These health considerations are not intended as medical advice and it is not suggested that any research end here. It is also not suggested that when it is considered safe to breastfeed that it is, therefore, safe to donate milk.

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

In the spirit of informed choice, 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.

When parents and caretakers look for information about the safe sharing of human milk, it is important that all available information is presented. The standard should not be the only information given and deviation from the standard is and should be a personal choice.

Air pollution

Breastfeeding may diminish the adverse effects of air pollution and despite the risks associated with the chemical contamination of breastmilk, lactating parents should be encouraged to breastfeed their infants. 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, or 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 disclose any alcohol consumption to a recipient family.

Drugs, medication, alcohol, and the decision to discard breastmilk

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}

Please also see General Information on Medication.

Bacteria

Breastmilk contains antimicrobial components 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 spores when exposed to heat. Bacillus cereus is such a spore-forming bacterium and has been known to cause about 2% of the total cases of food poisoning. It is widely found in nature (soil, crops, water).¹²

Bacillus food poisoning usually occurs because heat-resistant endospores survive cooking or pasteurization 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. Home screening 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. Please see What about premature babies? for more information and consult with a specialized healthcare provider when planning on donating to a premature baby.

Birth control

At about six weeks postpartum, once milk supply is firmly established, synthetic hormone-based contraceptives are considered safe to take.¹⁶

However, supply can still be affected. Discuss the desire to use oral contraceptives and any potential consequences it may have on milk supply¹⁷ 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 for more information.

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 months. You may not donate if you received a blood transfusion since 1980 in France, Ireland, England, Wales, Scotland, Northern Ireland, Channel Islands, Isle of 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. However, 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. However, 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 contraindicated for breastfeeding, the use of chemotherapy, radiation with radioactive isotopes,^{28 29} and certain cancer-related drugs are.³⁰

A 2014 case report on the effect of chemotherapy on the microbiota and metabolome of human milk found that chemotherapy caused a significant deviation from a healthy microbial and metabolomic profile.³¹

It is advised to speak to a healthcare provider about concerns regarding breastfeeding while undergoing cancer treatment, donating breastmilk after cancer treatment, and receiving milk from a former cancer patient. Many will pump during treatment and discard the milk so that breastfeeding can continue after treatment is completed.

General  Information on Medication

Diagnostic scans (x-rays, mammograms, MRI, and CT/CAT)

In her article Breastfeeding and Cancer,³² Diane West, BA, IBCLC, writes that radiation from diagnostic procedures using x-rays, mammograms, MRI, 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 and radiocontrast agents typically used in ductogram, CT/CAT, MRI, 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, The Breastfeeding Answer Book³³ 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 section Medication.

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.

Eats on Feets

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, midwives, and anyone legally allowed to prescribe medication, including the nurse practitioner. 

Siblings, children, grandparents, friends, aunts, sister-/brother-in-law, etcetera, are not legally nor clinically responsible parties. IBCLCs, nurses, and doulas are also not clinically responsible parties and they cannot request milk for their clients.

For screening suggestions, see Questions for addressing recipients and Questions for addressing donors.

Donor testing

Milk banking guidelines³⁹ in most countries require donors to be tested every 3-6 months (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. Please, 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.

It is worth mentioning that many free clinics provide anonymous testing. Since those lab results will not contain the name of the patient, it is important to ask to have it added when requesting a copy.

For blood screening, please visit your healthcare provider, or you may be able to order tests yourself via certain laboratories.⁴⁵ See these suggested screening tests for milk donors.

Drugs, medications, alcohol, 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 more detrimental.

It is very important that all medication, alcohol, 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 sections Alcohol and Medication.

Exposure to needles

Unsafe exposure to non-sterilized needles (i.e. accidental needle stick, body piercing, tattoo, electrolysis, acupuncture) can lead to infections and diseases. Full disclosure 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.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Herbs, vitamins, and other supplements

Milk banks exclude⁴⁶ donors who ‪regularly use most medications and herbal supplements. This may include vitamin-herb combinations, megavitamins‬, 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 Medications

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.

Please see the section Medication for more information.

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 Medication.

More information in Surgery and the Breastfeeding Infant.

Please see also the section Anesthesia.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Infections

Introduction to infectious diseases

When babies are born, they acquire intestinal flora from their parent’s microbiota. The composition of this microbiota is affected by the mode of delivery as well as by genetics, the environment, and the mode of feeding. The act of breastfeeding influences the infant’s intestinal flora because of the transmission of the skin organisms of the parent. 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 lesions from diseases like HSV, Hepatitis, Syphilis, Chickenpox, and Monkey Pox), and Brucellosis.⁵⁸

When someone is diagnosed with an infectious disease, 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. Therefore, common bacterial, fungal, and viral infections in which someone’s health is not compromised are not contraindications to breastfeeding.

However, 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. Please also see Home pasteurization 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

Please see General Information on Medication 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, etcetera, 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 lactoferrin, 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 for 30 minutes or 72ºC/161.6ºF for 15 seconds).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-infective factors and enzymatic activities. Therefore, 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 month) 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 However, 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 and Herpes.

Please see How can breastmilk be pasteurized at home? 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

Heat-treating breastmilk remains an option in any affected area if necessary.

