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Does RA Limit Breastfeeding in Women with RA?
A lesser proportion of women with rheumatoid arthritis (RA) and women who have earlier cessation breastfeed compared with the general population, a new study found. The nationwide prospective cohort study followed 249 pregnancies from pregnancy until 6 months postpartum. Proportion tests were used to compare percentages of breastfeeding between the study population and the general (reference) population. Researchers found:
- At 4‒6, 12, and 26 weeks postpartum, 43%, 26%, and 9% of the RA patients breastfed their offspring, respectively, compared with 63%, 46%, and 41% in the general population.
- The prime reason given for women discontinuing breastfeeding was the restart of medication (57.8%).
- However, >40% of these patients restarted medication that was considered compatible with breastfeeding.
Ince-Askan H, Hazes JMW, Dolhain RJEM. Breastfeeding among women with rheumatoid arthritis compared with the general population: Results from a nationwide prospective cohort study. [Published online ahead of print May 1, 2019]. J Rheumatol. doi:10.3899/jrheum.180805.
There has been increased attention to and awareness of reproductive health issues in women with rheumatologic diseases. This study focuses on breastfeeding rates in women with rheumatoid arthritis using data from the PARA study, a prospective cohort study from the Netherlands. Breastfeeding rates from 249 pregnancies in 216 women were compared to a reference group of 3009 women of the general population. 43% of women with RA in the study breastfed until their infants were 4-6 weeks old, 26% until 12 weeks, and 9% until 26 weeks, compared to 63, 46, and 41% in the general population. Despite the fact that many women began and remained on breastfeeding compatible medications, the main reason for discontinuing breastfeeding was given as restarting medication therapy for RA. This study suggests that targeted education to improve awareness of breastfeeding-compatible medications could increase breastfeeding rates among women with RA in the Netherlands. Of note, the study uses data from 2002-2008 and biologic medications are classified as incompatible with breastfeeding, raising the question of whether breastfeeding rates and reasons for discontinuing would be different in more recent years. In addition, women with higher HAQ scores (poorer functional status) in the third trimester were more likely to discontinue breastfeeding early; the authors suggest that interventions aimed at improving the mechanics of breastfeeding for women with RA may improve this number, though it would be of interest to know how many women with RA would otherwise have wanted to breastfeed and for how long. —Arundathi Jayatilleke, MD