Ciguatera Poisoning and Breastfeeding

Summary of use during lactation

Ciguatera toxin is created in tropical reef-dwelling fish that ingest toxins from algal blooms produced by the dinoflagellate Gambierdiscus toxicus. The main toxin appears to be ciguatoxin, although maitotoxin has also been implicated. Ciguatera can present initially with gastrointestinal or neurological symptoms, such as paresthesia of the extremities and around the mouth. Although the fatality rate is low, neurologic effects can last for weeks. Mothers suspected of having ciguatera poisoning should not breastfeed until they have recovered.

Drug levels in milk and infant serum

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

Effects in breastfed infants

A review of 12,890 cases in French Polynesia from 1964 to 1986 found 3 breastfed infants between 6 and 10 months of age who were affected following maternal poisoning.[1] Another case of a breastfed infant under 3 months of age was reported in 1989 from Hawaii, in which green stools were the primary symptom. Breastfeeding was discontinued with improvement. Symptoms reappeared when breastfeeding was resumed a few days later.[2] Because of the time between exposures, it is unclear if ciguatera toxin was the offending agent. A 4-month old who was breastfed 1 and 4 hours after maternal ingestion of a kingfish occurred in the Bahamas. Symptoms included colic, and diarrhea persisting for 48 hours beginning about 10 hours after the first nursing. This was followed by fine maculopapular rash and fussiness that lasted for 2 weeks.[3]

Effects on lactation and breastmilk

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

References

1. Bagnis RA, Legrand AM. Clinical features on 12,890 cases of ciguatera (fish poisoning) in French Polynesia. In, Gopalakrishnakone P, Tan CK, eds Progress in venom and toxin research: Proceedings of the First Asia-Pacific Congress on Animal, Plant, and Microbial Toxins Singapore June 24-27, 1987:372-84.
2. Anon. Letter to the editor. Vet Hum Toxicol 1989;31:71.2711614 PubMed
3. Blythe DG, de Sylva DP. Mother's milk turns toxic following fish feast. JAMA 1990;264:2074.2214071 PubMed