Creutzfeldt-Jakob Disease (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:

• From January 1, 1980, through December 31, 1996, you spent (visited or lived) a cumulative time of 3 months or more, in any country in the United Kingdom (UK), Channel Islands, England, Falkland Islands, Gibraltar, Isle of Man, Northern Ireland, Scotland, Wales
• From January 1, 1980, to present, you had a blood transfusion in any of the countries listed below: France, Ireland, Channel Islands, England, Falkland Islands, Gibraltar, Isle of Man, Northern Ireland, Scotland, Wales
• You spent (visited or lived) a cumulative time of 5 years or more from January 1, 1980, through December 31, 2001, in France or Ireland
• 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 years of age, 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. Currently, 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 Travel to various countries with regards to Creutzfeldt-Jakob Disease (CJD)

Milk banks follow blood bank guidelines. However, 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. However, the value of routinely feeding human milk from seropositive mothers to preterm infants outweighs the risks of clinical disease, especially because no long-term neurodevelopmental 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 antibodies and could get sick, especially if they are premature or immuno-compromised. With proper screening, a recipient can avoid donor milk from a CMV+ person if they themselves are negative or they may decide to freeze or pasteurize the milk to avoid contamination if needed and the donor status is unknown.¹⁰¹

How can breastmilk be pasteurized at home?

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

Hepatitis A
HAV is mainly transmitted through the fecal-oral route, which includes ingesting contaminated food or water, engaging in oral-anal sex, and other incidences where fecal matter can be passed from person to person. As such, 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

Hepatitis 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. Hepatitis 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. Please also see Open sores, blisters and/or bleeding cracks on the skin, Handling Milk, and Introduction to Infectious Diseases 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.

How can breastmilk be pasteurized at home?

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, blisters, 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 contaminate donor milk if they have any lesions on their bodies.

Please also see medication and breastfeeding and open sores, blisters, and/or cracks on the skin.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Human Immunodeficiency Virus (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

However, 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. Breastfeeding, 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.

In the US, 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. There are 3 methods for HIV testing available depending on which one is appropriate in someone’s circumstances.¹¹⁴

In the US, 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 and the global context of infant feeding

Update in progress with the 2016 guidelines.

Investing in improving infant feeding practices in the context of HIV, the World Health Organization 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 (see below).

“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:

• In special circumstances such as when the infant is born with low birth weight or is otherwise ill in the neonatal period and unable to breastfeed;
• When the parent is unwell and temporarily unable to breastfeed or has a temporary breast health problem such as mastitis;
• To assist parents to stop breastfeeding;
• If antiretroviral drugs are temporarily not available.

In ‘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

Currently, there is no clear evidence on whether heat-treating breastmilk should be used as a permanent solution.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating.

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

Human T-lymphotropic Virus (HTLV)  is a virus that may cause blood or nerve disease. 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}

Due to inadequate treatment options and the lack of effective vaccination, prevention is currently only possible by restricting transmission, including the usage of condoms during sexual intercourse or avoiding breastfeeding if HTLV-seropositive. If due to socio-economic reasons, breastfeeding cannot be avoided, short-term breastfeeding for a maximum of up to 6 months is suggested.¹²⁶

Babies born to parents with HTLV-1 seem to acquire some limited immunity in-utero that may protect them in the early months but few studies have examined the impact of HTLV-1 infection on fertility or pregnancy outcomes or the susceptibility of the mother to infection during pregnancy and lactation. Breastfeeding is strongly associated with transmission and avoidance of breast-feeding a proven intervention, 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) to prevent this route of transmission.¹²⁷

HTLV is not common in the US but is regularly found in some parts of Japan, the Caribbean, and Central Africa.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. Further testing will be necessary in order to rule out false-positive results.¹²⁹

Most people with HTLV I or II do not develop the disease throughout life.^{130 131} We are of course not suggesting that an HTLV+ person donate their milk to someone else’s child. The below information can, however, be helpful in case the full health of a donor is not known:

• HTLV-1 is destroyed within 20 minutes at 56°C (or 10 minutes at 90°C), or by freezing at -20°C for 12 hours.¹³²
• Freeze-thaw processing can eliminate the  HTLV-I infectivity of human milk and HTLV-I carriers can indirectly feed their infants using expressed frozen-thawed milk as a way to prevent HTLV-I infection.¹³³

Please see How can breastmilk be pasteurized at home? 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.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Lyme disease

Reasons to suspect that you have Lyme disease include:

• You live in a region where Lyme disease is common
• Fever, chills, headache, fatigue, 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, the 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 regimen.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 self-exclusion, 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, please see General Information on Medication.

Please see How can breastmilk be pasteurized at home? 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

Currently, 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 over and covered by normal skin), the infant could return to breastfeeding. However, 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.

Please see How 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. Because 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, however, 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 and feeding with (donor) human milk. Current recommendations change regularly depending on local situations and occurrences.^{157 158}

In short
As always, follow the Four Pillars of Safe Breastmilk Sharing. Frequently wash hands, face, objects, 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.

Recipients
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 months.
• 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 (STIs)

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, see Syphilis and Herpes. Please consult a healthcare provider if there is a reason to suspect an STI.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Syphilis

Syphilis is a treatable illness, passed from person to person through direct contact with syphilis sores or by sexual activity.¹⁶¹ Syphilis is not spread by contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.^{162 163}

If someone has an active syphilis outbreak on their breast, nipples, or areolae, it is suggested that they stop breastfeeding. To maintain milk supply while being treated for a syphilis outbreak, it is recommended to express breastmilk and then discard it. After being treated and lesions have healed, it is considered safe to resume breastfeeding.

Please see a healthcare provider in case of any unfamiliar/unknown lesions and open sores and disclose any outbreaks to a recipient. Both donors and recipients can infect expressed milk by improper handling if they have Syphilis. Also, see STIs for information.

