Can you breastfeed with rheumatoid arthritis?
- 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 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:
Does breastfeeding help prevent rheumatoid arthritis?
Recent studies have found that longer the history of breastfeeding, 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.
Does breastfeeding make your joints hurt?
Soreness in your joints commonly results from joint tension, muscle tension and fatigue, which are not strangers to breastfeeding mothers. Women with RA 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. These can be as follows:
Which drugs are safe for breastfeeding women with rheumatoid arthritis?
Some of the medicines are found to be excreted in the 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. These include the following:
- 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)
- 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. Some of these include the following:
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.
Rheumatoid Arthritis Resources
Health Solutions From Our Sponsors
Silman A, Kay A, Brennan P. Timing of pregnancy in relation to the onset of rheumatoid arthritis. Arthritis Rheum 1992; 35:152.
Guidelines for monitoring drug therapy in rheumatoid arthritis. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Arthritis Rheum 1996; 39:723.
Rheumatoid Arthritis and Pregnancy. Available at: https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning/rheumatoid-arthritis-and-pregnancy
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.
Akasbi N, Abourazzak FE, Harzy T. Management of pregnancy in patients with rheumatoid arthritis. OA Musculoskeletal Medicine. 2014;2(1):3.
Wambach and Spencer, Breastfeeding and Human lactation 6e, 2020 p 530
Breastfeeding Answers Made Simple, Mohrbacher, 2010, p 766
Dr Jack Newman’s Guide to Breastfeeding, 2014, p. 234
Olsen et al, Hormones, Pregnancy, and Rheumatoid Arthritis, J Gend Specif Med, 2002
Hampl and Papa, Breastfeeding-related onset, flare, and relapse of rheumatoid arthritis, Nutrition Reviews, 2009
Brennan and Silman, Breastfeeding and the onset of rheumatoid arthritis, Arthritis Rheum. 1994
Maternal Autoimmune Disorders and Breastfeeding, Breastfeeding USA, Shimamto, 2014
Jacobson et al, Perinatal characteristics and risk of rheumatoid arthritis, British Medical Journal, 2003
Raising a Baby When You Have RA. Available at: https://www.webmd.com/rheumatoid-arthritis/features/ra-raising-baby
Breastfeeding Overview. Available at: https://www.webmd.com/parenting/baby/nursing-basics#1
Positions for breastfeeding. Available at: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Positioning-Your-Baby-For-Breastfeeding.aspx
Drugs and Lactation Database (LactMed) Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/