I did this last month for our PNT Committee.  It may help some.
Perinatal Meperidine & Breastfeeding
 
SUMMARY:
 
Meperidine is a potent opiate analgesic that is rapidly and completely 
metabolized by the adult and neonatal liver to an active form, normeperidine. 
 
There is rapid equilibrium of meperidine in maternal plasma and fetus (~6 
min).
 
 Small but significant amounts of meperidine are also secreted into 
breastmilk.
 
Half-lives of meperidine (~13 hrs) and normeperidine (~63 hrs) in neonates 
are long and could concentrate in the plasma of a neonate.
 
Infants of mothers treated with meperidine demonstrate neurobehavioral 
depression, including poor sucking, for days after exposure, thereby compromising 
bonding and breastfeeding.
 
[In contrast, morphine is a good subarachnoid opiod giving long analgesia 
with low dose. Suggest we shouldn’t use morphine antepartum (IV, IM or epidural) 
because of neonatal depression in utero & at birth and maternal 
nausea/vomiting and rashes.  Postpartum: ideal analgesic for breastfeeding mothers due to 
high first-pass uptake in liver.]
 
ANNOTATED LITERATURE REVIEW (1990-2004):
 
(1)   Hale TW. Medications and Mothers’ Milk, 11th Ed, 2004, Pharmasoft 
Publishing LP, Amarillo, TX
 
Overview of meperidine and breastfeeding with references, drug levels. Copy 
attached.
 
(2)   Yost NP, Bloom SL, Sibley MK, Lo JY, McIntire DD, Leveno KJ. A 
hospital-sponsored quality improvement study of pain management after cesarean 
delivery.  Am J Ob Gynecol 2004; 190:1341-6
 
Controlled trial of IM and PCA morphine sulfate and meperidine.  Pain reflief 
was superior with morphine regimens and was positively associated with 
breastfeeding and infant rooming in.
 
(3)   Ransjo-Arvidson AB, Mathiesen AS, Lilja G et al. Maternal Analgesia 
During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, 
and Crying.  Birth, March 2001; 28(1):5-12
 
Video recordings of 28 newborns placed skin to skin post birth.  Observers 
blinded as to infant exposure to no analgesia vs. mepivacaine via pudendal block 
vs. pethidine or more than 1 type of analgesia during labor.  Several types 
of analgesia may interfere with the newborn’s spontaneous breast-seeking and 
breastfeeding behaviors and increase the newborn’s temperature and crying.
 
(4)   Wittels B, Glosten B, Faure EA et al. Postcesarean analgesia with both 
epidural morphine and intravenous patient-controlled analgesia: 
neurobehavioral outcomes among nursing neonates. Anesth Analg 1997 Sep; 85(3):600-6
 
Among nursing parturients after cesarean delivery, IV PCA with meperidine is 
associated with more neonatal neurobehavioral depression than PCA with 
morphine.  Even with small doses, meperidine was associated with significantly poorer 
neonatal alertness and orientation than morphine.
 
(5)   Nissen E, Widstrom AM, Lilja G et al. Effects of routinely given 
pethidine during labor on infants’ developing breastfeeding behavior.  Effects of 
dose-delivery time interval and various concentrations of pethidine/norpethidine 
in cord plasma. Acta Paediatr 1997 Feb; 86(2):201-8
 
Standard dose of 100 mg pethidine given IM to 13 primips between 1.1-5.3 hrs 
(short DDI) and 8.1-9.9 hrs (long DDI) prior to delivery.  Infants in short 
DDI group had delayed or no suck in 45 min observation period.
 
(6)   Nissen E, Lilja G, Matthiesen AS et al. Effects of maternal pethidine 
on infants’ developing breast feeding behavior. Acta Paediatr 1995 Feb; 
84(2):140-5
 
Blinded observational study of 44 infants placed skin-to-skin after delivery. 
 Those infants exposed to pethidine (18/44 had delayed and depressed sucking 
and rooting behavior.
 
(7)   Rajan L. The impact of obstetric procedures and analgesia/anaesthesia 
during labor and delivery on breast feeding. Midwifery 1994; 10:87-103
 
Secondary analysis of data from UK study of pain relief in labor revealed 
women who had pethidine late in labor needed extra help with breastfeeding.  Only 
38% of women given pethidine in labor were breastfeeding at 6 wks 
post-delivery, compared to 45% who did not receive the drug.
 
(8)   Righard L, Alade MO. Effect of delivery room routines on success of 
first breast-feed. Lancet 1990 Nov 3; 336(8723):1105-7
 
40/72 infants received pethidine during labor: the infants were sedated and 
most (25/40) did not suck at all.
 
 
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatology
July 14, 2005

Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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