Seven Years of Breastfeeding Consultations at the National Lactation Study Center-June 2018 to December 2024

Background: The National Lactation Study Center was established by Ruth Lawrence, MD, in 1981 to offer consultations on complex breastfeeding and lactation issues. In 2018, a REDCap® database was developed to track cases. Methods: We conducted a retrospective, observational review of cases from June 2018 to December 2024. We report frequencies of exposures (medication and toxin), along with geographic area, provider type, and lactation concerns. Results: We recorded 4,965 consultations (4,791 exposures and 174 breastfeeding management encounters). There were 4,941 cases from 44 states (United States), and 24 cases from other countries. Most occurred by telephone (n = 3,394; 71%), with fewer by email (n = 1,522; 28%). There were 4,049 (82%) from providers and 916 cases (18%) from consumers/patients. Of these, lactation consultants were the primary users (n = 2,915; 72%), with physicians accounting for 14% (n = 578). There were 10,435 total medications reviewed, with most cases involving ≤2 medications (n = 6,395; 61%). Drugs with central nervous system (CNS) activity accounted for the largest portion of queries (n = 5,389; 52%). Most lactation management cases were primarily maternal-side concerns such as low milk supply or oversupply (n = 116; 85%), fewer were primarily infant concerns, such as rare metabolic and cardiac conditions (n = 21; 15%), and questions related to human milk, including milk storage and properties (n = 17; 11%). Conclusion: Inquiries regarding medications with CNS activity were the most prevalent. Of management concerns, most were related to low or oversupply of milk. The use of this service reflects an ongoing need for information on medication use and complex concerns in lactation.