Is Botulinum Poisoning safe while breastfeeding?

Summary of use during breastfeeding

It is unlikely that botulinum toxin enters breastmilk because of its high molecular weight of about 150,000 Da. Three infants have been safely breastfed during maternal botulism poisoning. Infants of breastfeeding mothers should be monitored closely for signs and symptoms of botulism such as low muscle tone, a weak cry, gastrointestinal symptoms, or difficulty feeding and swallowing. The Centers for Disease Control and Prevention recommends that if the decision is made to temporarily stop breastfeeding, the mother should express her milk and discard it until she receives the antitoxin. Breastfeeding can continue while receiving botulinum antitoxin. Monitor breastfed infants for signs of adverse impacts from botulinum antitoxin including flu-like symptoms, such as fevers, chills, and malaise.

Effects on the breastfed infant

The three breastfeeding women who safely breastfed their children while ill with botulism are briefly described in the literature. One mother with severe type A foodborne botulism breastfed her infant aged 8 months while acutely ill with cranial nerve palsies, weakness, and shortness of breath that required intubation and respiratory support for 2 weeks. Neither C. botulinum nor botulinum toxin were identified in her breastmilk, which was obtained for testing on the third day of her illness, 4 hours after she received trivalent ABE botulinum antitoxin. The infant was reportedly breastfed throughout the mother’s illness, including before the mother received antitoxin, and did not develop any signs or symptoms of botulism. The infant did not receive antitoxin, C. botulinum was not identified in the infant’s stool, and botulinum toxin was not identified in the infant’s stool or serum collected on the third day of the mother’s illness. Another case involved an infant aged 2 months who breastfed while the mother was acutely ill with botulism. The mother was reported to have died from type A botulism; however, the signs and symptoms she experienced were not specified. The infant did not develop any signs or symptoms of botulism. The study did not specify whether the infant received testing. Another infant aged 2 months breastfed without becoming symptomatic while the mother was acutely ill with type B botulism. The mother had cranial nerve palsies and generalized weakness, and required a tracheostomy. The infant received antitoxin (timing of antitoxin not specified) and remained asymptomatic. The study did not specify whether the infant received testing.[2,3]

Effects on milk supply

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

Levels in milk

Maternal Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. The mother was given 2 vials of trivalent botulism antitoxin, 1 intravenously and 1 intramuscularly. A milk sample obtained 4 hours after administration of the antitoxin had no detectable botulinum toxin nor botulism organisms.[1]

Infant Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. No botulinum toxin was detected in the infant’s blood or stool on the day the mother was admitted to the hospital and no botulism organisms were detected in the infant’s stools.[1]