We have a few mothers breastfeeding while on azathioprine (imuran) and
cyclosporin.  Of two whom I remember some of the details, one had a
kidney transplant, the other a liver transplant.  In the latter case
the mother started but was given very bad help and did not nurse long.
In the case of the mother with the kidney transplant, who was on
cyclosporin and azathioprine, I believe she is still nursing a 1 year
old, who appears perfectly normal, is growing well.

It should be pointed out that the baby has been exposed to
azathioprine and cyclosporin throughout the pregnancy.  This at a time
when the baby is much more sensitive and and getting these drugs in
much higher doses than in the milk.  The amount in the milk is far
inferior to what the baby gets in utero.

Why should a woman who has had a kidney transplant be denied the
experience of nursing her baby?  Is there proof that the small amount
of drug in the milk outweighs the risks of formula feeding?  Or is
this just the opinion of the physicians who probably feel there is no
advantage to breastfeeding over formula feeding?  Why should the baby
be denied breastfeeding?

Surely formula should be considered a drug. It is very different from
what it is meant to replace.  It has no antibodies, no lactoferrin, no
lysozyme, no macrophages, no lymphocytes, no epidermal growth factor,
no nerve growth factor, no prostaglandin E2, no oligosaccharides, no
DHA, so important to visual and brain development, no...and it would
take pages and pages to list the differences between infant formula
and breastmilk.  And this, no one can deny.  This is true.
Furthermore, like all drugs, infant formula has side effects, short
term, long term, some serious.  True, most babies who receive infant
formula do thrive and seem to do well.  But so do most people who get
Bactrim, for example.  But occasionally someone dies from taking
Bactrim.  Infant formula increases the risk of several acute and
chronic illnesses.

When all is said and done, the mother should breastfeed if she wants,
but the decision is up to her, not the doctors.

Jack Newman, MD, FRCPC