Breastfeeding With Rheumatoid Arthritis

Women with rheumatoid arthritis (RA) and other rheumatic conditions who want to breastfeed their newborns can do so.

• Consult your doctor before starting.
• RA is not transmitted through breast milk or delivery.
• RA does not affect the quality of breast milk.
• Some RA medications may be secreted in breast milk and should be discussed with your doctor.
• Breastfeeding offers benefits for the mother and baby.

The benefits of breastfeeding include:

• Reduces the risk of ovarian and breast cancer.
• Provides ideal nutrients for the baby.
• Develops a bond between the woman and her baby.
• Helps mothers deal with postpartum blues.

Does breastfeeding help prevent rheumatoid arthritis?

Recent studies found that longer breastfeeding duration decreases the risk of rheumatoid arthritis (RA) in babies. Initial studies suggesting increased risk of RA in mothers might be due to genetic factors.

For women with pre-existing RA, the first three months after delivery may cause flare in symptoms. Some women experience relief.

Women who breastfeed for one to two years have a 20-50% reduced risk of RA compared to those who do not breastfeed at all.

Does breastfeeding cause joint pain?

Joint soreness in breastfeeding mothers is common due to joint and muscle tension, fatigue, and hormonal changes.

Women with RA may have increased joint pain and discomfort while breastfeeding.

To alleviate joint pain, adopt comfortable positions and seek guidance from an occupational therapist.

QUESTION

Which drugs are safe for breastfeeding women with rheumatoid arthritis?

Some medications are excreted in breast milk, but their quantities are negligible when timed correctly.

The following medications are considered safe for breastfeeding women with RA:

• NSAIDs (ibuprofen and paracetamol)
• Low-dose prednisone
• Hydroxychloroquine (HCQ)
• Sulfasalazine
• Cyclosporine
• Colchicine
• Tacrolimus
• Low-dose aspirin
• Intravenous immune globulin
• TNF inhibitors (caution advised)

Certain drugs are generally avoided during breastfeeding:

• Methotrexate
• Leflunomide
• Cyclophosphamide
• Mycophenolate mofetil

Some drugs have limited safety data, and their usage should be determined by a doctor.

Drugs That Slow Down RA’s Progress

Can rheumatoid arthritis affect pregnancy?

Rheumatoid arthritis (RA) affects pregnancy in various ways.

Most pregnant women with RA have low disease activity and some achieve remission. Complications such as preterm birth, preeclampsia, and low birth weight are possible.

How does pregnancy affect rheumatoid arthritis?

Pregnancy improves RA symptoms due to hormonal changes, immune system suppression, and anti-inflammatory substances.

What do pregnant women with rheumatoid arthritis need to know?

Pregnant women with RA should take precautions such as managing blood sugar and pressure levels, taking calcium and vitamin D, and using mercury-free fish oil.

Gum disease should be monitored, as it can increase the chance of preterm birth.

Does rheumatoid arthritis increase the chance of pregnancy complications?

Women with poorly managed RA have a higher risk of early delivery, low birth weight, preeclampsia, and cesarean section delivery.

What effect does rheumatoid arthritis have on the baby?

Rheumatoid arthritis may lead to low birth weight and a small percentage of birth defects. Precautions should be taken, and medications might need to be discontinued before conception.

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References:

1. Rheumatoid arthritis and pregnancy. Available at: https://emedicine.medscape.com/article/335186-questions-and-answers

2. Silman A, Kay A, Brennan P. Timing of pregnancy in relation to the onset of rheumatoid arthritis. Arthritis Rheum 1992; 35:152.

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4. Rheumatoid Arthritis and Pregnancy. Available at: https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning/rheumatoid-arthritis-and-pregnancy

5. Breastfeeding Helps Avoid Rheumatoid Arthritis. Available at: https://www.webmd.com/rheumatoid-arthritis/news/20041104/breastfeeding-helps-avoid-rheumatoid-arthritis#:~:text=Nov.,woman’s%20risk%20for%20rheumatoid%20arthritis.

6. Akasbi N, Abourazzak FE, Harzy T. Management of pregnancy in patients with rheumatoid arthritis. OA Musculoskeletal Medicine. 2014;2(1):3.

7. Wambach and Spencer, Breastfeeding and Human lactation 6e, 2020 p 530

8. Breastfeeding Answers Made Simple, Mohrbacher, 2010, p 766

9. Dr Jack Newman’s Guide to Breastfeeding, 2014, p. 234

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11. Hampl and Papa, Breastfeeding-related onset, flare, and relapse of rheumatoid arthritis, Nutrition Reviews, 2009

12. Brennan and Silman, Breastfeeding and the onset of rheumatoid arthritis, Arthritis Rheum. 1994

13. Maternal Autoimmune Disorders and Breastfeeding, Breastfeeding USA, Shimamto, 2014

14. Jacobson et al, Perinatal characteristics and risk of rheumatoid arthritis, British Medical Journal, 2003

15. Jacobson et al, Perinatal characteristics and risk of rheumatoid arthritis, British Medical Journal, 2003