Background It is known that pregnancy in rheumatoid arthritis (RA) patients has a beneficial effect on disease activity in 43-66% cases, but at the same time RA flares would hit up to 40-70% patients after delivery. However, the postpartum period is associated with breastfeeding, the importance of which for the mother and the child can not be overestimated.
Objectives To evaluate the likelihood of breast-feeding in patients with RA.
Methods It was a prospective study of 32 cases of postpartum course of the disease in 29 women with documented RA (ACR 1987), 10 of which had the juvenile onset of the disease. Patients were observed at V.A. Nasonova Research Institute of Rheumatology from February 2011 to August 2014y., all gave written informed consent to participate in the study. Therapy after delivery consisted of 400-1200mg/day Ibuprofen - 27 (84.4%) patients, and Metypred 4-12mg/day - 24 (75%) patients. Patients were subjected to thorough examination at 1, 3, 6 and 12 months after delivery.
Data are presented as Me [IQR].
Results 27 out of 32 (84.4%) patients did not discontinue breastfeeding. The duration of lactation was from 2 weeks to 12 months (Me =2.5 [1.6] months). The lactation was suppressed immediately after birth in 5 cases: in 2 - due to the high activity of RA, in 2 – on mother's request, and in 1 – because of perinatal death of the child. Exacerbation of the disease within 3 [1.5-3.5] months after delivery was the main reason for not breastfeeding in 14 (43.8%) cases. In 12 (37.5%) patients breastfeeding was disrupted due to low or disappearing milk supply within 2 [1.7] months after the birth. Only 4 (12.5%) patients were breastfeeding for 12 or more (up to 16) months. All these patients had low RA activity (n=3) or RA remission (n=1).
Conclusions RA exacerbation requiring active drug therapy in mothers was the key reason for not breastfeeding in 16 (50%) cases.
Disclosure of Interest None declared
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