Breastfeeding and Rheumatoid Arthritis

Rheumatoid arthritis is a condition involving very painful and stiff joints such as hands, wrists, elbows, feet and knees. Rheumatoid arthritis is different to the type of arthritis that arises from wear and tear on the joints that older people can have (known as osteoarthritis). Rheumatoid arthritis is an autoimmune disorder and can affect other areas of the body not just the joints 1. This article looks at frequently asked questions surrounding breastfeeding with rheumatoid arthritis.

What is an autoimmune disorder?

An autoimmune disorder is one where, rather than attacking bacteria and viruses, the body’s immune system attacks body tissues and causes inflammation. There are many types of autoimmune disorders which can affect various parts of the body. Autoimmune disorders tend to be more common in women than men.

Types of autoimmune disorder

Autoimmune disorders include, among others, Grave’s disease or thyroiditis which affects the thyroid gland, multiple sclerosis which affects the central nervous system, inflammatory bowel disease, and psoriasis. Many autoimmune disorders affect more than one body part e.g. systemic lupus erythematous (SLE or lupus) and type one diabetes.

Rheumatoid arthritis

In rheumatoid arthritis, the immune system sends antibodies to the lining of the joints, where, instead of protecting the body from bacteria, they cause inflammation in the tissue surrounding the joint causing pain, stiffness and damage which can eventually damage the bone and cartilage.

Can breastfeeding help prevent rheumatoid arthritis in nursing mothers?

Studies have shown that breastfeeding can help to protect mothers from developing autoimmune disorders such as rheumatoid arthritis and lupus in later life, and that the longer a mother breastfeeds, the more protection she might have 2.

In one 2009 study, Pikwer and colleagues 3 found mothers who breastfed for 13 months or more were 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. Other studies found similar trends 4 5 6.

Pregnancy and rheumatoid arthritis?

An older study found a link between the number of births, and to a lesser extent breastfeeding, with the risk of developing severe rheumatoid arthritis 7. Getting symptoms of rheumatoid arthritis for the first time is said to be three to five times more common in the first six months after birth, but whether this is associated with breastfeeding is not clear 8 .

Can breastfeeding help prevent babies from developing rheumatoid arthritis in later life?

Jacobson et al 9 found that rheumatoid arthritis was associated with low breastfeeding frequency suggesting breastfeeding may protect the baby against rheumatoid arthritis in later life. Another study 10 did not find any association between being breastfed as a baby with the occurrence of lupus.

Will breastfeeding worsen my existing symptoms of rheumatoid arthritis?

Some mothers are told that breastfeeding will make their symptoms worse because of the prevalence of hormones involved in making milk. However there is currently no evidence that rheumatoid arthritis is worsened by breastfeeding for most mothers (see next section below). The information available currently indicates pregnancy tends to offer a break in symptoms and breastfeeding may help prolong this break:

  • Remission in pregnancy. Many mothers with rheumatoid arthritis (and other conditions e.g. multiple sclerosis) will enjoy a break from symptoms (a remission) during their pregnancy which may continue for four to twelve weeks after the birth 11.
  • Remission while breastfeeding. The hormonal changes of breastfeeding may help lengthen the pregnancy related break in symptoms for some women 12 13. And some mothers enjoy reduced symptoms in chronic illnesses such as rheumatoid arthritis, multiple sclerosis, lupus, and diabetes while they are breastfeeding 14.

Breastfeeding may worsen symptoms in genetically susceptible women

Although some mothers may experience a break in symptoms while breastfeeding, Olsen et al 15 suggested there may be a connection between breastfeeding (possibly related to higher prolactin levels) and a higher risk of rheumatoid arthritis. Other researchers qualified this connection as being only in a small group of genetically susceptible women, particularly following a first pregnancy 16 17. Shimamoto queries the quality of these studies as the exclusivity of breastfeeding was not clearly defined 18.

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 (2010) 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 breastfed.

Breastfeeding and rheumatoid arthritis—caring for your baby

Due to joint pain, mothers with rheumatoid arthritis can find it difficult to position themselves comfortably to breastfeed. There are lots of ways to position a baby to breastfeed including positions where your body takes the baby’s weight rather than your arms and wrists. An IBCLC lactation consultant or other breastfeeding specialist will be a great help to find the most comfortable positions to suit each individual mother and baby. The mother’s health care professionals will be able to advise on whether exercises, stretches or physiotherapy may be helpful for a particular situation and discuss medications. Kathleen Kendall-Tackett explains:

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.

Medications compatible with breastfeeding

Dr Jack Newman discusses the compatibility of drugs that may be prescribed for symptoms of rheumatoid arthritis (see excerpt 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, Lactmed 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.

If there is concern, drug levels in the milk can be measured.

Many but not all RA [rheumatoid arthritis] medications may be used during lactation with low risk to the nursing infant

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 explaining that alfalfa seeds, sprouts, and tablets, contain L-canavanine, which has been found to cause or worsen lupus symptoms.

Further reading

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

Summary

Rheumatoid arthritis is an autoimmune disorder that causes inflammation of the joints. Although more research is needed, several studies indicate that breastfeeding may help prevent rheumatoid arthritis developing in later life for both mother and baby. It is not thought that choosing to breastfeed would worsen existing symptoms of rheumatoid arthritis for most mothers, and a baby can’t catch rheumatoid arthritis by breastfeeding. Several medications prescribed for symptoms of rheumatoid arthritis are thought to be compatible with breastfeeding.

*Book extracts reproduced by permission from Pinter & Martin.

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