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Correspondence response
Response to: ‘Postpartum breastfeeding status’ by Betzold
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  1. Amanda M Eudy1,
  2. Anna Maria Siega-Riz2,
  3. Stephanie M Engel3,
  4. Nora Franceschini3,
  5. Annie Green Howard4,
  6. Megan E B Clowse1,
  7. Michelle Petri5
  1. 1 Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
  2. 2 University of Virginia School of Nursing, Charlottesville, Virginia, USA
  3. 3 Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  4. 4 Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  5. 5 Department of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Amanda M Eudy, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; amanda.eudy{at}duke.edu

https://doi.org/10.1136/annrheumdis-2018-213427

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    Thank you for your question1 regarding our article ‘Effect of pregnancy on disease flares in patients with systemic lupus erythematosus’.2 We did not have data available on lactation status for women during the postpartum period, and we were unable to account for this in our analysis. We agree that it could be an important factor that may influence disease activity during this time period. Previous studies have found a positive association between plasma/serum prolactin levels and disease activity among patients with lupus.3 4 It is possible that the natural increased levels of prolactin during pregnancy and while breast feeding5 6 may help explain our finding of increased disease activity during pregnancy and a 3-month postpartum period. Even though we were unable to fully explore this hypothesis, our results did indicate that use of hydroxychloroquine may help reduce the risk of flare during pregnancy and post partum. Future studies could explore the effect lactation has on postpartum flare for hydroxychloroquine users and non-users, as well as analyse how prolactin levels may explain the increased risk of flare during pregnancy and post partum.

    References

    1. ↵
      2. Betzold C
      . Postpartum breastfeeding status. Ann Rheum Dis 2019;78:e37.
    2. ↵
      2. Eudy AM ,
      3. Siega-Riz AM ,
      4. Engel SM , et al
      . Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis 2018;77:855–60.doi:10.1136/annrheumdis-2017-212535
      OpenUrlAbstract/FREE Full Text
    3. ↵
      2. Jacobi AM ,
      3. Rohde W ,
      4. Ventz M , et al
      . Enhanced serum prolactin (PRL) in patients with systemic lupus erythematosus: PRL levels are related to the disease activity. Lupus 2001;10:554–61.doi:10.1191/096120301701549688
      OpenUrlCrossRefPubMedWeb of Science
    4. ↵
      2. Pacilio M ,
      3. Migliaresi S ,
      4. Meli R , et al
      . Elevated bioactive prolactin levels in systemic lupus erythematosus--association with disease activity. J Rheumatol 2001;28:2216–21.
      OpenUrlAbstract/FREE Full Text
    5. ↵
      2. Abbassi-Ghanavati M ,
      3. Greer LG ,
      4. Cunningham FG
      . Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009;114:1326–31.doi:10.1097/AOG.0b013e3181c2bde8
      OpenUrlCrossRefPubMedWeb of Science
    6. ↵
      2. Riordan J
      . Breastfeeding and human lactation. 3rd edn. Boston and London: Jones and Bartlett, 2005:75–7.

    Footnotes

    • Handling editor Josef S Smolen

    • Contributors All authors read and approved the correspondence response.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

    Linked Articles

    • Correspondence
      Postpartum breastfeeding status
      Christine Betzold
      Annals of the Rheumatic Diseases 2018; 78 e37-e37 Published Online First: 11 Apr 2018. doi: 10.1136/annrheumdis-2018-213414