IBCLC Detailed Content Outline: Pharmacology and Toxicology Focused CERPs - Section IV
Access CERPs on Pharmacology and Toxicology for the IBCLC Detailed Content Outline recertification requirements. Enjoy convenient on-demand viewing of the latest Pharmacology and Toxicology focused IBCLC CERPs at your own pace.
Cannabis Use During Lactation: Evidence-Based and Parent Centred Care
Treasure McGuire,
PhD, BSc, BPharm, GradDipClinHospPharm Adv Prac Pharm, GCHEd, CertIVTAE, FACP, FPS
Associate Professor Treasure McGuire is a clinical pharmacist, educator, and researcher. She holds two senior appointments in her hospital role (as Assistant Director of Pharmacy, Practice and Development, Mater Health Brisbane) with 1) Bond University Medical School (as Associate Professor of Pharmacology and 2) The University of Queensland School of Pharmacy (as Associate Professor, Clinical). She is passionate about improving the consumer voice and health outcomes for mothers and babies through the development and access to more effective and safer approaches towards medicines use.
Treasure’s research is translational and evidence-based, focusing on patient centred-care and quality use of medicines in women’s and newborn health, medicines information, medication safety and complementary medicines. She has published widely and authored the chapter on Safe use of drugs while breastfeeding In Brodribb W, ed. Breastfeeding management in Australia, 5th ed, Melbourne: Australian Breastfeeding Association, 2019. She is a regular invited speaker at national and international conferences, with over 60 keynote addresses. In recognition of her services to medicines information, she received the Lilly International Fellowship in Hospital Pharmacy. In 2015, she was the recipient of the Sr Eileen Pollard Medal (Mater Research-UQ) for excellence in incorporating research into clinical care provision.
Treasure McGuire,
PhD, BSc, BPharm, GradDipClinHospPharm Adv Prac Pharm, GCHEd, CertIVTAE, FACP, FPS
Cannabis is the most consumed psychoactive drug, with global estimated use approaching 200,000 million people. Legalization in different countries, together with apparent safety perception, has led to increased cannabis use by up to 5% of pregnant and breastfeeding women. This presents significant challenges for health professionals who promote breastfeeding. As central nervous system drugs need to be sufficiently lipophilic to pass the blood brain barrier, there will be extensive cannabis passage into lipophilic breast milk. Pre- and post-natal exposure is likely to impact not only on the mother but may also induce neurobiological alterations in the infant that persist beyond the first 1000 days of life. This presentation will take an evidence-based approach to outline the pharmacology, potential benefits, and risks of the main cannabinoids (THC and CBD) used in their various dose forms (ingested oils, topical gels or inhalation of buds by pipe or vaporizer). It will focus on the available evidence, potential consequences, and considerations when cannabis is used in lactation. Regardless of personal opinion, it is imperative that women feel comfortable to ask questions of their primary health care professionals about cannabis use or misuse while breastfeeding, to promote harm minimization.
View Details / Enroll
Joke graduated as a Midwife in 2006 and a Master in Midwifery in 2008. She obtained the IBCLC lactation consultant degree in 2011. She graduated in specialised applied pharmacology in 2015. She has experience as midwife and lactation consultant in her own primary care practice, lecturer at the University College Brussels, head editor of the Flemish Journal of Midwifery and board member of the Flemish Organisation of midwives and ELACTA. At the moment Joke is also a researcher on COVID-19 vaccination during lactation at the University of Brussels.
Topic: Ready-Made Educational Breastfeeding Material to Improve Parental Education and Empower Parents. - [View Abstract]
Breastfeeding parents will encounter the SARS-CoV-2 virus and may contract COVID-19. The availability of new vaccines against COVID-19 created a need for guidance about vaccination during lactation. We aim to get an insight into the effects of COVID-19 vaccines during the lactation period. This entails the safety of vaccination during lactation, the immune response in lactating women and the excretion of immunological factors in breastmilk. Not a lot is known about the transfer of immunoglobulin A (IgA) and the mechanisms by which these antibodies provide protection to the neonate via breast milk. This presentation contributes to the knowledge of SARS-COV-2 infections and the use of different vaccine-platforms during breastfeeding and will benefit the population with respect to public health. As vaccination during lactation could result in clinically relevant sIgA-titers in breastmilk and protecting the child in early life, it is of importance that women have this information to decide whether to take the vaccine.
