Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: A review

In July-October 2010, keywords (e.g. health professionals, doctors, nurses, pharmacists, lactation, breastfeeding, medication, medicine, knowledge, attitude/s, practice/s, behaviour/s) were used, either separately or in combination, to search databases such as Ovid, Pub Med, International Pharmaceutical Abstracts and Google Scholar. The search was restricted to articles published on primary research data, in English, and from 1990 onwards. The same keywords were used to search relevant journals such as BMC Women's Health, Medical Journal of Australia, International Breastfeeding Journal and Journal of Human Lactation. The reference lists of relevant articles retrieved from these journals were hand-searched for additional studies.Thirty-one publications were found that were assessed for relevance to the topic area, 15 of which were not within the scope of this review - 13 that did not investigate health professionals' breastfeeding knowledge, attitudes or practices in the context of prescribing medication for women [1-13]; one that did not determine women's experiences with receiving advice from health professionals on medication use and safety in breastfeeding [14]; and another that was a review of primary research data [15].Tables 1, 2 and 3 show the 17 publications that were critiqued [16-32]. These reported on studies that mostly used cross-sectional designs; generally had low response rates (RRs); and were undertaken in Australia, Canada, Israel, The Netherlands, USA and United Kingdom (UK), and whose findings therefore cannot be generalised to other settings.Table 1 details 11 studies - seven that have been conducted with health professionals only [17,18,21,26,28,31,32] (where references 17-18 and 21 concern the same study); two with pharmacists, general practitioners (GPs) and breastfeeding women together [22,23] (these concern the same study); another with pharmacists and breastfeeding women [25]; and one with endocrinologists, family physicians and women [30