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 said to be an “autoimmune disorder”—one of a group of disorders associated with inflammation in the body.1 This article looks at frequently asked questions surrounding breastfeeding and rheumatoid arthritis.
What is an autoimmune disorder?
An autoimmune disorder is usually described as one where the body’s immune system apparently mistakes body tissues as foreign and attacks them causing inflammation. Factors that may be involved in triggering or exacerbating prolonged or severe inflammation could include dietary factors (nutritionally poor diet/deficiency in key vitamins or minerals/food allergies/pesticides) and exposure to environmental chemicals, solvents and medications that cause side effects in the body.2 34
Types of autoimmune disorder
Various disorders are classed as autoimmune disorders including; 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 are said to affect more than one body part e.g. systemic lupus erythematous (SLE or lupus) and type one diabetes.
In rheumatoid arthritis inflammation in the tissue surrounding the joints causes pain, stiffness and damage which may eventually damage the bone and cartilage. There can be an increased risk of rheumatoid arthritis if you are a woman, have a family history of the condition and/or if you smoke (NHS, 2019).
Can pregnancy affect rheumatoid arthritis?
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.56 However some mothers may have more severe symptoms (possibly thought related to changes in medication during pregnancy).7
Return of rheumatoid arthritis after pregnancy
After pregnancy, rheumatoid arthritis may flare up again (relapse) in 39-62% of cases (Wambach and Spencer, 2021). The flare up may be two to three months after delivery and may be related to the change in hormonal balance following pregnancy (nras.org, 2019).
New onset rheumatoid arthritis post partum
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 the cause for this is unknown (Akasbi et al, 2014). Several studies indicate that breastfeeding may give protection against rheumatoid arthritis in later life (see below).
Will breastfeeding worsen my existing symptoms of rheumatoid arthritis?
Irrespective of feeding choices there can be a remission (disappearance) of symptoms while pregnant with a relapse after the baby is born (Wambach and Spencer, 2021). There is no evidence that rheumatoid arthritis is worsened by breastfeeding for most mothers. Information available in breastfeeding resources includes:
Symptoms of rheumatoid arthritis may be improved for some women
The hormonal changes of breastfeeding may help lengthen the pregnancy related break in symptoms for some women,89 and some mothers find the symptoms of their chronic illnesses such as rheumatoid arthritis, multiple sclerosis, lupus, and diabetes are not as bad while they are breastfeeding.10
Breastfeeding may worsen symptoms in genetically susceptible women
Although some mothers may experience a break in symptoms while breastfeeding, Olsen et al hypothesised there may be a connection between breastfeeding and a higher risk of rheumatoid arthritis related to higher prolactin levels since prolactin is said to be pro-inflammatory.11 Other researchers qualified this connection as being only in a small group of genetically susceptible women, particularly following a first pregnancy.1213 Shimamoto queries the quality of these studies as the exclusivity of breastfeeding was not clearly defined.14
Can breastfeeding help prevent rheumatoid arthritis in nursing mothers?
Studies have shown that breastfeeding may 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.15
In one 2009 study, Pikwer and colleagues 16 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. 17 1819
Can breastfeeding help prevent babies from developing rheumatoid arthritis in later life?
Jacobson et al 20 found that rheumatoid arthritis was associated with low breastfeeding frequency suggesting breastfeeding may protect the baby against rheumatoid arthritis in later life. One study did not find any association between being breastfed as a baby with the occurrence of lupus.21
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.
How can I manage breastfeeding with rheumatoid arthritis?
Due to joint pain, mothers with rheumatoid arthritis can find it difficult to hold baby comfortably during breastfeeding. 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. Ideas include:
- Positions where the mother’s body or bed takes the baby’s weight rather than her hands, wrists, arms or elbows, for example reclining positions or side lying on a bed.
- Using rolled up blankets, cushions or pillows to support a mother’s arms and/or baby can be helpful. A foot stool or other forms of support may also be useful to improve comfort levels and avoid stress to muscles and joints.
Caring for baby
Carrying a baby around can be difficult when a mother’s movement is impaired. Baby slings and car seats may be difficult to manage.22 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.
Are medications compatible with breastfeeding?
Many of the drugs used for rheumatic disease are compatible with breastfeeding.2324
The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) have produced guidelines on prescribing drugs in pregnancy and breastfeeding in two documents:
- British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology 02 November 2022.
- British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice. Rheumatology 02 November 2022.
Parents and health professionals can check the compatibility of any medication with breastfeeding in several places online e.g. at Halesmeds.com [paywall], Lactmed or e-lactancia and The Breastfeeding Network ( a breastfeeding charity in UK) has a guide to the compatibility of pain killers while breastfeeding see Analgesics (Pain killers) and Breastfeeding, 2021.
The following article from 2014 explains more about autoimmune disorders including the many different types and their effects on pregnant and breastfeeding women;
Rheumatoid arthritis is described as an autoimmune disorder that causes inflammation of the joints. Several studies indicate that breastfeeding may help reduce the risk of rheumatoid arthritis developing in later life for both mother and baby. It is not thought that choosing to breastfeed will worsen existing symptoms of rheumatoid arthritis for most mothers. A baby can’t catch rheumatoid arthritis by breastfeeding. Several medications prescribed for symptoms of rheumatoid arthritis are said to be compatible with breastfeeding.
*Book extracts reproduced by permission from Pinter & Martin.