Please see How can breastmilk be pasteurized at home? 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.

Please see How can breastmilk be pasteurized at home? 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. Therefore, 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.

Please see How can breastmilk be pasteurized at home? 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, bacteria, and fungus
• 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: Drugs, medication, alcohol, and the decision to discard breastmilk

Medication

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. However, 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 and Herbs, vitamins, and other supplements.

Resources for medication and breastmilk:

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

Antidepressants (coming soon)

Immunomodulatory drugs (coming soon)

Immunosuppressant drugs (coming soon)

Insulin

Insulin is not passed into breastmilk and is considered safe¹⁷⁸ for use during breastfeeding. Glyburide is sometimes prescribed for type 2 Diabetes. Limited data¹⁷⁹ indicate that the levels of glyburide in milk are negligible.

Those with diabetes who are breastfeeding and using insulin can nurse their infants. Exogenous insulin is excreted into breastmilk, including newer biosynthetic insulins (e.g., aspart, deglutec, detemir, glargine glulisine, lispro), but insulin is a normal component of human milk and may decrease the risk of type 1 diabetes in human milk-fed infants.¹⁸⁰

Insulin-dependent donors are encouraged to make healthy lifestyle choices and to stay in close communication with their healthcare providers.

Please see Medications for more information as well.

Thyroid medication

Thyroid hormones play a role in the production of breastmilk and just like naturally produced thyroid hormones, some thyroid medication will pass to the breastmilk. This is considered safe and is not contraindicated for breastfeeding.^{181 182}

Please also see Medication for more information.

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. However, 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 fatty acids 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 Please see What about premature babies for more information on lipase, fat absorption, and heat-treating for preterm babies.

Open sores, blisters, bleeding cracks on the skin

Someone with chronic Hepatitis 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 Syphilis and Herpes. Even though there is no data to suggest that Hepatitis, Syphilis, 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, blisters, 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 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. 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.

Please see How can breastmilk be pasteurized at home? for more information on heat-treating and pathogens.

Organ transplant (coming soon)

Pasteurization

Home pasteurization

When full screening is not available, donor health status is unknown, or to reduce the potential risks of exposure to HIV and/or other pathogens, breastmilk can be pasteurized at home.

Holder pasteurization
(Low-Temperature Long Time – 62.5°C/145°F for 30 minutes)

Holder pasteurization is considered the standard¹⁹⁷ for human and cow’s milk pasteurization. It has been shown to inactivate pathogens while maintaining adequate nutritious properties. However, given its longer time-temperature curves, this method damages more of the antimicrobial factors¹⁹⁸ of breastmilk than would flash pasteurization.¹⁹⁹

This method of pasteurization can be done by parents or caregivers on the stovetop, or with a home pasteurizer kit for human milk. Some may decide they want to buy commercial-grade pasteurizers which are also available.

Explanation of how to perform Holder pasteurization at home.

Flash-heating
(High-Temperature Short Time – (72ºC/161.6ºF for 15 seconds)

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 Studies²⁰¹ by a research team led by Israel-Ballard,^{202 203 204} have shown that FH breastmilk inactivates HIV and 4 common bacteria.²⁰⁵

Explanation of how to perform the Flash-heat method of pasteurization at home.

Cooling down heat-treated milk

Cooked foods have a danger zone,²⁰⁶ a temperature range from 60ºC/140ºF to 4ºC/39ºF where bacteria like to grow. It is therefore important to cool the milk down quickly after it has been heated. Cooling the container in ice water)) leaving some milk too warm for too long. Please know that not all glass is suited for heating and rapid cooling.

Reusing heat-treated milk

In the study on bacterial safety, K. Israel-Ballard, et al. discuss that after cooling, flash-heat was successful in eliminating bacteria in the majority of samples, and prevented substantial growth for up to 8 h when stored at room temperature.

A study from 2013 concludes that “HIV-positive mothers living without access to refrigeration can be reassured that heat-treated breastmilk is safe for their infant to drink for up to 24 h after flash heating.“⁴⁵

Milk banks recommend that refrigerated pasteurized donor human milk be used within the next 48 hours.⁴⁶

Heat-treated milk can possibly be refrigerated or frozen following common food safety protocols.⁴⁷ We suggest, however, that after a first feeding, milk that was heat-treated not be refrigerated and reheated again as anti-bacteriological properties can decline with increased handling.

To date, the safety of reheating previously heat-treated milk has not, to our knowledge, been studied. It should be noted that most literature speaks in terms of heating expressed milk for feeding but that parents generally warm the (thawed) milk under running warm water or set it in a container in warm water for a short while to get the chill out of it. Gently warming should not be considered heat-treating. For optimal properties of breastmilk, reheating (warming) milk should not be done directly in a pan on the stovetop nor in a container set in boiling water on the stovetop (which would be heat-treating it unnecessarily).⁴⁸

Holder method explanation

1. Place milk in glass milk bottles or canning jars. Fill only four-fifths full to allow for expansion of milk when heated.
2. Place the bottles or jars on a rack inside a large canner. Fill the canner with warm water until the water level is slightly above the milk level in the jars.
3. Start heating. Stir the milk in each container with a long-handled spoon to achieve uniform distribution of the heat. Monitor the temperature with an accurate, metal-stem thermometer. As the temperature approaches 145ºF, stop stirring, and loosely cover all jars but one with lids. Cover the remaining jar with aluminum foil. Punch a hole in the center of the foil and insert the
thermometer.
4. Continue heating until the temperature is 145ºF or slightly above. Adjust the heat to maintain the temperature at 145ºF for 30 minutes. If at any time the temperature drops below 145ºF, reheat and hold at 145ºF or above for 30 minutes.
5. After 30 minutes, gradually replace the hot water with cold water to cool the milk. If this is not done gradually, the bottles or jars may break.
6. Continue cooling the milk until the temperature is 80ºF or less. At this temperature, ice water can be used for cooling. Cool milk to 40ºF or colder. Tighten the covers and store in the refrigerator at 40ºF or colder until used.²¹¹

