Mastitis is an inflammation of the breast tissue, sometimes involving a bacterial infection. While most frequently associated with the postpartum period and active breastfeeding, mastitis can occur before giving birth. Mastitis that develops during pregnancy is considered a form of non-puerperal mastitis, meaning it is not related to the typical challenges of lactation and milk stasis. This antenatal occurrence is significantly less common than mastitis seen after delivery, but inflammation can still develop in the rapidly changing breast tissue.
Understanding Mastitis Occurrence Before Birth
The development of mastitis before birth is rare, contrasting sharply with the commonality of puerperal mastitis following delivery. Puerperal mastitis is primarily driven by milk stasis, or ineffective drainage of milk, which allows bacteria to multiply. Antenatal mastitis, however, occurs without the stimulus of full milk production.
During pregnancy, breast tissue undergoes profound changes in preparation for lactation, including the proliferation of mammary ducts and glands. Hormonal shifts increase secretory activity, leading to the accumulation of various secretions within the ducts. This combination of structural growth and increased ductal fluid creates a potential pathway for inflammation and infection.
The breast is already primed with increased blood flow and glandular activity, making it susceptible to blockages and subsequent bacterial overgrowth. Recognizing this distinction is important, as the underlying mechanisms and potential complications during pregnancy require specific attention.
Recognizing the Symptoms and Underlying Causes
Mastitis in pregnancy presents with signs that often begin abruptly, typically affecting only one breast. A pregnant person may first notice a localized area of the breast that is painful, swollen, and feels warm to the touch. This inflamed region can appear as a red, wedge-shaped area of erythema, though this redness may be more difficult to detect on darker skin tones.
Systemic symptoms often accompany the localized breast pain, mimicking the flu. These can include a sudden onset of fever, chills, and generalized body aches or fatigue. It is important to distinguish these symptoms from the normal, generalized breast tenderness and growth commonly experienced throughout pregnancy, which is not usually accompanied by a high fever or concentrated area of redness and hardness.
The primary underlying cause of antenatal mastitis is often a bacterial infection that enters the breast tissue through a break in the skin, such as a minor abrasion on the nipple or areola. The most common culprit is the bacterium Staphylococcus aureus, a normal skin flora that can become pathogenic when it gains access to the ducts. Hormonal changes contribute by causing duct ectasia, where the milk ducts widen and become clogged with thick secretions, creating an ideal breeding ground for these bacteria. In rare instances, a clinician may investigate other causes, including inflammatory carcinoma, especially if the mastitis does not respond to initial treatment.
Safe Medical Treatment During Pregnancy
Immediate medical evaluation is necessary for suspected mastitis during pregnancy to prevent the infection from worsening or progressing to an abscess. Untreated infection poses risks to both the pregnant person and the fetus, making prompt intervention a priority. Primary treatment involves antibiotics effective against the typical causative bacteria while being safe for use during gestation.
Healthcare providers commonly prescribe penicillin-based antibiotics, such as dicloxacillin or cephalexin, which are generally categorized as safe during pregnancy. For individuals with penicillin allergies, alternatives like clindamycin may be selected to effectively target the infection. It is necessary to complete the entire course of antibiotics as prescribed, even if symptoms begin to improve quickly.
Supportive care measures are incorporated to help manage discomfort and inflammation. Pregnancy-safe pain relievers, such as acetaminophen, can be used to control fever and localized pain. Applying a warm compress to the affected area helps improve blood flow and ease discomfort, though this should be balanced with cold compresses between applications to reduce swelling. If a localized collection of pus, or an abscess, forms, a medical procedure to drain the fluid, often guided by ultrasound, is performed to resolve the infection.