Breastfeeding management in women with Rheumatic and Musculoskeletal Disease
We are now moving on to our series regarding the management of mothers who suffer from rheumatic and musculoskeletal disease (RMD).
We have some concerns about the use of medication by mothers who suffer from RMD and at the same time engage in breastfeeding.
We all know how valuable breastfeeding is for the health of the child.
In fact, the American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months and to continue breastfeeding until the child turns one year old.
Women with RMD may experience disease flare post partum and may require some treatment.
For this reason, it is imperative to balance the risks of infant exposure to the medication through breast milk and benefits of disease control.
The serum levels of the drugs consumed by the mother largely depend on several variables such as drug concentration and the amount of breastmilk the child ingests.
There is a possibility for premature infants or children with gastrointestinal disorders to ingest the medication quite differently.
The rheumatologist needs to coordinate with the pediatrician about the drug exposure of the child through the breastmilk and determine which level of drug exposure is considered to be safe.
Mothers with RMD are highly encouraged to breastfeed their respective babies.
At the same time, experts suggest to use lactation-compatible drugs as the risks should be reviewed with each patient.
It is a good thing that most RMD drugs can be used during lactation.
For most part drugs such as hydroxychloroquine (HCQ) colchicine, sulfasalazine, rituximab, and all tumor necrosis factor (TNF) inhibitors are known to be compatible with lactation.
Experts also recommend prednisone (or equivalent nonfluorinated glucocorticoid) as compatible with breastfeeding. However, the use of prednisone should be carefully considered including the administration of breastmilk four hours after taking the prednisone.
In some situations, experts conditionally recommend the use of azathioprine/6-mercaptopurine, calcineurin inhibitors, non-steroidsl anti-inflammatory drugs (NSAID) and the non–TNF inhibitor biologic agents (anakinra, rituximab, belimumab, abatacept, tocilizumab, secukinumab, and ustekinumab) as compatible with lactation.
Experts say that mothers with RMD should not use cyclophosphamide (CYC), mycophenolate mofetil(MMF), leflunomide, m, and thalidomide while the mother is breastfeeding.
Experts may recommend against the use of methotrexate (MTX) while breastfeeding.