Breastfeeding With Rheumatoid Arthritis

Women with RA who want to breastfeed their newborns are generally able to do so. 

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

• You must always consult your doctor before you start the process.
• RA is not an infectious disease. It cannot be transmitted from a mother to her baby during delivery or through breast milk.
• RA does not affect the quality of your breast milk.
• However, certain medications taken for RA may be secreted in your breast milk. These medicines may cause ill effects in the newborn. Hence, you need to discuss this with your doctor. 
• Breastfeeding offers numerous benefits for the mother and her baby. Hence, women with RA are encouraged to breastfeed their newborns wherever possible.

The benefits of breastfeeding include the following:

• Reduces the risk of ovarian and breast cancer in women
• Provides an ideal source of nutrients for the baby
• Develops a bond between the woman and her baby (due to the physical closeness, skin-to-skin touching, and eye contact with the baby)
• Helps mothers deal with postpartum blues.

Recent studies have found that the longer the history of breastfeeding, the less is the risk of rheumatoid arthritis (RA) in the baby. Breastfeeding may protect the baby against RA in later life. Earlier studies suggested that breastfeeding increases the risk of RA in the mother but that might be due to the genetic makeup making the women more likely to get flare after the pregnancy.

For women already affected with RA before their delivery/pregnancy, the first three months after delivery can cause a flare in RA symptoms. However, scientists are still unsure if breastfeeding further increases this risk. Some women report relief in their symptoms after delivery.

A study found that women who breastfed their babies for one to two years exhibited a 20% reduced risk of RA compared with those who did not breastfeed at all. Breastfeeding for at least two years reduced the risk of RA by almost half.

Soreness in your joints commonly results from joint tension, muscle tension, and fatigue, which are no strangers to breastfeeding mothers.

Women with RA are slightly more affected with the following issues:

• Flares in rheumatoid arthritis (RA) after delivery are common due to hormonal changes. 
• Sitting in an uncomfortable position can make women’s joints hurt more if they have RA and vice versa (RA can make breastfeeding difficult for women due to the painful joints). 

Women can avoid joint aches by adopting certain positions that put less pressure on their joints, such as:

• Reclining positions or side-lying on a bed
• Making use of cushions, pillows, or blankets to support a mother’s arms and/or baby
• Taking the support of a footstool or other forms of support
• Consulting an occupational therapist will help new mothers to choose the best positions for breastfeeding.

Some of the medicines are found to be excreted in breast milk, but their quantities differ. Women should pump their milk just before they take medicines so that the amount of medicine in the milk is negligible.

There are several medications prescribed for rheumatoid arthritis (RA) that are considered safe for breastfeeding women, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and paracetamol
• Prednisone in low doses (20 mg/day) (At higher doses, women should pump and discard breast milk that is produced during the first four hours after taking the tablet)
• Hydroxychloroquine (HCQ)
• Sulfasalazine
• Cyclosporine
• Colchicine
• Tacrolimus
• Aspirin in low doses (81 mg/day)
• Intravenous immune globulin
• Tumor necrosis factor (TNF) inhibitors such as etanercept, infliximab or adalimumab have limited safety data and should be avoided wherever possible.

Certain drugs used for RA are generally avoided during breastfeeding, such as:

• Methotrexate
• Leflunomide 
• Cyclophosphamide
• Mycophenolate mofetil

Reports suggest that certain drugs such as Rituxan (rituximab), Kineret (anakinra), and Orencia (abatacept) have shown no adverse effects on the baby during breastfeeding. However, there is a lack of long-term safety data, and doctors prescribe these drugs with caution. Hence, only the doctor can decide the most appropriate drug for a breastfeeding woman with RA.

RA affects pregnancy in various ways.

Yes, rheumatoid arthritis (RA) affects pregnancy. Most of the pregnant women with RA have low disease activity during pregnancy (60%) and may achieve remission by the third trimester as well. Few women may have worse or high disease activity.

RA can lead to complications like preterm birth, raised blood pressure (preeclampsia), and low birth weight babies.

Overall, the women who have well-controlled RA have healthier pregnancies and newborns compared to women with active disease.

Researchers state the various factors that improve the symptoms of rheumatoid arthritis in pregnancy:

• Overall suppression of the immune system to prevent seeing the fetus as a foreign object
• Hormonal changes that decrease disease activity during pregnancy
• Increased level of anti-inflammatory substances in the blood that reduce inflammation and pain
• Decreased levels of reaction causing proteins in the blood
• Decreased white blood cell function during pregnancy

The overall suppression of the immune system and the release of anti-inflammatory decrease the RA activity in pregnant women. It also reduces inflammation and pain during pregnancy.

Women with rheumatoid arthritis should take special precautions during pregnancy:

• Taking steroids may increase the risk of increased blood sugar and blood pressure levels. High blood pressure and high blood sugar can cause preeclampsia and gestational diabetes, respectively. These can be life-threatening and increase the risk for mothers and babies.
• Prednisone increases the risk of bone loss; hence, taking calcium and vitamin D is essential.
• Take mercury-free fish oil to fight inflammation.
• There might be an increased risk of gum disease in women with RA. Gum disease can increase the chance of preterm birth.

Women with poorly managed RA are at higher risk for early delivery (delivery before 37 weeks) and low birth weight babies. This can increase the possibility of health problems in the newborn. RA can also increase the probability of extremely high blood pressure and protein loss through urine (preeclampsia). Women with moderate to high disease activity have reported undergoing cesarean section delivery.

RA may lead to low birth weight babies. Of the newborns, 3-5% may have birth defects. There are a few antirheumatic drugs that have the potential to cause birth defects. However, most of the time, pregnant women with RA have healthy pregnancies and babies provided adequate precautions have been taken. A few drugs may need to be discontinued well before conception. Consult with your doctor before you plan a baby.