Hilal Ince-Askan1,2, Johanna M W Hazes3,4, Radboud J E M Dolhain3,4. 1. From the Department of Rheumatology, Erasmus Medical Center (MC), Rotterdam, the Netherlands. h.ince-askan@erasmusmc.nl. 2. H. Ince-Askan, MD, Department of Rheumatology, Erasmus MC; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC; R.J. Dolhain, MD, PhD, Department of Rheumatology, Erasmus MC. h.ince-askan@erasmusmc.nl. 3. From the Department of Rheumatology, Erasmus Medical Center (MC), Rotterdam, the Netherlands. 4. H. Ince-Askan, MD, Department of Rheumatology, Erasmus MC; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC; R.J. Dolhain, MD, PhD, Department of Rheumatology, Erasmus MC.
Abstract
OBJECTIVE: The World Health Organization recommends that infants be exclusively breastfed until the age of 6 months. The first objective was to compare breastfeeding frequencies and time of cessation between women with rheumatoid arthritis (RA) and the general population. The second objective was to identify why patients with RA discontinue breastfeeding. METHODS: This study was embedded in the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a nationwide prospective cohort study. From 2002 to 2008, a total of 249 pregnancies were followed from pregnancy until 6 months postpartum. Data on lactation and medication use were collected. Proportion tests were used to compare percentages of breastfeeding between the study population and the general/reference population. RESULTS: 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, respectively (p < 0.001). The main reason for women to discontinue breastfeeding was the restart of medication (n = 129, 57.8%). Nevertheless, more than 40% of these patients restarted medication that was considered compatible with breastfeeding. CONCLUSION: This large prospective study demonstrates that RA is associated with lower proportions of women breastfeeding their offspring and earlier cessation compared with the general population. A considerable number of patients discontinued breastfeeding so that they could start medication, even though many of the medications are considered safe to use during lactation. Using the results of this study, intervention strategies supporting RA patients who wish to breastfeed may be developed.
OBJECTIVE: The World Health Organization recommends that infants be exclusively breastfed until the age of 6 months. The first objective was to compare breastfeeding frequencies and time of cessation between women with rheumatoid arthritis (RA) and the general population. The second objective was to identify why patients with RA discontinue breastfeeding. METHODS: This study was embedded in the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a nationwide prospective cohort study. From 2002 to 2008, a total of 249 pregnancies were followed from pregnancy until 6 months postpartum. Data on lactation and medication use were collected. Proportion tests were used to compare percentages of breastfeeding between the study population and the general/reference population. RESULTS: At 4-6, 12, and 26 weeks postpartum, 43%, 26%, and 9% of the RApatients breastfed their offspring, respectively, compared with 63%, 46%, and 41% in the general population, respectively (p < 0.001). The main reason for women to discontinue breastfeeding was the restart of medication (n = 129, 57.8%). Nevertheless, more than 40% of these patients restarted medication that was considered compatible with breastfeeding. CONCLUSION: This large prospective study demonstrates that RA is associated with lower proportions of women breastfeeding their offspring and earlier cessation compared with the general population. A considerable number of patients discontinued breastfeeding so that they could start medication, even though many of the medications are considered safe to use during lactation. Using the results of this study, intervention strategies supporting RApatients who wish to breastfeed may be developed.