New mothers with systemic lupus erythematosus (SLE) are less likely to breastfeed their infants, or to do so for a shorter span of time, than are woman without this disease — despite guidelines favoring breastfeeding throughout a baby’s first months of life, a study in Argentina reports.
The study, “Breastfeeding initiation, duration, and reasons for weaning in patients with systemic lupus erythematosus,” published in the journal Rheumatology International, also reported that the most common reason for stopping breastfeeding was the resumption of SLE medications. But researchers found the treatments were used at doses not likely to pose any risk to an infant.
SLE commonly affects women of child-bearing age, and post-natal care of both mother and child are given close attention in this patient population. But studies into the breastfeeding habits of mothers with SLE are few.
According to The World Health Organization, “breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development,” and “exclusive breastfeeding is recommended up to 6 months of age, and continued along with appropriate complementary foods up to 2 years of age or beyond.”
Researchers followed 36 pregnancies in 31 women with SLE and an equal number among women without SLE. The two groups were similar in age, level of education, number of children, and in the numbers of those who had breastfed for the first time.
Minor complications were more common in babies of SLE mothers (25% vs 11.1%), and one-quarter of SLE patients also had some sort of complication, generally associated with disease activity, during the post-natal period, defined as the roughly six-week period following a baby’s birth.
More woman — 19.4% — of new mothers with SLE chose not to breastfeed compared to 5.6% of those without the disease, and on average these mothers breastfed their infant for only six months, while non-SLE mother breastfed for an average of 12 months.
Mothers with SLE were most likely to say that they chose to wean their infants from the breast because they had started taking medication (41%) for their disease.
Those without SLE, in comparison, stopped breastfeeding for different reasons than those with SLE: 53% versus 17% cited no particular cause, 24% versus 28% said they lacked breast milk, and 15% of non-SLE mothers said that a return to work was the reason for weaning. These women were also more likely to feel they had breastfed their babies for a suitable amount of time (53%), compared to women with SLE (24%).
The lower rates and shorter durations of breastfeeding among SLE mothers was a concern, and the research team attributed it largely to a failure to inform women and their doctors of treatments and doses that are “of low risk.”
“The leading cause for weaning in SLE patients was treatment onset, but … the prescribed drugs turned out to have been low doses of either corticosteroids or hydroxychloroquine which are regarded as safe drugs for breastfeeding,” the study states. “The accepted safety of using hydroxychloroquine in breastfeeding women is not mentioned in the patient information leaflets of the 4 main commercial forms of hydroxychloroquine in Argentina.”
Given that disease treatment was the major reason for stopping breastfeeding and that certain SLE therapies — corticosteroids and hydroxychloroquine — are considered safe for mothers while breastfeeding, the researchers concluded the breastfeeding by SLE patients can be optimized by improving the level and quality of information they are provided.