Breastfeeding Can Lead to Flare, Relapse in Women with RA
I'm at a phase in my life right now that seems to be all about weddings and babies, if only in my head.
For me, as someone with lupus and rheumatoid arthritis, every life event is complicated by my illnesses. Getting pregnant and having a child/children is one of the biggest events that will need to be well thought out, in order to make sure that both myself and my future child/children stay as healthy as possible.
When it comes to RA, we give a lot of thought to how the medications we take impact getting pregnant, and the subsequent ability to breastfeed. I'm going to try not to focus too much on that here, because Lisa Emrich has a very comprehensive post in this regard.
We also concentrate a lot on the pre-pregnancy preparations that are required of women who have RA.
But what happens after the baby is born? There is so much focus on getting off meds in order to get pregnant, but what is life like with RA, once you have the baby in hand?
It's important to note here early on that the battle between breast and bottle is not new, and is waged between perfectly healthy women all the time.
The debate over whether or not the "breast is best" has raged since the 1950s, when Dr. Spock came out as a major proponent of breastfeeding (Knaak 2005), suggesting that some of the benefits of breastfeeding are passing on immunity to the baby, and creating a bond between mother and baby.
Not only are there these benefits, but there is a degree of morality connected to breastfeeding; that breastfeeding makes you a good mother, or at least a better mother than those who do not breastfeed.
This puts perfectly healthy mothers in a difficult spot, and even more for chronically ill women.
As Thulier (2009) suggests, there has always been several sub-sets of infants who cannot be breastfed, whether because the mother died in childbirth, works away from home, or simply chose not to.
Several articles on rheumatoid arthritis and breastfeeding suggest that breastfed infants have a lower incidence rate of developing RA later in life than those who are not breastfed (Colebatch and Edwards 2010; Pikwer, et al. 2009). This is less understood directly and not agreed upon by all (Simard, et al. 2010).
And this may be distressing for those of us who have RA and will not be able to breastfeed our children, for whatever reason.
As I was a premie and spent three months in the neonatal intensive care unit, I was not able to be breastfed. But I don't really want to think about whether that is one of the reasons I ended up getting RA.
And what if you can't breastfeed?
What if the pain and fatigue of RA is too much to handle?
While RA tends to go into remission during pregnancy, in general, postpartum relapse of RA tends to be common in women (Hampl and Papa 2001).
An article by Barrett, et al. (2000) suggests that breastfeeding can cause a woman to flare after pregnancy, and that this flaring was not related to non-treatment of the disease to allow for breastfeeding to occur.
This means that women with RA may have a very difficult decision to make: breastfeed and risk a relapse or flare, or not breastfeed, in the hopes of staying symptom free for as long as possible after pregnancy.
I'm not taking sides here. The decision to breastfeed is a personal and emotional one. While those of us who are chronically ill may have less of a choice and have the decision made for us, it is no less trying and stigmatizing to choose bottle over breast in a country where those who opt for the bottle are seen as failures.
I can imagine that being a mother with chronic illness is difficult. But being a mother with a chronic illness who is made to feel guilty for not breastfeeding is worse. It's not just the medication side of things that is the issue. It's the psychosocial implications. It's the fact that being cognizant of maternal health makes a woman with chronic illness better able to care for her child/children.
Barrett, J.H., P. Brennan, M. Fiddler, and A. Silman. 2000. "Breast-feeding and Postpartum Relapse in Women with Rheumatoid and Inflammatory Arthritis." Arthritis & Rheumatism 43(5): 1010-1015.
Colebatch, A.N., and C.J. Edwards. 2010. "The Influence of Early Life Factors on the Risk of Developing Rheumatoid Arthritis." The Journal of Translational Immunology 163(1): 11-16.
Hampl, J.S., and D.J. Papa. 2001. "Breastfeeding-related Onset, Flare, and Relapse of Rheumatoid Arthritis." Nutrition Reviews 59(8): 264-268.
Knaak, S. 2005. "Breast-feeding, Bottle-feeding and Dr. Spock: The Shifting Context of Choice." Canadian Review of Sociology 42(2): 197-216.
Pikwer, M., U. Bergstrom, J.A. Nilsson, L. Jacobsson, G. Berglund, and C. Turesson. 2009. "Breast Feeding, But Not Use of Oral Contraceptives, is Associated with a Reduced Risk of Rheumatoid Arthritis." Annals of the Rheumatic Diseases 68(1): 526-530.
Simard, J.F., K.H. Costenbader, M.A. Hernan, M.H. Liang, M.A. Mittleman, and E.W. Karlson. 2010. "Early Life Factors and Adult-Onset Rheumatoid Arthritis." The Journal of Rheumatology 37(1): 32-37."
Thulier, D. 2009. "Breastfeeding in America: A History of Influencing Factors." Journal of Human Lactation 25(1): 85-94.