145. Katrina B. Mitchell, e outros. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 ↩︎
146. Healthy Children – Mastitis ↩︎
147. WHO. 2000. Mastitis – Causes and Management ↩︎
148. Infant Risk Center – InfantRisk Center Statement on Monkeypox: Infection, Vaccines, and Treatment for Pregnant or Breastfeeding Women ↩︎
149. CDC - Clinical Considerations for Monkeypox in People Who are Pregnant or Breastfeeding ↩︎
150. Government of Canada – Pathogen Safety Data Sheets: Infectious Substances – Rubella virus ↩︎
151. Cleveland Clinic – Vaccination During Pregnancy ↩︎
152. NHS - Rubella ↩︎
153. Riordan, janeiro. Aleitamento Materno e Lactação Humana. Sudbury: Jones and Bartlett, 2005. 167. Imprimir. ↩︎
154. CDC - Transmission ↩︎
155. CDC - Q&As About Vaccination Options for Preventing Measles, Mumps, Rubella, and Varicella ↩︎
156. CDC - Vaccination Safety for Breastfeeding Mothers) ↩︎
157. Organização Mundial de Saúde - Coronavirus disease (COVID-19): Pregnancy, childbirth and the postnatal period ↩︎
158. United States Breastfeeding Committee – Infant and Young Child Feeding in Emergencies, including COVID-19 ↩︎
159. Research shows that Holder pasteurization deactivated SARS-CoV-2. Carina Conzelmann, e outros. 2020. Holder Pasteurization Inactivates SARS-CoV-2 in Human Breast Milk ↩︎
160. Escritório de Saúde da Mulher – Sexually transmitted infections, gravidez, and breastfeeding ↩︎
161. CDC - Sífilis - Ficha informativa do CDC ↩︎
162. Escritório de Saúde da Mulher – Sífilis ↩︎
163. Um teste de triagem positivo não significa que alguém tenha uma infecção atual. Se o teste de triagem for positivo, mas o teste confirmatório for negativo, o resultado é considerado um falso positivo. Sobre 1% para 2 % da população dos EUA tem resultados falso-positivos. Resultados falso-positivos são mais comuns na gravidez e em pacientes com lúpus, HIV, endocardite, uso de drogas IV, gravidez, Doença de Lyme, certos tipos de pneumonia, malária, tuberculose, certos distúrbios autoimunes, incluindo lúpus, e até imunização recente. Mais no Centro de DST – Teste de sífilis: tipos, cronometragem, e precisão ↩︎
164. CDC - West Nile Virus ↩︎
165. CDC - Transmission ↩︎
166. CDC - Mother to Baby during Pregnancy, Delivery, or Breast Feeding ↩︎
167. Healthy Children – Serious Illnesses and Breastfeeding ↩︎
168. WHO. 2016. Guidance for national tuberculosis programmes on the management of tuberculosis in children ↩︎
169. Canadian Paediatric Society. 2006. Updated 2016. Maternal Infectious Diseases, Antimicrobial Therapy or Immunizations: Very Few Contraindications to Breastfeeding ↩︎
170. AAP - Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk ↩︎
171. NIH - Cannabis ↩︎
172. Frontiers in Psychiatry – Cannabis Use in Pregnant and Breastfeeding Women: Behavioral and Neurobiological Consequences ↩︎
173. CDC - Marijuana ↩︎
174. AAP - Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes ↩︎
175. ACOG – Marijuana Use During Pregnancy and Lactation (Reaffirmed 2021) ↩︎
176. AAP. 2001. The Transfer of Drugs and Other Chemicals Into Human Milk’ ↩︎
177. Por que leite humano? ↩︎
178. JOAN P. SPENCER, M.D., e outros. 2001. Medicamentos na mãe que amamenta ↩︎
179. NIH - Gliburida ↩︎
180. NIH - Insulina ↩︎
181. NHS - Levotiroxina e amamentação ↩︎
182. Wendy Jones. 2021. Medicação para tireóide (sob e sobre-ativo) e Aleitamento Materno ↩︎
183. Mary Frances Picciano. 2003. Pregnancy and Lactation: Physiological Adjustments, Nutritional Requirements and the Role of Dietary Supplements ↩︎
184. Susana Ares Seguraa. 2003. The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements? ↩︎
185. Lindsay H Allen. 2005. Multiple micronutrients in pregnancy and lactation: an overview ↩︎
186. Victoria State Government Dept. of Health – Water – a vital nutrient ↩︎
187. Types of vegetarian diets:
     – Lactovegetarian: This diet includes dairy products in addition to the foods listed below in the vegan diet. Meat, poultry, fish, and eggs are excluded from the diet
     – Lacto-ovovegetarian: This diet includes dairy products and eggs in addition to the foods listed below in the vegan diet. Meat, poultry, and fish are excluded from the diet.