Decision Making and Psychiatric Medications in Pregnancy and Lactation
Rebecca Feldman is Certified Nurse Midwife, and Psychiatric Nurse Practitioner who practices in a dual role in the field of reproductive psychiatry. She is the founder and director of Brooklyn Parent Support, a group mental health practice providing group and individual therapy and medication management. Rebecca is a graduate of Frontier Nursing University in midwifery, and New York University with a Post Master’s in Psychiatric Nursing. She has practiced perinatal psychiatry at the Motherhood Center of New York, and Zucker Hillside Hospital. As a midwife, she created a mental health program housed within the Department of Obstetrics and Gynecology at Woodhull Medical Center, a large public hospital in Brooklyn. She is currently an adjunct professor at New York University, providing lectures to the midwifery and psychiatric nurse practitioner programs. A frequent guest speaker on the topic of promoting access to parental mental health care, she has recently presented for the American College of Nurse-Midwives, the National Perinatal Association, and Postpartum Support International.
Perinatal mood and anxiety disorders are the most common complication of pregnancy. Midwives have a key role to play in assisting clients with decision making around use of psychiatric medications in pregnancy and lactation. This presentation will explore client considerations around mental health in pregnancy and postpartum, including the risks of untreated mental illness in these life phases. How midwives may counsel their clients as well as when to refer them for mental health care, will be an additional element of this presentation.
Common Post-partum Mood and Anxiety Disorders will be described in detail as well as a summary of evidence-based treatment options. Following this part of the presentation, the main classes of psychiatric medications commonly used in pregnancy and lactation will be described. Considerations for the use of SSRIs, atypical antipsychotics, mood stabilizers and benzodiazepines will be discussed.
View Details / Enroll
Ying-Tang Ng is an Assistant Professor in the Department of Pharmacy Practice at Husson University School of Pharmacy in Bangor, Maine. She received her Doctor of Pharmacy degree from Wingate University School of Pharmacy in Wingate, NC. Post graduation, Dr. Ng completed her pharmacy practice residency at Wolfson Children’s Hospital in Jacksonville, FL and pediatric specialty residency at Texas Tech University School of Pharmacy in Amarillo, TX. Prior to joining Husson University, Dr. Ng practiced at New Hanover Regional Medical Center in Wilmington, NC as a clinical pharmacist and at Children’s Hospital of Michigan (CHM) in Detroit, MI as a clinical pharmacy specialist in the Neonatal Intensive Care Unit (NICU). At CHM, Dr. Ng also served as the Post-Graduate-Year (PGY-1) residency coordinator for 1st-year residents. Dr. Ng is a Board Certified Pediatric Pharmacotherapy Specialist. She is currently an active member of the American College of Clinical Pharmacy (ACCP) and the Pediatric Pharmacy Advocacy Group (PPAG).
Extracorporeal Membrane Oxygenation (ECMO) provides support to neonates with cardiac and/or respiratory failure despite all other conventional management therapies. Neonates on ECMO are management on a variety of medication therapy including anticoagulation and antimicrobial therapy. Due to the nature of the ECMO circuit, pharmacokinetic properties of medications change which can make pharmacotherapy management challenging. Understanding these difference and changes will help maximize medication therapy in this vulnerable population.
Rania Abdou is a Pediatrics and neonatology consultant at Faculty of medicine, Ain shams university where she teaches Pediatrics and neonatology courses. She earned a Diploma in the clinical nutrition from the European society for clinical nutrition and metabolism. Dr. Rania is also a certified international lactation consultant since 2013. She has dedicated much of her time to the improvement of breastfeeding practice between Egyptian women. Previously, she worked as a clinical director of the neonatal intensive care unit of ain shams university pediatric hospital and vice-director of the pediatrics department at the ain shams specialized university hospital.
The commonest reason of interrupted exclusive breastfeeding is assumption of insufficient breastmilk. Fenugreek has been traditionally used by Egyptian women to increase milk supplementation. However, this practice has not been scientifically evaluated yet. We elucidated fenugreek-tea effect on expressed breast milk quantity by a Comparative study on 2 groups of healthy mothers according to fenugreek consumption whom baby was admitted to Ain shams University NICU for more than 2 weeks and expressed breastmilk using manual breast pump divided into. Results showed earlier increase in mean breastmilk-volume in fenugreek group. Significant difference of pumped breastmilk quantity between groups at day 3 & 8 where fenugreek group showed higher volume yet at day 15 the net daily volume showed no significant difference between both groups. We concluded that fenugreek consumption may affect earlier stages of lactogenesis so can be used for satisfaction and reassurance in those stages.
