Psychotropic Medication Exposure via Breast Milk: A Population-Based Descriptive Study in Denmark

Background: 

There is limited data on the extent of psychotropic medication exposure through breast milk in infants. This information is essential for identifying research gaps and informing clinical practice. 

Objectives: 

To examine the prevalence and trend of psychotropic medication exposure among exclusively breastfed infants. 

Methods: 

A population-based descriptive study among exclusively breastfed infants during 2012–2022, using Danish nationwide registers. Psychotropic prescriptions (Anatomical Therapeutic Chemical Classification System codes N05–N06) filled by mothers during the recorded breastfeeding period were identified in the Prescription Registry. We calculated the prevalence of potential exposure to any psychotropic medication (expressed per 1000 infants), categorised by drug class and stratified by maternal demographic and clinical factors. 

Results: 

Among 446,573 exclusively breastfed infants, 7882 (17.6 per 1000 infants, 95% confidence interval [CI] 17.2, 18.1) were exposed to at least one, and 699 (1.6 per 1000 infants, 95% CI 1.5, 1.7) to two different psychotropic medications via breastfeeding. The most frequent exposure was antidepressants, with a prevalence of 15.0 per 1000 infants (95% CI 14.6, 15.4), primarily sertraline. This was followed by hypnotics and sedatives, at 1.3 per 1000 infants (95% CI 1.2, 1.4), predominantly zopiclone, and antipsychotics, at 1.1 per 1000 infants (95% CI 1.0, 1.2), mainly quetiapine. Psychotropic medication exposure in exclusively breastfed infants increased 1.39-fold, from 15.7 per 1000 infants (95% CI 14.5, 17.1) in 2012 to 21.8 per 1000 infants (95% CI 20.3, 23.4) in 2022. This increase was observed for all drug classes except anxiolytics. The prevalence of psychotropic medication exposure varied by maternal demographic and clinical factors. 

Conclusions: 

Approximately 2% of exclusively breastfed infants are potentially exposed to psychotropic medications through breast milk in Denmark. The prevalence has shown an upward trend over time, especially for psychostimulants.