A Vital App for Medication Safety in Pregnancy and Breastfeeding
Most providers and patients are aware of the benefits of breastfeeding and it is universally recommended by both the World Health Organization and the American Academy of Pediatrics among numerous other healthcare organizations. Proven benefits to the mother include: decreased risks of breast and ovarian cancers, decreased risk of postpartum depression, and even decreased risk of common chronic diseases including type 2 diabetes, and cardiovascular disease. Proven benefits to the infant include decreased risk of atopic dermatitis, gastroenteritis, and a higher IQ later in life. Additional beneficial associations regarding less risk of autism, cancer, asthma, are seen in observational studies. Consequently, the number of women breastfeeding their children continues to increase. Furthermore, it is our “duty” in primary care to promote breastfeeding. The United States Preventive Services Task Force (USPSTF) via a 2016 Grade B recommendation states, “the USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding.”
One of the most common questions that comes up in practice surrounds the safety of medications during pregnancy and breastfeeding. Drug “X” may be unsafe in pregnancy, but safe for breastfeeding mothers. Drug “Y” may be safe in pregnancy, but unsafe for breastfeeding mothers. Where do you go to find this vital information quickly at the point of care? Previously, I have used the fantastic LactMed app from the NIH. Unfortunately, the NIH announced in December 2019, they would be “retiring” their iOS and Android apps. Finding information in drug guides such as Epocrates and LexiComp let alone UpToDate can be frustrating. The drug monograph frequently is more information than you want/need, and if strictly followed could result in advising a breastfeeding mother to pump/dump and/or choosing a less ideal medication. If you instead use the Relative Infant Dose (RID) you may be able to save yourself and your patient a lot of trouble and keep that mother breastfeeding. Typically, a RID less than 10% is considered safe if not otherwise contraindicated. Where can you find the RID?
Thankfully, there is a wonderful app that provides the RID and other information in a similarly easy to use the format as LactMed: InfantRisk Center Health Care Mobile Resource. The InfantRisk Center is based at Texas Tech University Health Sciences Center in Amarillo, Texas where the current director is Thomas Hale, PhD.
The InfantRisk Center has a fabulous website for providers and patients alike, a blog, apps for HCPs and patients, and most importantly, a hotline that is worldwide in scope. This hotline is available for patients and providers to call with questions about medication safety in pregnancy and breastfeeding. Their app, Infant Risk Center HCP, provides quick reference information on most prescription, OTC, vitamins/supplements for pregnancy, and breastfeeding safety. Again, it is the only app left currently that provides the RID information in an easy to access format. Here on iMedicalApps we have examined several breastfeeding apps over the years and recommend readers consider LactMed from the NIH, and Breastfeeding Management 2. Those excellent apps focus on medication safety and general guidance on breastfeeding respectively. We also recently favorably reviewed a new breastfeeding app called LactFacts.
Evidence-based medicine
The Infant Risk Center HCP app contains critical safety information on prescription, OTC, vitamins/supplements in pregnancy and breastfeeding. The app provides color-coded safety information that is easy to use rapidly at the point of care. The app includes the RID data that is not found in drug guides such as Epocrates, Lexicomp, etc. The Infant Risk Center uses evidence from the drug companies, available literature, and their own research to provide their safety ratings and RID data. The author team from the Infant Risk Center consists of experts in the breastfeeding field and range from PhD’s, OB/GYN physicians and pediatricians to lactation nurse experts.
What providers would benefit from this App?
Students, residents, mid-levels, lactation consultants, nutritionists, primary care, OB/GYN, any provider who counsels women on medication safety in pregnancy and breastfeeding.
Price
o App is free.
Likes
o Easy to use, detailed information on medications in pregnancy/breastfeeding.
o Contains the Relative Infant Dose (RID) for most medications (when available).
o Links to website and ability to call Infant Risk Center from app.
Dislikes
o Hot Topics section of app not currently working.
o Some OTC meds not included.
o No true directions or detailed explanations (must use their website for details).
Overall
The Infant Risk Center app for healthcare providers is an indispensable guide to medication safety for pregnancy and breastfeeding counseling. The companion app to their website, call center, and “mommymeds” app, the Infant Risk Center HCP app provides the hard to find but VERY helpful Relative Infant Dose (RID) information for most medications unlike most drug guides. If you care for pregnant or breastfeeding patients you need this app (or at least LactMed by the NIH (which are being retired!).
Overall Score
o 4.5 stars
User Interface
o 4.5 stars
Nothing fancy but easy to navigate, multiple search options, and mostly clear explanations.
Multimedia Usage
o 4.0 stars
The app includes hyperlinks to the Infant Risk Center, information/link to call the Infant Risk Center. Hot Topics not working on the version of the app I reviewed.
Price
o 5.0 stars
App is free.
Real World Applicability
o 5.0 stars
A fabulous free app for primary care providers and lactation consultants to provide the most-accurate counseling of our patients regarding medication safety in pregnancy and during breastfeeding. Not only does it have 99% of the answers you are looking for in the app, you can also call the Infant Risk Center for free.
Device Used For Review
o iPhone 11 Pro running iOS 13.5.1
Available for Download for iPhone, iPad, and Android.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
