Development of lactation and breast/chestfeeding adverse event terminology (LaBAET) through a Delphi consensus approach.

Abstract

Background: Most women who give birth will initiate lactation and breast/chestfeeding, with up to 40% of infants globally receiving human milk exclusively for the first 6 months of life. One of the studies indicates that 40% of breastfeeding women had used at least one prescription medication in the first 3 months postpartum. The lack of information on the safety of medications during lactation may lead to cessation of lactation in favor of treatments, therefore contribute to suboptimal breastfeeding rates. Inadequate terminology to define and grade adverse events for lactation and breast/chestfeeding limits the understanding of potential therapeutic harms. This results in lactating women commonly being excluded from participation in clinical trials, leading to inequitable access to effective treatments. We developed a comprehensive framework with new definitions and grades for breastfeeding Adverse Events (AEs) through consideration of the physiology and pathology of lactation.

Methods: We performed the Delphi consensus process between January 2021 and November 2023. An international multidisciplinary group of lactation and breast/chestfeeding experts identified a gap in AE terminology and developed definitions and grading of AEs based on the generic Common Regulatory Criteria for Adverse Events (CTCAE) structure. These underwent two rounds of a modified Delphi procedure involving an international multidisciplinary team of experts and patient representatives. The web platform REDCap^Ⓡ was used to collect the results of the Delphi surveys.

Results: Three new definitions, delayed secretory activation, primary lactation insufficiency, and secondary lactation insufficiency, were developed and mapped to the Medical Dictionary of Regulatory Activities (MedDRA, March 2023). Oversupply of milk and other changes in lactation/feeding patterns were mapped to existing MedDRA terms. Grading for all five definitions was developed and agreed upon through consensus.

Conclusions: These new definitions and grading of adverse events in lactation and breast/chestfeeding fill the gap in existing classifications and should encourage the inclusion of postpartum individuals into clinical trials.