Flash-heating explanation

• Always wash all utensils that you will use to express and heat treat your breastmilk with clean water and soap. It is best to boil these utensils after washing to make sure that they are clean.
• Put all the milk in a heat-resistant glass (not plastic) jar. The amount of milk should be between 50 ml and 150 ml. If you have more milk, you may divide it into 2 jars.
• Place the jar of milk in a small pan of water. Make sure the water is about two fingers above the level of milk so that all the milk will be heated well.
• Heat the water on a very hot fire or on the highest level of your stove until it reaches a rolling boil (when the water has large bubbles). Stay close by because this should only take a few minutes. Leaving the water to boil too long will damage some of the nutrients in the milk.
• Remove the jar of milk from the boiling water immediately after the water comes to a boil. Place the jar in a container of cool water, or let it stand alone to cool until it reaches room temperature.
• Protect the milk as it cools and during storage by placing a clean lid or small plate on it.
• You can safely feed your baby this heated milk within 6 hours.
• You can feed the baby using a clean open cup. Even a newborn baby learns quickly how to drink from a cup. Avoid using bottles and nipples. They are difficult to clean and may make your baby sick.^212 213

Below is Kiersten Israel-Ballard demonstrating flash-heating on the stovetop.

❆✼❆

Flash heat and HIV
Given the specific risks for lactating parents in developing country settings, research studies focused on determining the impact of flash-heat on HIV, bacteria, and breastmilk’s protective elements, such as immunoglobulins, vitamins, and the immunoreactive proteins lactoferrin and lysozyme.

Studies²¹⁴ by a research team led by Israel-Ballard,^{215 216 217} have shown that FH breastmilk inactivates HIV and 4 common bacteria²¹⁸ while retaining high levels of vitamins,²¹⁹ lactoferrin,²²⁰ and immunoglobulin,²²¹ which are important for the health of a baby and its immunity to infections. See Why breastmilk for more information on the importance of the anti-infective components of breastmilk.

Safety of flash-heating
When researchers designed the flash-heat method for lactating parents in developing countries, it was an attempt to replicate the flash-pasteurization methodology for a low-resource setting. Flash-heating is a simplified in-home process and as such is not as controlled as the actual flash pasteurization method. Altitude, breastmilk volumes, water volumes, and human error could contribute to differences in the flash-heat process. Although researchers hypothesize that the temperatures achieved during flash-heat render breastmilk safe, it should be noted that its effectiveness to inactive all viruses and spores²²² has not been thoroughly researched and remains theoretical.

When heat-treating human milk, many important anti-infective properties are reduced. The Holder method affects these properties in a greater way than Flash heating. Any heat treatment deactivates lipase, an enzyme that helps with the breakdown and absorption of fats, and the long-term effects of feeding heat-treated milk have not been researched²²³ Raw (unpasteurized), fresh (not frozen when possible) human milk, from a properly screened donor, and properly handled is a better option when available.

Flash-heating versus Flash-pasteurizing

Flash-heating (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.²²⁴ Studies²²⁵ by a research team led by Israel-Ballard,^{226 227 228} have shown that FH breastmilk inactivates HIV and 4 common bacteria.²²⁹ The World Health Organization supports expressing and heat-treating milk of those who are HIV positive for temporary feeding during an emergency and when no other safe options are available.²³⁰

Flash-heating is however not to be confused with flash-pasteurizing (FP), which is a commercial process. Both are forms of High-Temperature Short-Time (HTST) Pasteurization, but flash-pasteurizing requires special equipment whereas flash heating does not.²³¹ FP involves heating to exactly 72ºC/161.5ºF for 15 seconds. This process is followed by the dairy industry and is an officially accepted method of pasteurization.^{232 233} Flash-pasteurization of human milk has been demonstrated to inactivate bacteria as well as certain important pathogenic viruses, specifically HIV, HTLV, HBV and HCV, and CMV.²³⁴

While the temperature of milk when FH typically reaches 72ºC/161.5ºF,²³⁵ this is not as accurate as with the FP process. In a home setting, the time and temperature are not easily controlled, nor are milk and water volumes.

For instance, the temperature of human milk when using FH will greatly vary depending on altitude and atmospheric pressure. Water boils at 100ºC/212ºF at sea level, but the higher the altitude, the lower the boiling point of water.²³⁶ Using FH at home and removing the milk from the heat when the water boils will thus not always result in the milk attaining exactly 72ºC/161.5ºF, the safe temperature needed for flash pasteurization. We do not know how heat-treating milk at 71ºC for instance affects the viral load, except for HIV (see below).

Another aspect is that, contrary to FP where the temperature is held for 15 seconds, the whole process of FH takes about 5 minutes. Holding the milk at a precise temperature for a specific amount of time is not feasible in a home setting. Both temperature and time are important however when flash-pasteurizing.

