Pregnancy and Lactation

Pregnancy

Use mannitol with caution during pregnancy.

There is extremely limited information about its use in pregnancy. Schaefer (2007) states that if an osmotic diuretic is required during pregnancy mannitol may be used, although diuretics are not part of the standard therapy for hypertension and oedema in pregnancy. Schaefer concludes that exposure to a diuretic is not an indication for interrupting the pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use mannitol with caution during breastfeeding.

It is unknown if mannitol is excreted into human breast milk. Although there is no hard data, drawing on knowledge of mannitol and mother and infant physiology, one author suggests that passage into the milk is only likely in the first few days post partum, and considers passage into the breast milk likely to be minimal beyond 48 hours post-partum. Further, that oral absorption by the infant is likely to be minimal after the first few days post partum (when the gastrointestinal tract becomes less porous). Watery diarrhoea in the infant is a remote possibility. A reduction in the production of milk, from the osmotic diuretic effect is possible (Hale, 2010).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.