Choice of breastfeeding and physicians' advice: A cohort study of women receiving propylthiouracil

Objective. To examine the gap between the current social/medical practice a nd the evidence-based recommendation in favor of breastfeeding during mater nal propylthiouracil (PTU) therapy. Design. Prospective, observational, cohort study. Subjects. Women requiring PTU during pregnancy, and endocrinologists and fa mily physicians in Ontario, Canada. Interventions. Questionnaire. Main Outcome Measures. Women were interviewed postpartum regarding their ch oice of infant feeding method and relevant advice received from physicians. Physicians were questioned about their advice to nursing women receiving P TU. Results. Of 78 women, 66 had live births. Thirty-six required PTU postpartu m (group 1), and 30 did not (group 2). Thirty-six healthy women served as c ontrols (group 3). Breastfeeding initiation rates for groups 1, 2, and 3 we re 44%, 83%, and 83%, respectively. In group 1, 15 women who breastfed rece ived advice from 22 physicians regarding breastfeeding (20 in favor, 1 agai nst, and 1 equivocal). Eleven who formula fed received advice from 17 physi cians (4 in favor, 12 against, and 1 equivocal). A logistic regression anal ysis of group 1 showed that physicians' advice was the only significant pre dictor of the woman's choice to breastfeed during PTU therapy (relative ris k: 5.48; 95% confidence interval: 1.28-23.40). The physician survey showed that 44% of endocrinologists do not recommend breastfeeding during PTU ther apy. Conclusions. A substantial proportion of the lactating patients on PTU stil l receive advice against breastfeeding from their physicians. Physicians' a dvice and attitudes toward breastfeeding during PTU therapy are a major fac tor in women's final decision to breastfeed. Physicians' compliance with ev idence-based data will facilitate breastfeeding in this group.