Is Chlorhexidine Safe in Breastfeeding

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

Iodine-free disinfectant which is widely use for skin, mouth, and, obstetric disinfection. It is preferred over iodine-based disinfectants in order to avoid high iodine exposure to the child in the neonatal and breastfeeding period that would pose a higher risk for thyroid dysfunction. Because of pharmacokinetic data (high molecular weight, high capacity for serum protein-binding and poor oral or gut absorption) significant excretion into breast milk is unlikely. Used for obstetrical purposes (vaginal or C-section wounds) even during birth or in the puerperal period, has failed to cause harm neither to the newborn nor the breastfed child. Although use in the nipple may not cause troubles to the breastfed infant (except one reported case in 1989) it is not considered to be a justified practice for prevention of mastitis. Any way, it is preferred to avoid use on the nipple, at least on a long-term basis. If used, wash the nipple thoroughly before nursing. List of Essential Medicines by WHO 2002: compatible with breastfeeding.

Chlorhexidine has been used vaginally or topically on the abdomen or perineum prior to delivery to prevent infection. No toxicity has been reported in breastfed infants and it has clearly less toxicity compared to povidone-iodine in these situations. Topical application of chlorhexidine to the breast before and after nursing did not appear to adversely affect the breastfed infants in one study. Use of chlorhexidine oral rinse by a nursing mother is unlikely to adversely affect her infant.

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.[2] 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.[3] 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.[1] Studies in Africa have used chlorhexidine vaginally prior to delivery in an attempt to reduce the frequency of mother-to-child transmission (MTCT) of HIV. In one, cotton soaked in 0.25% chlorhexidine solution was used to swab the vaginal walls every 4 hours from admission into labor until delivery in 4078 women.[4] The other study used 120 mL of either 0.2% or 0.4% chlorhexidine solution as a vaginal lavage every 3 hours from admission to labor until delivery in 309 women. The average number of lavages was 2.1 (range 1 to 11).[5] Chlorhexidine 0.25% swabs reduced MTCT in patients whose membranes ruptured more than 4 hours before delivery, but not in other women. Vaginal lavage showed a statistically nonsignificant trend towards reduction of MTCT, with the 0.4% greater than the 0.2%. Almost all of the infants in these studies were breastfed. No adverse events were reported in the infants, but follow-up related primarily to infant mortality and HIV status rather than effects of chlorhexidine.

A randomized study compared 0.2% chlorhexidine in alcohol to distilled water as a spray to the breast in 200 mothers who were nursing newborns. The mothers sprayed their breasts with the liquid before and after each feeding. Mothers and infants were assessed at discharge and weekly thereafter. Discomfort and nipple trauma were less frequent in the chlorhexidine group than in the placebo group, particularly at the first assessment. Although skin flora on the breasts of the treated mothers was reduced, there was no difference in the frequency of mastitis between the treated and placebo groups. No obvious side effects occurred in the breastfed infants and there were no differences in the rates of oral thrush in infants between the treatments.[6] A systematic review concluded that this practice is not justified based on current evidence.[7]