While FH has been researched and is proven to deactivate HIV, its effectiveness on other viruses is theoretical. We, as a milksharing network, cannot make assumptions and tell our community that both processes do the same thing. HIV is destroyed at low temperatures (57ºC/134.5ºF) and so boiling water anywhere for any time will result in milk that is hot enough to deactivate the virus. While the positive results of FH might be comparable to those of FP, when it comes to the other viruses, more research is needed to address this directly.

Currently, there is no clear evidence on whether heat-treating breastmilk should be used as a permanent solution.²³⁷

For more information on infant feeding and HIV, please see Human Immunodeficiency Virus (HIV) and HIV and the global context of infant feeding

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.²³⁸ This method has however not shown to be as effective as Flash-heating.²³⁹

Pregnancy

Pregnancy is not a condition that requires the cessation of breastfeeding. However, 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.^{240 241}

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.²⁴²

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; however, there have been no recent reports of clinical problems in infants of a breastfeeding parent with silicone breast implants.^{243 244}

The surgical procedure used to place the implant might disrupt the ability to breastfeed effectively. Research, however, 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.²⁴⁵

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.²⁴⁶ Viruses such as CMV and HTLV are reduced or eliminated.²⁴⁷ Hopefully, more research will be done regarding cold temperatures as milk treatment.

See the section on CMV  and 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, and bacteria. Each process has a different effect on the anti-infective properties and biologically active components of human milk.

Flash-heating has been shown to deactivate HIV and 4 bacteria while retaining most anti-infective properties, but further research is needed to assess the effect on other pathogens.

It is important to note that some bacteria form spores when exposed to heat. Bacillus cereus is such a spore-forming bacterium and has been known to cause about 2% of the total cases of food poisoning. It is widely found in nature (soil, crops, water). For more information please see Bacteria.

See this How can breastmilk be pasteurized at home? for more information.

Substance Use Disorder

Those who suffer from substance use disorder (recreational and/or prescription) should not donate their milk.²⁴⁸ 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.²⁴⁹

See Medication for more information.

Tear gas and pepper spray

By Dr. Angie Bond, PhD

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 months.²⁵⁰ 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.²⁵¹

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.²⁵² 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.²⁵³

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.²⁵⁴ 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 minutes. 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.²⁵⁵ 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.²⁵⁶ 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.²⁵⁷

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.²⁵⁸

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.^{259 260}

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.

Travel: (update coming soon)

By air

X-rays and backscatter scanning devices used in airports are safe for breastmilk and breastfeeding parents/caretakers. However, these devices do utilize low levels of radiation, which has raised some health concerns.^{261 262 263}

X-rays used in airport screenings have no known effect on breastfeeding, human milk, 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.²⁶⁴

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 hours

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, Handling Donor Milk and 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 biohazard²⁶⁵ 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.²⁶⁶

To Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria

Travel to these countries increases the risk of exposure to the Human T-Lymphotropic Virus (HTLV)  and possibly HIV Group O.^{267 268}

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 tuberculosis²⁶⁹ are the only infectious diseases that are considered contraindications to breastfeeding in North America.^{270 271} Also see Introduction to infectious diseases.

Please see a primary care physician with any concerns.

Please see How can breastmilk be pasteurized at home? 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.

In most countries, it is common for donors to be rejected if they have spent a cumulative 3-6 months in the UK, France, or Ireland. The USA has an especially stringent travel policy for blood and/or milk donors. While the specific timelines allowed for living in or visiting certain geographic areas may differ slightly from country to country, the concern is the same. Please read the section on Creutzfeldt-Jakob Disease (CJD) to learn about how this does or does not apply to the sharing of breastmilk.

Canada
As per the Canadian blood services:²⁷²
Anyone who traveled to the UK from 1980 through 1996 or to France and/or Ireland (Republic of Ireland) from 1980 through 2001, is not eligible to donate if they:

• Spent a cumulative total of three months or more in the United Kingdom (UK) between January 1980 and December 31, 1996
• Spent a cumulative total of 5 years or more in France and/or Ireland (Republic of Ireland) between January 1, 1980 and December 31, 2001

USA
The American Red Cross policy considers you not eligible to donate if:²⁷³

• From January 1, 1980, through December 31, 1996, you spent (visited or lived) a cumulative time of 3 months or more, in any country in the United Kingdom (UK)²⁷⁴
• From January 1, 1980, to present, you had a blood transfusion in any of these countries: France, Ireland, Channel Islands, England, Falkland Islands, Gibraltar, Isle of Man, Northern Ireland, Scotland, Wales
• You spent (visited or lived) a cumulative time of 5 years or more from January 1, 1980, through December 31, 2001, in France or Ireland.

AUS
A similar policy applies to potential donors to the Australian Red Cross Blood Service, precluding people who have spent a cumulative time of six months or more in the United Kingdom between 1980 and 1996 and/or have received blood transfusions in the UK since 1 January 1980.²⁷⁵

Czech Republic
In the Czech Republic, anyone who spent more than six months in the UK or France between the years 1980 and 1996 or received a transfusion in the UK after the year 1980 is not allowed to donate blood.

Denmark
The Association of Blood Donors of Denmark excludes potential donors who have spent a cumulative time of at least twelve months in the United Kingdom between 1 January 1980 and 31 December 1996.²⁷⁶

Germany
Similar regulations are in place in Germany, where anyone who has spent six months or more living in the UK between January 1980 and December 1996 is permanently excluded from donating blood.

Singapore
The Singapore Red Cross excludes potential donors who have spent a cumulative time of three months or more in the United Kingdom between 1980 and 1996.²⁷⁷

New Zealand
In New Zealand, anyone who has lived in the UK, France, or the Republic of Ireland for a total of six months or more between 1980 and 1996 is not allowed to donate blood.

