{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:51:49Z","timestamp":1789761109254,"version":"4.0.1"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography\u2013tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82\u20130.88;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1.3\n                      <jats:italic toggle=\"yes\">\u03bc<\/jats:italic>\n                      g\/L [range, 0.0\u20134.0] versus 1.0\n                      <jats:italic toggle=\"yes\">\u03bc<\/jats:italic>\n                      g\/L [range, 0.0\u20132.3], respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Ingestion of tacrolimus by infants\n                      <jats:italic toggle=\"yes\">via<\/jats:italic>\n                      breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.06400612","type":"journal-article","created":{"date-parts":[[2013,1,24]],"date-time":"2013-01-24T22:50:50Z","timestamp":1359067850000},"page":"563-567","source":"Crossref","is-referenced-by-count":126,"title":["Breastfeeding and Tacrolimus"],"prefix":"10.2215","volume":"8","author":[{"given":"Kate","family":"Bramham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Chusney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liz","family":"Lightstone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Nelson-Piercy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-10-20230811","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1097\/00007890-200012270-00010","article-title":"Review of the course and outcome of 100 pregnancies in 84 women treated with tacrolimus.","volume":"70","author":"Kainz","year":"2000","journal-title":"Transplantation"},{"key":"R3-10-20230811","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1258\/000456302320314502","article-title":"Evaluation of a rapid micro-scale assay for tacrolimus by liquid chromatography-tandem mass spectrometry.","volume":"39","author":"Keevil","year":"2002","journal-title":"Ann Clin Biochem"},{"key":"R4-10-20230811","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1177\/00912700122009999","article-title":"Effect of low- and high-fat meals on tacrolimus absorption following 5 mg single oral doses to healthy human subjects.","volume":"41","author":"Bekersky","year":"2001","journal-title":"J Clin Pharmacol"},{"key":"R5-10-20230811","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2165\/00003088-200140040-00004","article-title":"Comparative clinical pharmacokinetics of tacrolimus in paediatric and adult patients.","volume":"40","author":"Wallemacq","year":"2001","journal-title":"Clin Pharmacokinet"},{"key":"R6-10-20230811","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/01.AOG.0000164052.66219.c7","article-title":"Breastfeeding during tacrolimus therapy.","volume":"107","author":"Gardiner","year":"2006","journal-title":"Obstet Gynecol"},{"key":"R7-10-20230811","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/00007890-199708270-00002","article-title":"Pregnancy after liver transplantation under tacrolimus.","volume":"64","author":"Jain","year":"1997","journal-title":"Transplantation"},{"key":"R8-10-20230811","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1345\/aph.1C312","article-title":"Milk transfer and neonatal safety of tacrolimus.","volume":"37","author":"French","year":"2003","journal-title":"Ann Pharmacother"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201304000-00010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:42:59Z","timestamp":1786369379000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201304000-00010"}},"subtitle":["Serial Monitoring in Breast-Fed and Bottle-Fed Infants"],"short-title":[],"issued":{"date-parts":[[2013,4]]},"references-count":7,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.06400612","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718020130.793478582","asserted-by":"object"}]},"ISSN":["1555-9041"],"issn-type":[{"value":"1555-9041","type":"print"}],"subject":[],"published":{"date-parts":[[2013,4]]}}}