Obstetrics

The correct answer is C

Mothers on heparin can continue to breast-feed without concern for fetal anticoagulation. Heparin does not cross into breast milk and is not active orally.

Warfarin is 98% protein bound and is present in very low concentrations in breast milk. Thus, 1 liter of breast milk would contain 20 micrograms of drug at maximum which is an insignificant amount to anticoagulate the fetus. (19) With careful monitoring of maternal prothrombin time so that the dose is minimized, warfarin can be safely administered to nursing mothers. (9)

References:

9. Gabbe SG NJ, Simpson JL: Obstetrics Normal & Problem Pregnancies, Third ed. New York: Churchill Livingstone Inc., 1996.

19. Orme ME LP, deSwiet M et al: May mothers given warfarin breastfeed their infants? Br Med J 1977; 1: 1564.

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