Is Povidone-Iodine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Povidone-Iodine? Is Povidone-Iodine safe for nursing mother and child? Does Povidone-Iodine extracts into breast milk? Does Povidone-Iodine has any long term or short term side effects on infants? Can Povidone-Iodine influence milk supply or can Povidone-Iodine decrease milk supply in lactating mothers?

The use of povidone-iodine in the mother near term and during breastfeeding increases breastmilk iodine levels and can cause transient hypothyroidism in breastfed infants, especially in geographic areas that are iodine deficient. Maternal exposure to povidone-iodine near term can sometimes interfere with thyroid studies done as a part of newborn screening tests. Although iodine from povidone-iodine is minimally absorbed through intact adult skin, exposure of mothers who are or will be breastfeeding to povidone-iodine should be minimized by using lower concentrations of povidone-iodine, applying it to the smallest possible surface areas of the body, shortening contact time, and avoiding repeated applications. Iodine absorption can be extensive with vaginal use; avoid douching with povidone iodine or use of iodine-containing tampons during breastfeeding.

In a study in Belgium, breastfed infants had thyroid function tests measured at 5 days of age. Both basal and thyrotropin-releasing hormone-stimulated thyrotropin (TSH) levels were higher in infants exposed to the breastmilk from mothers who received topical povidone-iodine during delivery. Serum thyroxine (T4) and liothyroinine (T3) levels were normal in all groups.[1] A woman began bathing almost daily with povidone-iodine (1% iodine) and applying povidone-iodine 1% ointment to her skin daily during pregnancy and for 6 weeks postpartum for furunculosis. At 6 weeks of age, her breastfed (extent not stated) infant had a low serum thyroxine level of 4 ng/L (normal 7 to 20 ng/L), a greatly elevated serum thyrotropin level of 99 units/L (normal 0.8 to 5 units/L). The infant was treated with oral levothyroxine until the age of 7 months at which time thyroid function tests and development were normal.[6] A woman began using povidone-iodine as a vaginal douche twice daily after delivery. Her breastfed infant developed hypothyroidism (low serum thyroxine and high thyrotropin) over the first 3 weeks of life. After oral levothyroxine supplementation of the infant was begun and maternal povidone-iodine was discontinued, the infant's thyroid function tests normalized within a week.[5] A group of investigators in Belgium reviewed the results of infant thyrotropin levels on day 5 postpartum in 4745 newborn infants delivered over a 2-year period at their hospital. Infants were divided among those whose mothers had iodine overload (n = 3086) from topical povidone-iodine 10% solution during labor and delivery and those whose mothers had no iodine overload (n = 1659). Mothers had povidone-iodine applied either as a single application to 900 square cm for epidural anesthesia or 3 applications to the entire abdominal wall for cesarean section. Breastfed infants whose mothers had iodine overload had a greater risk for having elevated thyrotropin levels and requiring recall for retesting (3.2% with cesarean section and 2.7% with epidural anesthesia) compared to those who did not (0.1%). Bottle-fed infants were affected much less than breastfed infants.[7] After replacing povidone-iodine with chlorhexidine 0.5% in 70% isopropanol for disinfection for 6 months, 1178 infants that were delivered at this institution had no increased rate of elevations in thyroid function tests and a reduced rate of recalls in breastfed infants.[8] In a study of mothers in Spain who received 10% povidone-iodine (n = 21) or chlorhexidine (n = 13) topically to the perineum starting immediately before the final stage of labor and daily postpartum to the episiotomy, no differences in thyrotropin, thyroxine or free thyroxine was found among their breastfed infants at day 5 to 7 postpartum.[2] A breastfed infant whose mother was using povidone-iodine as a douche during pregnancy and during the first few weeks after delivery had symptoms of sinus tachycardia and increased concentrations of blood total and free thyroxine at 10 days of age and elevated thyrotropin at 1 month of age. The povidone-iodine was discontinued and the infant's total thyroxine normalized by 1 month of age, free thyroxine normalized by 1.5 months of age and the thyrotropin level normalized by 2.5 months of age. No other explanation for the thyroid function abnormalities could be found except maternal povidone-iodine use, but blood and milk iodine levels were not measured. Povidone-iodine was the probable cause of the adverse reaction in the infant.[9] A study in Japan randomized 80 consecutive term patients into 4 groups who received either povidone-iodine or benzalkonium chloride as a skin disinfectant before delivery and one of these for postpartum vaginal lacerations. Prepartum doses were about 7 mL and postpartum doses were about 0.5 mL of solution. Infant thyrotropin levels were elevated in the infants whose mothers received topical povidone-iodine pre- and postpartum compared to infants whose mothers received no povidone-iodine. After discontinuing the use of peripartum povidone-iodine, the rate of recall of infants for abnormal thyroid function tests dropped from 4.47% to 0.74%.[3] In Switzerland, a girl born at 29 weeks of gestation with adequate size for gestational age showed negative TSH screening on day 5. Her mother had developed an abscess of the abdominal wall 1 week after her cesarian section and was treated with povidone-iodine tampons. The baby's TSH was elevated to 23 milliunits/L on day 23, and 288 milliunits/L on day 29. Free thyroxine (T4) levels were decreased to 2.8 ng/L and free liothyronine (T3) with 1.52 ng/L, without signs or symptoms of hypothyroidism. Iodine contents of maternal milk and of infant urine were 4.4 mg/L and 3.9 mg/L, respectively. Treatment with levothyroxine was started, breastfeeding was discontinued and disinfection with povidone-iodine was stopped. The infant's thyroid function tests normalized after 6 days.[10] The infant's abnorm