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 and 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.
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 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.23 However some mothers may have more severe symptoms (possibly related to changes in medication during pregnancy).4
Return of rheumatoid arthritis after pregnancy
After pregnancy, rheumatoid arthritis can flare up again in 39-62% of cases (Wambach and Spencer, 2020). 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, 2020).
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 whether this is associated with breastfeeding is not clear (Akasbi et al, 2014). Several studies indicate that breastfeeding is more likely to give protection against rheumatoid arthritis in later life (see below).
Will breastfeeding worsen my existing symptoms of rheumatoid arthritis?
Some mothers are told that breastfeeding will make their symptoms worse because of the presence of the hormones involved in making milk. However it is not clear whether 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
Several authors talk about a remission in symptoms while breastfeeding. The hormonal changes of breastfeeding may help lengthen the pregnancy related break in symptoms for some women.5 6 And some mothers enjoy reduced symptoms in chronic illnesses such as rheumatoid arthritis, multiple sclerosis, lupus, and diabetes while they are breastfeeding.7
Breastfeeding may worsen symptoms in genetically susceptible women
Although some mothers may experience a break in symptoms while breastfeeding, Olsen et al 8 suggested there may be a connection between breastfeeding and a higher risk of rheumatoid arthritis. This may possibly be related to higher prolactin levels; prolactin is said to be pro-inflammatory. Other researchers qualified this connection as being only in a small group of genetically susceptible women, particularly following a first pregnancy.910 Shimamoto queries the quality of these studies as the exclusivity of breastfeeding was not clearly defined.11
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.12
In one 2009 study, Pikwer and colleagues 13 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. 14 1516
Can breastfeeding help prevent babies from developing rheumatoid arthritis in later life?
Jacobson et al 17 found that rheumatoid arthritis was associated with low breastfeeding frequency suggesting breastfeeding may protect the baby against rheumatoid arthritis in later life. Another study 18 did not find any association between being breastfed as a baby with the occurrence of lupus.
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 American research show that breastfed babies are less likely to contract these autoimmune disorders than babies not breastfed.
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.19 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.20 Dr Jack Newman explains;
There are several drugs that mothers can take while continuing breastfeeding. Acetaminophen [paracetamol] 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.
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 parts:
- Part I: Standard and biologic disease modifying anti-rheumatic drugs and corticosteroids, Rheumatology, 2016
- Part II: Analgesics and other drugs used in rheumatology practice, Rheumatology, 2016
In addition, 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, 2020.
The following article explains more about autoimmune disorders including the many different types and their effects on pregnant and breastfeeding women;
Rheumatoid arthritis is 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 but more research is needed. 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.