Poland
In Poland, anyone who cumulatively spent six months or longer between 1 January 1980 and 31 December 1996 in the UK, Ireland, or France is permanently excluded from donating.

Switzerland
The Swiss Blutspendedienst SRK excludes potential donors who have spent a cumulative time of at least six months in the United Kingdom between 1 January 1980 and 31 December 1996.²⁷⁸

Please visit the Red Cross website of a specific country for information on local, current, and complete listings.

Vaccines

Except for the Smallpox and Yellow Fever live virus vaccines, vaccines are considered safe for breastfeeding and thus for milk donors.²⁷⁹

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.²⁸⁰

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. American Academy of Pediatrics. 2022. Breastfeeding and the Use of Human Milk ↩︎
4. O. Spigset. 1994. Anaesthetic agents and excretion in breastmilk ↩︎
5. Erin Martin, et al, 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. Why breastmilk? ↩︎
10. How can breastmilk be pasteurized at home? ↩︎
11. Flash-heating ↩︎
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, et al. 2003. Bacillus cereus Bacteremia in a Preterm Neonate ↩︎
16. American Family Physician RICHARD A. GUTHMANN, M.D, et al. 2015. Combined Oral Contraceptives for Mothers Who Are Breastfeeding ↩︎
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. World Health Organization. 2001. Healthy Eating during Pregnancy and Breastfeeding ↩︎
27. P. Nawrot, et al. 2002. Effects of caffeine on human health ↩︎
28. MotherToBaby Fact Sheet. Chemotherapy ↩︎
29. Mohrbacher and Stock. 2003. The Breastfeeding Answer Book. Print ↩︎
30. NIH National Cancer Institute – A to Z list of Cancer Drugs ↩︎
31. Camilla Urbaniak, et al. 2014. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report ↩︎
32. West, D. BA, IBCLC, Breastfeeding and Cancer, Breastfeeding Today, Issue 10, 2011 ↩︎
33. Mohrbacher and Stock. 2003. The Breastfeeding Answer Book. Print ↩︎
34. University of California – UCSF Department of Radiology ↩︎
35. Katrina B. Mitchell. 2019. ABM Clinical Protocol #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. The Breastfeeding Answer Book. Print ↩︎
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 and Quest Diagnostics are 2 US resources only. Please let us know what is available in your country by emailing us so we can add this information. ↩︎
46. Human Milk Banking Association of North America. Archived. HMBANA|Donate Milk The US milk bank guidelines are followed fairly closely by other countries. 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. Lawrence. 2020. Transmission of Infectious Diseases Through Breast Milk and Breastfeeding ↩︎
52. See Human Immunodeficiency Virus (HIV) for more information ↩︎
53. Human Milk Banking Association of North America. Archived. HMBANA|Donate Milk excludes donors who have had a positive blood test result for HIV, HTLV, Hepatitis B or C, or Syphilis, whose sexual partner is at risk for HIV, who use illegal drugs, who smoke or uses tobacco products, who have received an organ or tissue transplant or a blood transfusion in the last 12 month, who regularly have more than two ounces or more of alcohol per day, who have been in the United Kingdom for more than 3 months or in Europe for more than 5 years since 1980 and who were born in or has traveled to Cameroon, Central Africa Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria. ↩︎
54. CDC – Human Immunodeficiency Virus (HIV) Note: recommendations about breastfeeding and HIV may be different in other countries ↩︎
55. AAP 2012. Breastfeeding and the Use of Human Milk ↩︎
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, et al. Letter to the 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. However, 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, et al. 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, et al. 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. Print, 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. The Breastfeeding Answer Book. Print. ↩︎
77. UnityPointHealth – Yeast Infection ↩︎
78. Wambach and Spencer. 2021. Breastfeeding and Human Lactation. p 544 ↩︎
79. See Bacteria ↩︎
80. NYS Dep. of Health – Chickenpox (varicella zoster infection) ↩︎
81. Riordan. 2005. Breastfeeding and Human Lactation ↩︎
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 – Creutzfeldt-Jakob Disease, 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, A. M. Emmerson. Manual of Infection Control Procedures. p.169. 2003. Print ↩︎
94. Stagno, et al. 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. Breastfeeding and the Use of Human Milk ↩︎
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, et al. 2005. La Trobe Tables ↩︎
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
     In the US, 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 Retrospective review of serological testing of potential human milk donors less of a concern for people participating in milksharing. The implications for a milk bank regarding testing expenses and logistics are different. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. ↩︎
104. CDC – Mothers with Hepatitis B or C infections can breastfeed their infants. ↩︎
105. Sarah Reece-Stremtan, et al. 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. Breastfeeding and the Use of Human Milk ↩︎
109. Los Alamos National Laboratry – HIV and SIV Nomenclature ↩︎
110. CDC – Human Immunodeficiency Virus (HIV) ↩︎
111. Word Health Organization. 2008. Module 6. Infant Feeding in the Context of HIV Infection, PMTCT– Generic Training Package Participant Manual ↩︎
112. Why human milk? ↩︎
