Breastfeeding and Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder where the body’s immune system attacks body tissues. Normally, our immune system makes antibodies that attack bacteria and viruses, to help protect the body against infection. If you have rheumatoid arthritis, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint causing pain and inflammation, stiffness and damage. Autoimmune disorders are more common in women than men and there are many different kinds.

The following article explains more about autoimmune disorders including the many different types and their effects on pregnant and breastfeeding women;

Can breastfeeding help prevent rheumatoid arthritis?

Studies have shown that the process of breastfeeding can help to protect mothers from developing autoimmune disorders such as rheumatoid arthritis and lupus and that the longer a mother breastfeeds the more protection she might have (Mohrbacher, 2010).

Pikwer and colleagues looked at whether breastfeeding could affect the future risk of getting rheumatoid arthritis. In a study published in 2009 they found that the longer women had breastfed their babies, the less likely they were to get rheumatoid arthritis. Mothers who breastfed for 13 months or more were found to be half as likely to get rheumatoid arthritis as those women who never breastfed, while breastfeeding for up to 12 months gave women 25 percent less chance of having this condition. The study did not find a reduced risk of getting rheumatoid arthritis from taking oral contraceptives. They also didn’t find a protective factor with the more children a mother had.1

Can breastfeeding help my symptoms of rheumatoid arthritis or will it make them worse?

You may have been told that breastfeeding will make your symptoms worse because of the hormones involved in making milk. However the information available seems to suggest the opposite may be true; that breastfeeding can reduce the symptoms of rheumatoid arthritis.

  • Many mothers with rheumatoid arthritis enjoy a break from symptoms (a remission) during their pregnancy continuing until their baby is three or four months old.  If the mother has been breastfeeding she may wonder if breastfeeding has caused her symptoms to return but for many mothers the hormonal changes of breastfeeding can help lengthen their remission (Breastfeeding Answers Made Simple, 2010, p 766).
  • The hormonal changes involved in breastfeeding can reduce the symptoms of chronic illnesses such as rheumatoid arthritis, multiple sclerosis, lupus, and diabetes. Some enjoy a temporary remission (Womanly Art of Breastfeeding, 2010, p. 362).
  • Many doctors feel that rheumatoid arthritis is worsened by breastfeeding however there isn’t any evidence for this. Some chronic illnesses such as rheumatoid arthritis and multiple sclerosis improve during pregnancy and get worse after the baby is born, so it may not be breastfeeding that causes a relapse. ( Dr Jack Newman’s Guide to Breastfeeding, 2014, p. 234)

Can breastfeeding with autoimmune disease be harmful to my baby?

Jack Newman a Canadian paediatrician and breastfeeding author explains why it is not possible to pass on an autoimmune disease such as rheumatoid arthritis or lupus to your baby by breastfeeding.

Sometimes a mother with an autoimmune disease (such as lupus erythematosis) caused by antibodies in her own body attacking her own tissues is told that she should not breastfeed because the antibodies will enter the milk and attack the baby’s tissues. This is nonsense, and it’s easy to see why. The antibodies in the blood of a mother with lupus do not have the special secretory chain that allows them to get into the milk. If the antibody did get into the milk, it doesn’t have the J chain, so it would be digested in the baby’s gut. If, by some miracle, the antibody survived digestion, it would not be absorbed by the baby. This is also true of antibodies that cause other autoimmune diseases such as autoimmune thyroid disease, idiopathic thrombocytopenic purpura, rheumatoid arthritis, etc.

And Nancy Mohrbacher offers several references in Breastfeeding Answers Made Simple arriving at the same conclusion, sharing that Swedish and U.S. research show that breastfed babies are less likely to contract these autoimmune disorders than babies not breastfed2.

Breastfeeding and rheumatoid arthritis—caring for your baby

The article below from LLLI talks about the different types of arthritis, the challenges mothers face, and gives an overview of types of medications that may be offered. In the following excerpt ideas are given to help with carrying your baby and positioning for breastfeeding when coping with the pain of arthritis.

Pain in the Upper and Lower Extremities
Proper positioning is important for all breastfeeding mothers, but it is even more so for a mother with arthritis or fibromyalgia. This mother needs to position her baby in a way that does not stress the muscles or joints of her upper and lower body. The use of pillows, footstools, and other supports may be necessary so that the mother does not stress her hands, wrists, elbows, shoulders, neck, hips, or knees. Carrying the baby may also stress these joints. A front-pack that causes the mother to lean forward might not be useful for long. A baby sling is helpful until the baby gets too heavy, then she may have to shift to a carrier that takes most of the weight in her hips. A baby car seat with a carrying handle may be very difficult to use. A mother may also need to give special consideration to the paraphernalia that she carries with her when she goes out with her baby.

Your IBCLC will be a good person to help you find the most comfortable positions for feeding your baby, while your health care professionals will be able to advise on whether exercises, stretches or physiotherapy may be helpful for your situation and discuss medications.

Medications compatible with breastfeeding

Dr Jack Newman discusses the compatibility of drugs that may be prescribed for symptoms of rheumatoid arthritis (see extract below). Bear in mind only your own doctor will know which drugs are appropriate for you according to your personal medical history. Your health professional can check the safety of these or other drugs in Medications & Mothers’ Milk, by Thomas Hale, 2014 or online at Medsmilk, Lactnet or e-lactancia.

There are several drugs that mothers can take while continuing breastfeeding. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are safe. The monoclonal antibodies such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) are extremely unlikely to get into the milk because of their very large size, so they are safe to take during breastfeeding no matter what the manufacturers say. With regard to some of the other drugs, there are differing opinions. One authority states that gold injections are not compatible with breastfeeding while another says they are. One says that hydroxychloroquine (Paquenil) is compatible with continued breastfeeding; the other says it’s not. I believe both gold and hydroxychloroquine are definitely compatible with breastfeeding. If there is concern, drug levels in the milk can be measured.

Pain relief

Breastfeeding Network has a guide to the compatibility of pain killers while breastfeeding see:

A note on alfalfa

In The Breastfeeding Mother’s Guide to Making More Milk the authors caution against taking alfalfa (a popular galactagogue) if you have an autoimmune disorder saying “alfalfa seeds and sprouts, including tablets, contain L-canavanine, which has been found to cause or exacerbate lupus symptoms” (West and Marasco, 2009).

*Book extracts reproduced by permission from Pinter & Martin.

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