     – Pescatarian: This diet includes dairy products and eggs in addition to the foods listed below in the vegan diet. Meat and poultry are excluded from the diet, but fish is permitted, focusing on the fattier omega-3 rich varieties.
     – The vegan diet includes fruits, vegetables, beans, grains, seeds, and nuts. All animal sources of protein —including meat, poultry, fish, eggs, leite, cheese, and other dairy products — are excluded from the diet. ↩︎
188. Reed Mangels, Doutorado, RD. Simply Vegan, 5th Edition 2013. Pregnancy and the Vegan Diet ↩︎
189. Reed Mangels, Doutorado, RD. 2018. Iron in the Vegan Diet ↩︎
190. Amanda Barrett. 2014. The Controversy over Added Hormones in Meat and Dairy ↩︎
191. European Parliament. 2016. Human health implications of organic food and organic agriculture ↩︎
192. An option is getting involved in community gardens and/or buying from local farmers’ markets. Check out what resources are in your area. ↩︎
193. Organic.org – The Dirty Dozen ↩︎
194. Emilio Herrera & Maria Pilar Ramos. 2008. Long-term effects of trans fatty acid intake during pregnancy and lactation: does it have deleterious consequences? ↩︎
195. Sheila M. Innis. 2008. Human milk: maternal dietary lipids and infant development ↩︎
196. Lourenço, Ruth. Amamentação, Um guia para a profissão médica. 6th edition. 2005. p.158. Imprimir. ↩︎
197. Kim Updegrove, MSN, MPH, APRN, CNM, e outros. 2020. Normas HMBANA para Banco de Leite Humano Doador: Uma visão geral ↩︎
198. Douglas B. Tully, e outros. 2001. Leite Doador: O que está nele e o que não está ↩︎
199. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
200. Por favor, veja Vírus da imunodeficiência humana (HIV) e HIV e o contexto global da alimentação infantil Para maiores informações. ↩︎
201. HIV no leite materno é morto por aquecimento instantâneo ↩︎
202. Inseto N. N. Mbuya, e outros. 2010. O tratamento térmico do leite materno extraído é uma opção viável para alimentação exposta ao HIV, Crianças não infectadas após 6 Meses de idade na zona rural do Zimbábue ↩︎
203. Kiersten Israel-Ballard, MPH, e outros. 2007. Inativação por calor instantâneo do HIV-1 no leite humano ↩︎
204. Carta para o editor. Mylene L. Volk, EM, Carlos V. Hanson, Doutorado, Kiersten Israel-Ballard, Doutorado, Caroline J. Capela, MD. J Adquirir Síndrome de Déficit Imunológico. Volume 53, Número 5, abril 15, 2010. Inativação do HIV-1 Associado a Células e Livre de Células por Tratamento Térmico Flash do Leite Materno ↩︎
205. K. Israel-Ballard, e outros. 2006. Segurança bacteriana do leite materno expresso aquecido e não aquecido durante o armazenamento ↩︎
206. Condado do Rei - Segurança alimentar na cozinha da sua casa ↩︎
207. FoodSafety.gov – Mantenha os alimentos seguros ↩︎
208. Ohio State University Extension Sheet. Arquivado. Preservando Bebidas: Água, Suco, e Leite O método de aquecer o leite a 62-63ºC/145ºF e mantê-lo lá por 30 minutos é o método Holder ou Batch de pasteurização, o padrão para leite humano e de vaca pasteurização. ↩︎
209. Fonte desconhecida – Como você pode tratar com segurança o leite materno ↩︎
210. Para mais informações sobre alimentação com copo, por favor, veja Como dar o leite ao meu bebê? ↩︎
211. UCBerkelyNews – HIV no leite materno é morto por aquecimento instantâneo ↩︎
212. Inseto N. N. Mbuya, e outros. 2010. O tratamento térmico do leite materno extraído é uma opção viável para alimentação exposta ao HIV, Crianças não infectadas após 6 Meses de idade na zona rural do Zimbábue ↩︎
213. Kiersten Israel-Ballard, MPH, e outros. 2007. Inativação por calor instantâneo do HIV-1 no leite humano ↩︎
214. Carta para o editor. Mylene L. Volk, EM, Carlos V. Hanson, Doutorado, Kiersten Israel-Ballard, Doutorado, Caroline J. Capela, MD. J Adquirir Síndrome de Déficit Imunológico. Volume 53, Número 5, abril 15, 2010. Inativação do HIV-1 Associado a Células e Livre de Células por Tratamento Térmico Flash do Leite Materno ↩︎