View Details / Enroll
Empowering Breastfeeding in Women Receiving Medication-Assisted Treatment for Opioid Use Disorder: A Call for Policy Change
Dr. Kelly McGlothen-Bell is an Assistant Professor at UT Health San Antonio, School of Nursing. As a nurse scientist, Dr. McGlothen-Bell is dedicated to understanding and resolving perinatal-infant health disparities in underrepresented groups, particularly among mother-infant dyads impacted by substance use disorders and preterm births. Dr. McGlothen-Bell uses interdisciplinary research, bio-behavioral methodologies, and community-engaged strategies to define and explore health priorities that can be remedied through culturally appropriate and sustainable health solutions. Her program of science focuses on understanding the relationship between infant feeding behaviors and readiness in high-risk infants and attunement between the primary caregiver and child during infancy and toddlerhood. The culmination of these findings contributes to the development of evidence-based interventions geared toward improving parental engagement and pediatric feeding success in marginalized populations. Dr. McGlothen-Bell has published numerous peer-reviewed articles related to developmental strategies for high-risk infants. She has also presented her work at conferences nationally and internationally. Dr. McGlothen-Bell has received numerous awards to include the 2019 National Association of Neonatal Nurses (NANN) Mentee/Mentor Grant Award. She was also selected as a 2019-2020 Academy Jonas Nurse Policy Scholar.
Topic: Feeding Behaviors in the Opioid Exposed Infant - [View Abstract]
Inequitable access to mother's milk often disempowers those who may benefit the most from it's' benefits. Moreover, suboptimal breastfeeding has the potential to negatively impact the health and well-being of future generations to come. Mother's own milk is internationally accepted as the most optimal source of nutrition for infants, yet breastfeeding initiation and duration rates among minority populations (i.e., women with opioid use disorders [OUDs]) continue to lag significantly behind that of the general population. The implications of the current U.S. opioid crisis and its increasing influence on women of reproductive age presents important considerations for the ways women and infants may receive inequitable access to breastfeeding and the benefits of mother's milk. In this presentation, learn the keys needed to empower lactation support providers to advocate for the use of scientific evidence that informs breastfeeding practices for women receiving MAT for OUD.
View Details / Enroll
Epilepsy in Pregnancy: Reducing Risks with a Multiprofessional Healthcare Team
Kim is an advanced clinical practitioner, independent nurse prescriber, registered nurse and registered midwife with additional qualifications in epilepsy, complex pregnancies, child protection, pharmacology, advanced decision making, epidemiology, diagnosis and history taking and research. She is a specialist in antiepileptic drug prescribing management & all aspects of reducing the impact of epilepsy. Since 2000, she has conducted a women with epilepsy service which provides holistic care and treatment support from teenage years to motherhood. In addition, she established and ran for 7 years a thriving community epilepsy specialist nursing service for Southampton and since 2017, a new rapidly expanding secondary care service for Winchester. Kim designed the maternity epilepsy toolkit embedded in the SUDEP (sudden unexpected death in epilepsy) Action professional checklist and focuses professionally and academically on safety and reducing the risk of avoidable adverse outcomes. She is an MBRRACE assessor and represents the Royal College of Midwives on behalf of midwives on the valproate stakeholders committee.
Epilepsy is a pre-existing, neurological disease present in 0.3%-0.5% of all pregnancies and is associated with increased risks of morbidity and mortality during the pregnancy continuum. These risks are often determined long before conception. This is because epilepsy and its treatment can impact on: education, employment, safety, menstruation, sexuality, fertility, contraception, pregnancy, breastfeeding, parenting, bone health, mental health, quality of life, driving status and independence. This trajectory and the quality of care received during the epilepsy journey can influence pregnancy presentation and outcome. The extremes can be a woman who has received expert epilepsy care and preconception preparation to ensure the risks were minimized when embarking on a planned pregnancy versus a woman who presents with an unplanned pregnancy having received no counselling, no epilepsy specialist care, prescribed a medication that is high risk to a developing baby whilst having uncontrolled seizures. These extremes highlight the need for maternity healthcare professionals to have awareness about the potential health burden associated with epilepsy, knowledge about seizure presentation and management, information about epilepsy treatments and understanding about potential risks to the women and her developing baby and how to reduce risks during pregnancy through joined-up, holistic, multi-professional healthcare provision.
View Details / Enroll
Professor Lisa Amir is a general practitioner and has been an International Board Certified Lactation Consultant since 1989. She is the author of over 120 peer-reviewed articles on breastfeeding. She works in breastfeeding medicine at The Royal Women’s Hospital in Melbourne, Australia. She is a Principal Research Fellow at Judith Lumley Centre, La Trobe University and is the Editor-in-Chief of the open access journal, International Breastfeeding Journal.
