The Basics
What is Dinoprostone?
Used to prepare the cervix for the induction of labor in pregnant women who are at or near term.
Brand names for Dinoprostone
Cervidil
How Dinoprostone is classified
Oxytocics, Prostaglandins
Dinoprostone During Pregnancy
Dinoprostone pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Dinoprostone while pregnant
CERVIDIL is indicated for the initiation and/or continuation of cervical ripening in pregnant women at or near term in whom there is a medical or obstetrical indication for the induction of labor. Fetal, neonatal, and maternal risks are discussed throughout the labeling. Limited available data with CERVIDIL use in pregnant women do not show a clear association with adverse developmental outcomes. Relevant animal reproduction data with dinoprostone is not available.
Taking Dinoprostone While Breastfeeding
What are recommendations for lactation if you're taking Dinoprostone?
Dinoprostone (prostaglandin E2) has not been measured in human milk after exogenous administration, but it is a normal component of breastmilk in small amounts where it may help protect the infant’s gastrointestinal tract. Use of vaginal dinoprostone to induce labor appears to have a negative effect on breastfeeding. Given orally in the first few days postpartum, dinoprostone can suppress lactation. Whether postpartum vaginal or endocervical administration suppresses lactation is not known, but it should probably not be used postpartum in mothers who wish to breastfeed. By one month postpartum, the drug appears not to suppress lactation.
Maternal / infant drug levels
Dinoprostone (prostaglandin E2) has not been measured in human milk after exogenous administration, but it is a normal component of breastmilk in small amounts where it may help protect the infant’s gastrointestinal tract. Use of vaginal dinoprostone to induce labor appears to have a negative effect on breastfeeding. Given orally in the first few days postpartum, dinoprostone can suppress lactation. Whether postpartum vaginal or endocervical administration suppresses lactation is not known, but it should probably not be used postpartum in mothers who wish to breastfeed. By one month postpartum, the drug appears not to suppress lactation.
Possible effects of Dinoprostone on milk supply
A retrospective cohort study of birth records in Cardiff, Wales, UK found that the use of vaginal prostaglandins for the induction of labor resulted in an 11% decrease in the likelihood that mothers would be breastfeeding at 48 hours postpartum. The subgroup of first-time mothers had a 15% decrease.[10]
A nonrandomized prospective study compared women who had spontaneous deliveries with those who had elective induction using dinoprostone vaginal gel. At hospital discharge, exclusive breastfeeding rates were similar between the two groups (88% and 89%). However, at 1 and 3 months postpartum, exclusive breastfeeding rates were significantly lower in mothers who had dinoprostone induction than in those who delivered spontaneously. Exclusive breastfeeding rates were 54% and 85% at 1 month and 46% and 59% at 3 months postpartum, respectively. Rates of supplemental and exclusive formula feeding were higher in the induced mothers at both time points also.[11]
Dinoprostone has been used investigationally to inhibit postpartum lactation and engorgement by reducing serum prolactin concentrations.[12][13][14][15][16] The effect on prolactin levels, engorgement and lactation appears to be dose and duration related. Oral dosages of 3 mg daily for 4 days[17] or 0.5 mg three times daily were ineffective,[16] whereas oral dosages of 8 to 12 mg over 24 to 30 hours were effective.[12][14] These effects seem to be limited to the first few days postpartum; dinoprostone had no effect on serum prolactin or milk production when given to women 30 days postpartum.[12] Compared to oral bromocriptine 2.5 mg every 12 hours for 14 days, dinoprostone 12 mg orally in divided doses over 30 hours was as effective as bromocriptine, but resulted in less rebound breast tenderness.[14]
Possible alternatives to Dinoprostone
None listed
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Lucas A, Mitchell MD. Prostaglandins in human milk. Arch Dis Child. 1980;55:950-2. PMID: 7458394
2. Neu J, Wu-Wang CY, Measel CP, Gimotty P. Prostaglandin concentrations in human milk. Am J Clin Nutr. 1988;47:649-52. PMID: 3162635
3. Hawkes JS, Bryan DL, James MJ, Gibson RA. Cytokines (Il-1beta, Il-6, TNF-alpha, TGF-beta1, and TGF-beta2) and prostaglandin E2 in human milk during the first three months postpartum. Pediatr Res. 1999;46:194-9. PMID: 10447115
4. Le Deist F, De Saint-Basile G, Angeles-Cano E, Griscelli C. Prostaglandin E2 and plasminogen activators in human milk and their secretion by milk macrophages. Am J Reprod Immunol Microbiol. 1986;11:6-10. PMID: 3461715
5. Shimizu T, Yamashiro Y, Yabuta K. Prostaglandin E1, E2, and F2 alpha in human milk and plasma. Biol Neonate. 1992;61:222-5. PMID: 1610950
6. Alzina V, Puig M, de Echaniz L et al. Prostaglandins in human milk. Biol Neonate. 1986;50:200-4. PMID: 3465374
7. Reid B, Smith H, Friedman Z. Prostaglandin in human milk. Pediatrics. 1980;66:870-2. PMID: 7454478
8. Goharkhay N, Stanczyk FZ, Gentzschein E, Wing DA. Plasma prostaglandin E(2) metabolite levels during labor induction with a sustained-release prostaglandin E(2) vaginal insert. J Soc Gynecol Investig. 2000;7:338-42. PMID: 11111068
9. Siqueira M, Neves J, Arteaga M et al. [Plasma prostaglandin E2 in pregnant women undergoing labor induction with endocervical gel application]. Rev Esp Med Nucl. 1999;18:268-71. PMID: 10481108
10. Jordan S, Emery S, Watkins A et al. Associations of drugs routinely given in labour with breastfeeding at 48 hours: Analysis of the Cardiff births survey. BJOG. 2009;116:1622-32. PMID: 19735379
11. Zanardo V, Bertin M, Sansone L et al. The adaptive psychological changes of elective induction of labor in breastfeeding women. Early Hum Dev. 2016;104:13-6. PMID: 27914274
12. Caminiti F, De Murtas M, Parodo G et al. Decrease in human plasma prolactin levels by oral prostaglandin E2 in early puerperium. J Endocrinol. 1980;87:333-7. PMID: 7452120
13. Beric B, Mitreski A, Kuzmancev O et al. [Inhibition of initial puerperal and postpartum lactation using oral prostaglandin E2 (dinoprostone)]. Med Pregl. 1992;45:421-6. PMID: 1344441
14. England MJ, Tjallinks A, Hofmeyr J, Harber J. Suppression of lactation. A comparison of bromocriptine and prostaglandin E2. J Reprod Med. 1988;33:630-2. PMID: 3172062
15. Nasi A, de Murtas M, Parodo G, Caminiti F. Inhibition of lactation by prostaglandin E2. Obstet Gynecol Surv. 1979;35:619-20. PMID: 7413116
16. Grunberger W. [Postpartum uterus involution and lactation levels in randomized comparison between prostin E2 tablets and methergine dragees]. Gynakol Rundsch. 1983;23:100-7. PMID: 6347832
17. Tulandi T, Gelfand MM, Maiolo LM. Effect of prostaglandin E2 on puerperal breast discomfort and prolactin secretion. J Reprod Med. 1985;30:176-8. PMID: 3858547
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
