Is Povidone-Iodine safe while breastfeeding?

Effects on the breastfed infant

In a study in Belgium, breastfed infants had thyroid function tests measured at 5 days of age. Both basal and thyrotropin-releasing hormone-stimulated thyrotropin (TSH) levels were higher in infants exposed to the breastmilk from mothers who received topical povidone-iodine during delivery. Serum thyroxine (T4) and liothyronine (T3) levels were normal in all groups.[ 2 ] A woman began bathing almost daily with povidone-iodine (1% iodine) and applying povidone-iodine 1% ointment to her skin daily during pregnancy and for 6 weeks postpartum for furunculosis. At 6 weeks of age, her breastfed (extent not stated) infant had a low serum thyroxine level of 4 ng/L (normal 7 to 20 ng/L), a greatly elevated serum thyrotropin level of 99 units/L (normal 0.8 to 5 units/L). The infant was treated with oral levothyroxine until the age of 7 months at which time thyroid function tests and development were normal.[ 7 ] A woman began using povidone-iodine as a vaginal douche twice daily after delivery. Her breastfed infant developed hypothyroidism (low serum thyroxine and high thyrotropin) over the first 3 weeks of life. After oral levothyroxine supplementation of the infant was begun and maternal povidone-iodine was discontinued, the infant's thyroid function tests normalized within a week.[ 6 ] A group of investigators in Belgium reviewed the results of infant thyrotropin levels on day 5 postpartum in 4745 newborn infants delivered over a 2-year period at their hospital. Infants were divided among those whose mothers had iodine overload (n = 3086) from topical povidone-iodine 10% solution during labor and delivery and those whose mothers had no iodine overload (n = 1659). Mothers had povidone-iodine applied either as a single application to 900 square cm for epidural anesthesia or 3 applications to the entire abdominal wall for cesarean section. Breastfed infants whose mothers had iodine overload had a greater risk for having elevated thyrotropin levels and requiring recall for ret

Effects on milk supply

Relevant published information was not found as of the revision date.

Levels in milk

Maternal Levels. Random samples of breastmilk from day 5 postpartum in 140 women were analyzed for iodine content. Iodine levels in milk samples were 0.095 mg/L in mothers not exposed to any iodine (n = 91). In women who had 10% povidone iodine (10 mg/mL of iodine) topically applied, iodine levels were about 0.14 mg/L in women who had it applied once to 900 square cm of skin for epidural analgesia (n = 39), and about 1.2 mg/L in women who it applied to the entire abdominal wall 3 times before cesarean section (n = 10).[ 2 ] Iodine milk levels were measured in a study of mothers who received 10% povidone-iodine (n = 21) or chlorhexidine (n = 13) topically to the perineum starting immediately before the final stage of labor and daily postpartum to the episiotomy. At 96 hours postpartum, milk iodine levels averaged 1.2 mg/L in mothers who received topical povidone-iodine compared to average milk levels of 0.1 mg/L in the mothers who received chlorhexidine.[ 3 ] A study randomized 80 consecutive term patients into 4 groups who received either povidone-iodine or benzalkonium chloride as a skin disinfectant before delivery and one of these for postpartum vaginal lacerations. Prepartum doses were about 7 mL and postpartum doses were about 0.5 mL. The calculated amount of iodine ingested by the infants in breastmilk during the first 5 days of life correlated well with the amount of povidone-iodine applied to their mothers' skin. Patients who received prepartum povidone-iodine had higher median breastmilk iodide levels on day 5 postpartum than those not exposed (0.93 mg/L pre- and postpartum, 0.76 mg/L prepartum only); those with only postpartum povidone-iodine did not have elevated iodine milk levels (0.62 to 0.64 mg/L).[ 4 ] A nursing mother who was 7.5 months postpartum used povidone-iodine gel containing 50 mg of iodine per 5 gram dose vaginally once daily for 6 days. Three days after discontinuing the gel, total milk iodine levels were 0.55 mg/L which was 3 to 4 times t

Alternatives LactMed lists

• Chlorhexidine
• Benzalkonium Chloride