Topic: Ethical Issues in the Use of Medications During Lactation - [View Abstract]
Topic: Taking a Lactation History: From Pregnancy to Postpartum and Beyond - [View Abstract]
Topic: Urban Design Solutions to Support Breastfeeding in Public - [View Abstract]
Public health ethics relates to moral implications of activities aimed at maintaining and improving population health. Public health researchers embrace participation of affected populations in all stages of research from design to translation. In the past, pharmaceutical companies have avoided the issue of women’s reproductive life and excluded pregnant and breastfeeding women from the drug development process and then advised prescribers to avoid their medications in pregnancy and lactation. Therefore, when clinicians need to prescribe medications during lactation, they do this off-label, often without evidence or guidance regarding optimal dosing or treatment recommendations. Application of the concept of equity should ensure that all groups, including breastfeeding parents, are not neglected and receive directly targeted interventions to improve their health outcomes. The ethical frame which routinely excluded participants who may be pregnant or lactating from clinical trials, is now being turned around to recognise that these groups have the right to be included.
Dr. Kelly McGlothen-Bell is an Assistant Professor at UT Health San Antonio, School of Nursing. As a nurse scientist, Dr. McGlothen-Bell is dedicated to understanding and resolving perinatal-infant health disparities in underrepresented groups, particularly among mother-infant dyads impacted by substance use disorders and preterm births. Dr. McGlothen-Bell uses interdisciplinary research, bio-behavioral methodologies, and community-engaged strategies to define and explore health priorities that can be remedied through culturally appropriate and sustainable health solutions. Her program of science focuses on understanding the relationship between infant feeding behaviors and readiness in high-risk infants and attunement between the primary caregiver and child during infancy and toddlerhood. The culmination of these findings contributes to the development of evidence-based interventions geared toward improving parental engagement and pediatric feeding success in marginalized populations. Dr. McGlothen-Bell has published numerous peer-reviewed articles related to developmental strategies for high-risk infants. She has also presented her work at conferences nationally and internationally. Dr. McGlothen-Bell has received numerous awards to include the 2019 National Association of Neonatal Nurses (NANN) Mentee/Mentor Grant Award. She was also selected as a 2019-2020 Academy Jonas Nurse Policy Scholar.
Topic: Feeding Behaviors in the Opioid Exposed Infant - [View Abstract]
As national rates of opioid use disorder continue to rise, the resulting impact on pregnant and parenting women and their children is immense. Severity of the central nervous system and gastrointestinal irritability in infants following prenatal opioid exposure, can affect their feeding behaviors and subsequently the caregiver-infant relationship. Feeding is a regulatory process that is difficult to characterize in prenatally opioid-exposed infants. As a result, caregivers, most often the mother, may struggle with feeding their infants. The complexity of an opioid use disorder for the mother and the subsequent opioid withdrawal of the infant may impede a mother’s ability to engage her irritable or sleepy baby.
Despite the known importance of feeding as a growth-fostering process, the evidence is lacking to guide recommendations for feeding management in this at-risk population. Evidence-based observational tools specific to the target population are warranted. Furthermore, feeding interactions between opioid- exposed infants and their caregivers need appropriate assessment and intervention to not only assist with the infant’s regulation and development of feeding skills, but also to support a nurturing feeding relationship. This presentation will shed new light on this important issue in infant feeding and highlight emerging research in the area.
In her employed life Wendy was a community pharmacist and also worked in doctor surgeries supporting cost effective, evidence-based prescribing.
Wendy left paid work to concentrate on writing Breastfeeding and Medication (Routledge 2nd edition 2018), developing information and training material on drugs in breastmilk as well as setting up her own website www.breastfeeding-and-medication. She has also published Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin). She is also co editor of a book to be published January 2020 called A guide to breastfeeding for medical professionals (Routledge).
Wendy is known for her work on providing a service on the compatibility of drugs in breastmilk and has been a breastfeeding peer supporter for 30 years. She is passionate that breastfeeding should be valued by all and that medication should not be a barrier. She has 3 daughters and 5 grandchildren. All her family seem as passionate about breastfeeding as she is and currently all 3 of her daughters are breastfeeding.
She was awarded a Points of Light award by the Prime Minister in 2018 and nominated for an MBE in the New Year's Honours List 2018 for services to mothers and babies. She received her award at Windsor Castle in May 2019 from Her Majesty the Queen.
Topic: Medication and Breastmilk in the NICU - [View Abstract]
Topic: Pharmacokinetics and Clinical Implications of Drugs in Human Milk: The Substance-Exposed Infant - [View Abstract]
We know that the most common reason mums stop breastfeeding before they would otherwise choose is because they believe they don’t have enough breastmilk. In many cultures there a herbal remedies to increase milk supply. We have medicinal options available as well. What is the research behind the “magic wands”? Can any products cause harm rather than benefit? When should they be used and when is skilled breastfeeding support more important? Why is some populations is poor milk supply never a concern? Who is responsible for the perceived need to increase milk supply?
