A majority of women with rheumatic disease want to and can safely breastfeed, according to study results published in Lupus Science & Medicine. Researchers also noted that very few women with rheumatic disease required a medication that was not compatible with breastfeeding; however, a minority of patients did not continue breastfeed due to concerns about the risks of antirheumatic medications on the health of their infant.

Researchers aimed to identify the frequency and predictors of desire and ability to breastfeed in women with rheumatic diseases.

The study included pregnant women with rheumatic diseases from whom data on demographics, maternal diagnosis, and intention to breastfeed were collected. Actual breastfeeding decision was recorded postpartum. Researchers used stepwise logistic regression to identify predictors of and intention to breastfeed.


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Of the 265 women enrolled in the study, 88 were diagnosed with systemic lupus erythematosus (SLE), 33 with undifferentiated connective tissue disease (UCTD), 100 with arthritis, and 44 with other rare rheumatic conditions. Mean age of study participants was 31.3 years. There was no difference in disease activity by diagnosis, and most women had low disease activity at the postpartum visit, which was conducted at an average of 7.6 weeks after delivery.

During pregnancy, 13% of participants indicated that they would use only formula, 51% planned to only breastfeed, 28% planned to both use formula and breastfeed, and 8% were unsure if they would breastfeed. Postdelivery, 84% of women attempted to breastfeed, and at the postpartum visit, two-thirds of these women were breastfeeding. Among the women who were still breastfeeding, one-thirds were using a combination of formula and breastmilk. Breastfeeding was more common among women with UCTD and arthritis than those with SLE, and nearly all women in the study reported that they breastfed for the health of their baby and to increase bonding.

The primary reason for never breastfeeding was medication concerns; however, only 4 of the 265 women (1.5%) were taking medications that were deemed not compatible with breastfeeding at the postpartum visit. An additional 10 (3.8%) women planned to start a noncompatible medication at the postpartum visit. The majority of women in the study were prescribed compatible antirheumatic medications; 64% of women receiving lactation-compliant medications breastfed. A total of 33 women were not breastfeeding at follow-up due to medication concerns, of whom 25 had never breastfed and 8 discontinued breastfeeding. Only 2 of the 33 (6%) women were taking incompatible medications. 

The strongest predictor of actual breastfeeding was intention to breastfeed, with 94% of women who planned to breastfeed starting. Of these women, 21% had stopped breastfeeding by follow-up. Breastfeeding at follow-up was primarily predicted by intention to breastfeed (odds ratio [OR], 8.29; 95% CI 3.70-18.59). Furthermore, breastfeeding increased with maternal age (OR, 1.12; 95% CI 1.05-1.19) and decreased if a baby was born preterm (OR, 0.31; 95% CI 0.13-0.70). The likelihood of breast feeding at the postpartum visit also decreased with an increasing number of weeks between delivery and the visit (OR, 0.93; 95% CI 0.87-1.00).

The study was limited by the variation in the timing of postpartum visit, the fact that not all women completed a postpartum visit, and the lack of a control group. The study also did not include levels of medication in the breastmilk and long-term data on infant health and disease activity.

Researchers concluded, “In our cohort, the vast majority of women were on lactation-compatible medications; nonetheless, among women with rheumatic disease, actual and perceived risks of medication [affected] a woman’s breastfeeding choice.” They added, “Future interventions may increase breast feeding by directly addressing women’s concerns about breastfeeding while taking antirheumatic medications.”

Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Ikram N, Eudy A, Clowse MEB. Breastfeeding in women with rheumatic diseases. Lupus Science & Medicine. 2021;8:e000491. doi:10.1136/lupus-2021-000491