215. K. Israel-Ballard, e outros. 2006. Segurança bacteriana do leite materno expresso aquecido e não aquecido durante o armazenamento ↩︎
216. Kiersten Israel-Ballard, e outros. 2008. Conteúdo vitamínico do leite materno de mães infectadas pelo HIV-1 antes e depois do tratamento com calor instantâneo ↩︎
217. Kiersten Israel-Ballard, MPH, e outros. 2007. Inativação por calor instantâneo do HIV-1 no leite humano ↩︎
218. Caroline J. Capela, e outros. 2009. Efeito do tratamento com calor instantâneo nas imunoglobulinas no leite materno. ↩︎
219. Por favor, veja Bactérias Para maiores informações. ↩︎
220. Veja também ‘E os bebês prematuros? ↩︎
221. Os termos aquecimento rápido e pasteurização rápida são frequentemente usados ​​de forma intercambiável. O aquecimento instantâneo refere-se ao método caseiro de pasteurização, conforme demonstrado nos estudos de Kiersten Ballard-Israel. Por favor, veja Explicação do aquecimento flash para obter informações sobre como isso é feito. ↩︎
222. UCBerkelyNews – HIV no leite materno é morto por aquecimento instantâneo ↩︎
223. Inseto N. N. Mbuya, e outros. 2010. O tratamento térmico do leite materno extraído é uma opção viável para alimentação exposta ao HIV, Crianças não infectadas após 6 Meses de idade na zona rural do Zimbábue ↩︎
224. Kiersten Israel-Ballard, MPH, e outros. 2007. Inativação por calor instantâneo do HIV-1 no leite humano ↩︎
225. Carta para o editor. Mylene L. Volk, EM, Carlos V. Hanson, Doutorado, Kiersten Israel-Ballard, Doutorado, Caroline J. Capela, MD. J Adquirir Síndrome de Déficit Imunológico. Volume 53, Número 5, abril 15, 2010. Inativação do HIV-1 Associado a Células e Livre de Células por Tratamento Térmico Flash do Leite Materno ↩︎
226. K. Israel-Ballard, e outros. 2006. Segurança bacteriana do leite materno expresso aquecido e não aquecido durante o armazenamento ↩︎
227. Organização Mundial da Saúde. 2016. Diretriz. Atualizações sobre HIV e alimentação infantil ↩︎
228. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
229. FDA - GUIA PARA INSPEÇÕES DE FABRICANTES DE LÁCTEOS ↩︎
230. A pasteurização legal é uma combinação de tempo e temperatura de acordo com o 2017 FDA - Portaria de Leite Pasteurizado Grau A item 16p Seção de procedimentos administrativos 1. ↩︎
231. Fokke G. Terpstra, e outros. 2007. Efeito antimicrobiano e antiviral de curto prazo de alta temperatura (HTST) Pasteurização Aplicada ao Leite Humano ↩︎
232. Kiersten Israel-Ballard. 2007. Inativação por calor instantâneo do HIV-1 no leite humano O aquecimento instantâneo normalmente atinge temperaturas superiores a 56Cº para 6 minutos 15 segundos e atingiu o pico de 72,9C.º ↩︎
233. Programa de Segurança Alimentar de Manitoba. Guia de calibração do termômetro Os termômetros precisam ser calibrados quando usados ​​em altitudes mais altas, se for necessário medir com precisão a temperatura do leite. ↩︎
234. Organização Mundial da Saúde. 2016. Diretriz. Atualizações sobre HIV e alimentação infantil Aqueles que são HIV positivos podem considerar a extração e o tratamento térmico do leite materno como uma estratégia de alimentação temporária nas seguintes circunstâncias: Em circunstâncias especiais, como quando a criança nasce com baixo peso ao nascer ou está doente no período neonatal e incapaz de amamentar; Quando a lactante ou cuidadora não está bem e temporariamente incapaz de amamentar ou tem um problema temporário de saúde da mama, como mastite; Para ajudar os pais lactantes e cuidadores a interromper a amamentação; Se os medicamentos antirretrovirais não estiverem temporariamente disponíveis. ↩︎
235. B. S. Jeffery, K. G. Mercer. 2000. Pasteurização de Pretória: Um método potencial para a redução da transmissão materno-infantil pós-natal do vírus da imunodeficiência humana ↩︎