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. (World Health Organization. 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. In 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; and, 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, and, the parent or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant; and, 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; and, 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. Breastfeeding and the Use of Human Milk ↩︎
124. Renu B. Lal, et al. 1993. Evidence for Mother-to-Child Transmission of Human T Lymphotropic Virus Type II ↩︎
125. Yoshiro Tsuji, MD, PhD. 1990. Prevention of Mother-to-Child Transmission of Human T-Lymphotropic Virus Type-I ↩︎
126. Ioannis Mylonas. 2010. HTLV infection and its implication in gynaecology and obstetrics ↩︎
127. Carolina Rosadas and Graham P. Taylor. 2019. Mother-to-Child HTLV-1 Transmission: Unmet Research Needs ↩︎
128. NORD – HTLV Type I and Type II ↩︎
129. ARUP Laboratories – Human T-Lymphotropic Virus Types I and II Testing ↩︎
130. NIH – Human T-cell leukemia virus type 1 ↩︎
131. NIH – Human T-cell leukemia virus type 2 ↩︎
132. Dr. John May, et al. 2005. La Trobe Tables ↩︎
133. Yoshiya Ando, et al. 1989. Effect of Freeze-Thawing Breast Milk on Vertical HTLV-1 Transmission from Seropositive Mothers to Children ↩︎
134. CDC – Influenza (Flu ↩︎
135. Jack Newman, MD. How breastmilk Protects Newborns ↩︎
136. Dr. John May, et al. 2005. La Trobe Tables ↩︎
137. Hanson L. 2007. Feeding and infant development: breast-feeding and immune function ↩︎
138. Carlson A, et al. 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 to 80 percent of infected persons
     – Begins at the site of a tick bite after a delay of 3 to 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, et al. 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, Jan. Breastfeeding and Human Lactation. Sudbury: Jones and Bartlett, 2005. 167. Print. ↩︎
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. World Health Organization – 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, et al. 2020. Holder Pasteurization Inactivates SARS-CoV-2 in Human Breast Milk ↩︎
160. Office on Women’s Health – Sexually transmitted infections, pregnancy, and breastfeeding ↩︎
161. CDC – Syphilis – CDC Fact Sheet ↩︎
162. Office on Women’s Health – Syphilis ↩︎
163. A positive screening test does not mean that someone has a current infection. If the screening test is positive but the confirmatory test is negative, the result is considered a false positive. About 1% to 2 % of the US population has false-positive results. False-positive results are most common in pregnancy and in patients with lupus, HIV, endocarditis, IV drug use, pregnancy, Lyme disease, certain types of pneumonia, malaria, tuberculosis, certain autoimmune disorders including lupus, and even recent immunization. More at STD Center – Syphilis testing: types, timing, and accuracy ↩︎
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. Why human milk? ↩︎
178. JEANNE P. SPENCER, M.D., et al. 2001. Medications in the Breast-Feeding Mother ↩︎
179. NIH – Glyburide ↩︎
180. NIH – Insulin ↩︎
181. NHS – Levothyroxine and breastfeeding ↩︎
182. Wendy Jones. 2021. Thyroid Medication (under and over-active) and Breastfeeding ↩︎
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, milk, cheese, and other dairy products — are excluded from the diet. ↩︎
188. Reed Mangels, PhD, RD. Simply Vegan, 5th Edition 2013. Pregnancy and the Vegan Diet ↩︎
189. Reed Mangels, PhD, 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. Lawrence, Ruth. Breastfeeding, A Guide for the Medical Profession. 6th edition. 2005. p.158. Print. ↩︎
197. Kim Updegrove, MSN, MPH, APRN, CNM, et al. 2020. HMBANA Standards for Donor Human Milk Banking: An Overview ↩︎
198. Douglas B. Tully, et al. 2001. Donor Milk: What’s in It and What’s Not ↩︎
199. Dr. John May, et al. 2005. La Trobe Tables ↩︎
200. Please see Human Immunodeficiency Virus (HIV) and HIV and the global context of infant feeding for more information. ↩︎
201. HIV in breastmilk killed by flash-heating ↩︎
202. Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
203. Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
204. Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
205. K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
206. King County – Food safety in your home kitchen ↩︎
207. ↩︎
208. ↩︎
209. FoodSafety.gov – Keep Food Safe ↩︎
210. ↩︎
211. Ohio State University Extension Sheet. Archived. Preserving Beverages: Water, Juice, and Milk The method of heating milk to 62-63ºC/145ºF and holding it there for 30 minutes is the Holder or Batch method of pasteurization, the standard for human and cow’s milk pasteurization. ↩︎
212. Source Unknown – How can you safely heat treat breastmilk ↩︎
213. For more information on cup feeding, please see How do I feed the milk to my baby? ↩︎
214. UCBerkelyNews – HIV in breastmilk killed by flash-heating ↩︎
215. Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
216. Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
217. Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
218. K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
219. Kiersten Israel-Ballard, et al. 2008. Vitamin Content of Breast Milk From HIV-1–Infected Mothers Before and After Flash-Heat Treatment ↩︎
220. Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
221. Caroline J. Chantry, et al. 2009. Effect of Flash-heat Treatment on Immunoglobulins in Breastmilk. ↩︎
222. Please see Bacteria for more information. ↩︎
223. Please also see ‘What about premature babies? ↩︎
224. The terms flash-heating and flash-pasteurizing are often used interchangeably. Flash-heating refers to the at-home method of pasteurizing as demonstrated in the Kiersten Ballard-Israel studies. Please see Flash heating explanation for information on how this is done. ↩︎
