Women with systemic lupus erythematosus (SLE) did not breastfeed at lower rates than the general population but had a higher prevalence of discontinuation within 3 months, according to study results published in Lupus.

Researchers noted that smoking, body mass index (BMI), and joint involvement were positively associated with the cessation of breastfeeding, whereas hydroxychloroquine use and disease duration during postpartum were positively associated with a longer breastfeeding duration.

Limited data are available on breastfeeding in women with SLE. In the current cross-sectional study, the researchers aimed to evaluate breastfeeding prevalence, duration, and associated factors among a cohort of women with SLE.


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Pregnant women with SLE were enrolled in the study between 2008 and June 2019. Researchers collected information on demographics, medical history, obstetric history, delivery method, and fetal outcomes. They also collected breastfeeding data, including intent, duration, use of formula, and reason for cessation, via a questionnaire. Disease activity in the 6 months before and during pregnancy were determined using the Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus Erythematosus Pregnancy Disease Activity Index, respectively. Disease flare was also measured during and after pregnancy.

A total of 43 women and 57 pregnancies were included in the study. Most women (96.5%) intended to breastfeed their child, and 71.9% initiated breastfeeding. Factors associated with nonbreastfeeding included caesarean section (P =.0001), intrauterine growth restriction (IUGR) below the fifth percentile (P =.004), and disease relapse after pregnancy (P =.0001). Using a cutoff of 6 months, factors associated with discontinuation of breastfeeding included smoking (P =.02), caesarean section (P =.009), difficulty initiating breastfeeding (P =.0001), and a higher BMI (P =.0001). Using a cutoff of 3 months, disease flare with joint involvement, especially of the wrists and small joints, was also associated with breastfeeding cessation (P =.004).

Two factors were positively associated with the continuation of breastfeeding. The first was hydroxychloroquine treatment, which is known to benefit the mother and child during and after pregnancy. The second factor was disease duration, which may reflect greater disease stability in patients with a longer duration of SLE.

Study limitations included small sample size and the lack of a control group.

“Our study provides new information about breastfeeding in women [with SLE],” the researchers concluded. “We found for the first time a positive correlation between hydroxychloroquine treatment and breastfeeding duration, underlying the relevance of this treatment even during postpartum. Our results could be useful for the clinicians to support mothers [with SLE] and promote longer breastfeeding duration, acting on modifiable factors, such as lifestyle, and postpartum treatment.”

Reference

Orefice V, Ceccarelli F, Pirone C, et al. Breastfeeding in women affected by system lupus erythematosus: Rate, duration and associated factors. Lupus. Published online February 20, 2021. doi:10.1177/0961203321995263