International Board of Certified Lactation Consultant (IBCLC) Practice Exam

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Which factor is least likely to affect drug transfer into breast milk?

  1. Maternal age

  2. Drug molecular weight

  3. Protein binding

  4. Lipid solubility

The correct answer is: Maternal age

Maternal age is least likely to influence the transfer of drugs into breast milk because the physiological aspects that directly impact drug pharmacokinetics are more closely linked to drug characteristics and the maternal body’s metabolic processes rather than age itself. Factors such as drug molecular weight significantly impact how readily a drug can cross biological membranes, which is critical in determining whether it will enter breast milk. Generally, drugs with a lower molecular weight are more likely to transfer into breast milk. Protein binding plays a crucial role as well; drugs that are highly protein-bound in the maternal serum typically have a lower concentration in breast milk. This binding affects the free (active) fraction of the drug that can cross into breast milk. Lipid solubility is another significant factor since lipophilic (fat-soluble) drugs can more easily pass through the lipid membranes of mammary glands, leading to a higher concentration in breast milk. In contrast, maternal age does not have a direct effect on these pharmacokinetic properties. While factors such as aging may lead to changes in metabolic processes or body composition over time, the direct mechanisms of drug transfer concerning molecular weight, protein binding, and lipid solubility remain more pertinent in the context of lactation.