236. Kiersten Israel-Ballard, e outros. 2005. Viral, Nutricional, e Segurança Bacteriana do Leite Materno Aquecido por Flash e Pasteurizado de Pretória para Prevenir a Transmissão do HIV de Mãe para Filho em Países com Pobres de Recursos ↩︎
237. Farah Madarshahian and Mohsen Hassanabadi. 2012. A Comparative Study of Breastfeeding During Pregnancy: Impact on Maternal and Newborn Outcomes ↩︎
238. (O.M. Shaaban, e outros. 2015. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study ↩︎
239. Healthy Children – Nursing During Pregnancy ↩︎
240. CDC - Breast Surgery ↩︎
241. AAP. 2001. The Transfer of Drugs and Other Chemicals into Human Milk ↩︎
242. Stuart Bondurant, e outros. 1999. The Safety of Silicone Breast Implants (página 251) ↩︎
243. Protocolo Clínico ABM #8: Informações de armazenamento de leite humano para uso doméstico para bebês a termo ↩︎
244. Dr.. John May, e outros. 2005. Mesas La Trobe ↩︎
245. Associação de Bancos de Leite Humano da América do Norte. Arquivado. HMBANA|Doe Leite ↩︎
246. CDC - Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants ↩︎
247. Karagama et al., 2003 ↩︎
248. Physicians for Human Rights – Chemical Irritants ↩︎
249. Rothenberg, 2016 – Tear gas: an epidemiological and mechanistic reassessment ↩︎
250. Center for Health Protection, Hong Kong – Health Information on Tear Gas ↩︎
251. National Collaborating Health Centre for Environmental Health, Canada – Pepper spray in the indoor environment and in the vicinity of food products and preparation surfaces ↩︎
252. LactMed –Capsaicin ↩︎
253. LactMed – Capsicum ↩︎
254. Healthy Children – How to Quit: When the Smoker is You ↩︎
255. Cândida Caniçali Primo1, e outros. 2013. Effects of maternal nicotine on breastfeeding infants ↩︎
256. Brian P. Jenssen, MD, MSHP, FAAP, e outros. 2019. E-Cigarettes and Similar Devices ↩︎
257. CDC – Tobacco and E-Cigarettes ↩︎
258. John Sedat. Department of Biochemistry and Biophysics. 2010. Letter of Concern ↩︎
259. TSA – Security Screening ↩︎
260. HPS – Pregnancy and Security Screening ↩︎
261. CDC - Traveler’s Health ↩︎
262. Is Breastmilk a Biohazard? ↩︎
263. Erica H. Anstey, Katherine R. Shealy. CDC Yellow Book. Chapter 7. Viagem & Amamentação ↩︎
264. Human T-Lymphotropic Virus (HTLV) ↩︎
265. HIV Sequence Database – HIV and SIV Nomenclature ↩︎
266. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and TB disease. ↩︎
267. CDC - Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infant ↩︎
268. Associação de Bancos de Leite Humano da América do Norte. Arquivado. HMBANA|Doe Leite Milk banks exclude donors who have had a positive blood test result for HIV, HTLV, Hepatite B ou C, ou Sífilis, cujo parceiro sexual está em risco de HIV, que usam drogas ilegais, que fuma ou usa produtos de tabaco, que receberam um transplante de órgão ou tecido ou uma transfusão de sangue na última 12 mês, que regularmente têm mais de duas onças ou mais de álcool por dia, que estão no Reino Unido há mais de 3 meses ou na Europa por mais de 5 anos desde 1980 e que nasceram ou viajaram para Camarões, República da África Central, Chade, Congo, Guiné Equatorial, Gabão, Níger, ou Nigéria. ↩︎
269. serviços de sangue canadenses - Viagem ↩︎
270. Política da Cruz Vermelha Americana – Material de referência de elegibilidade ↩︎
271. Ilhas do Canal, Inglaterra, Ilhas Malvinas, Gibraltar, Ilha de Man, Irlanda do Norte, Escócia, País de Gales ↩︎
272. Sangue da Cruz Vermelha Australiana – Formulário de doação após viagem ↩︎
273. Os doadores de sangue Dinamarca ↩︎
274. Autoridade de Ciências da Saúde - Posso doar sangue ↩︎
275. Doação de sangue SRC Suíça – QUEM PODE DOAR SANGUE? ↩︎
276. CDC - Vaccinations ↩︎
277. ABM STATEMENT. 2020. Considerations for COVID-19 Vaccination in Lactation ↩︎