225. UCBerkelyNews – HIV in breastmilk killed by flash-heating ↩︎
226. Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
227. Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
228. Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
229. K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
230. World Health Organization. 2016. Guideline. Updates on HIV and Infant Feeding ↩︎
231. Dr. John May, et al. 2005. La Trobe Tables ↩︎
232. FDA – GUIDE TO INSPECTIONS OF DAIRY PRODUCT MANUFACTURERS ↩︎
233. Legal pasteurization is a combination of time and temperature as per the 2017 FDA – Grade A Pasteurized Milk Ordinance item 16p Administrative procedures section 1. ↩︎
234. Fokke G. Terpstra, et al. 2007. Antimicrobial and Antiviral Effect of High-Temperature Short-Time (HTST) Pasteurization Applied to Human Milk ↩︎
235. Kiersten Israel-Ballard. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk Flash heating typically reached temperatures greater than 56Cº for 6 minutes 15 seconds and peaked at 72.9C.º ↩︎
236. Manitoba Food Safety Program. Thermometer Calibration Guide Thermometers need to be calibrated when used at higher altitudes if one needed to precisely measure the temperature of the milk. ↩︎
237. World Health Organization. 2016. Guideline. Updates on HIV and Infant Feeding Those who are HIV positive may consider expressing and heat-treating breastmilk as a temporary feeding strategy under the following circumstances: In special circumstances such as when the infant is born with low birth weight or is otherwise ill in the neonatal period and unable to breastfeed; When the lactating parent or caretaker is unwell and temporarily unable to breastfeed or has a temporary breast health problem such as mastitis; To assist lactating parents and caretakers to stop breastfeeding; If antiretroviral drugs are temporarily not available. ↩︎
238. B. S. Jeffery, K. G. Mercer. 2000. Pretoria Pasteurization: A Potential Method for the Reduction of Postnatal Mother to Child Transmission of the Human Immunodeficiency Virus ↩︎
239. Kiersten Israel-Ballard, et al. 2005. Viral, Nutritional, and Bacterial Safety of Flash-Heated and Pretoria-Pasteurized Breast Milk to Prevent Mother-to-Child Transmission of HIV in Resource-Poor Countries ↩︎
240. Farah Madarshahian and Mohsen Hassanabadi. 2012. A Comparative Study of Breastfeeding During Pregnancy: Impact on Maternal and Newborn Outcomes ↩︎
241. (O.M. Shaaban, et al. 2015. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study ↩︎
242. Healthy Children – Nursing During Pregnancy ↩︎
243. CDC – Breast Surgery ↩︎
244. AAP. 2001. The Transfer of Drugs and Other Chemicals into Human Milk ↩︎
245. Stuart Bondurant, et al. 1999. The Safety of Silicone Breast Implants (pg 251) ↩︎
246. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
247. Dr. John May, et al. 2005. La Trobe Tables ↩︎
248. Human Milk Banking Association of North America. Archived. HMBANA|Donate Milk ↩︎
249. CDC – Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants ↩︎
250. Karagama et al., 2003 ↩︎
251. Physicians for Human Rights – Chemical Irritants ↩︎
252. Rothenberg, 2016 – Tear gas: an epidemiological and mechanistic reassessment ↩︎
253. Center for Health Protection, Hong Kong – Health Information on Tear Gas ↩︎
254. National Collaborating Health Centre for Environmental Health, Canada – Pepper spray in the indoor environment and in the vicinity of food products and preparation surfaces ↩︎
255. LactMed –Capsaicin ↩︎
256. LactMed – Capsicum ↩︎
257. Healthy Children – How to Quit: When the Smoker is You ↩︎
258. Cândida Caniçali Primo1, et al. 2013. Effects of maternal nicotine on breastfeeding infants ↩︎
259. Brian P. Jenssen, MD, MSHP, FAAP, et al. 2019. E-Cigarettes and Similar Devices ↩︎
260. CDC – Tobacco and E-Cigarettes ↩︎
261. John Sedat. Department of Biochemistry and Biophysics. 2010. Letter of Concern ↩︎
262. TSA – Security Screening ↩︎
263. HPS – Pregnancy and Security Screening ↩︎
264. CDC – Traveler’s Health ↩︎
265. Is Breastmilk a Biohazard? ↩︎
266. Erica H. Anstey, Katherine R. Shealy. CDC Yellow Book. Chapter 7. Travel & Breastfeeding ↩︎
267. Human T-Lymphotropic Virus (HTLV) ↩︎
268. HIV Sequence Database – HIV and SIV Nomenclature ↩︎
269. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and TB disease. ↩︎
270. CDC – Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infant ↩︎
271. Human Milk Banking Association of North America. Archived. HMBANA|Donate Milk Milk banks exclude donors who have had a positive blood test result for HIV, HTLV, Hepatitis B or C, or Syphilis, whose sexual partner is at risk for HIV, who use illegal drugs, who smoke or uses tobacco products, who have received an organ or tissue transplant or a blood transfusion in the last 12 month, who regularly have more than two ounces or more of alcohol per day, who have been in the United Kingdom for more than 3 months or in Europe for more than 5 years since 1980 and who were born in or has traveled to Cameroon, Central Africa Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria. ↩︎
272. Canadian blood services – Travel ↩︎
273. American Red Cross policy – Eligibility Reference Material ↩︎
274. Channel Islands, England, Falkland Islands, Gibraltar, Isle of Man, Northern Ireland, Scotland, Wales ↩︎
275. Australian Red Cross Life blood – Donating after travelling form ↩︎
276. Bloddonorerne Danmark ↩︎
277. Health Sciences Authority – Can I donate blood ↩︎
278. Blutspende SRK Schweiz – WER KANN BLUT SPENDEN? ↩︎
279. CDC – Vaccinations ↩︎
280. ABM STATEMENT. 2020. Considerations for COVID-19 Vaccination in Lactation ↩︎