Can You Breastfeed if You Have Rheumatoid Arthritis?

There may be challenges, but women with RA who want to breastfeed their newborns are encouraged to do so.

woman mother polka dots breastfeeding baby infant couch
Most RA medications won’t interfere with nursing.iStock

There are numerous benefits to breastfeeding: breast milk contains antibodies that protect infants from ear infections, diarrhea, respiratory illnesses, and allergies, according to the American College of Obstetricians and Gynecologists (ACOG). It also can make it easier for moms to lose pregnancy weight, and it may reduce their risks of breast cancer and ovarian cancer. The American Academy of Pediatrics recommends exclusive breastfeeding for approximately six months after birth, while recognizing there are many reasons women can’t breastfeed (for example, not making enough milk or certain medical health issues). If you have rheumatoid arthritis, especially if you need to take certain medications to manage your RA, you may be wondering if it’s safe to breastfeed your baby.

The good news is that women with rheumatoid arthritis (RA) and other rheumatic conditions who want to breastfeed their newborns are generally able to do so. That’s the finding of a study published in April 2021 in the journal Lupus Science & Medicine.

Additionally, the American College of Rheumatology released guidelines in 2020 encouraging women with rheumatic diseases “to breastfeed if they so desire and are able to do so.” The ACR also recommends that “lactation-compatible medications” be used to manage disease and that individualized risks and benefits be reviewed with each patient.

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Concerns and Misinformation About RA Medication

Still, not every woman living with rheumatic disease who wants to breastfeed does so, in some cases because of unfounded concerns about the safety of medicines they're taking.

In the research published in Lupus Science & Medicine, 79 percent of the pregnant women studied indicated their desire to nurse (before they delivered). By the time of their postpartum visit an average of 7.5 weeks after delivery, three-quarters of these women were in fact doing so.

This means 25 percent of the women who had hoped to breastfeed were not. Some tried but stopped, in some cases because they couldn’t develop a milk supply or because their baby had health issues. Other women said they gave up breastfeeding because they worried that the medicines they were taking might possibly pass through to the baby.

This mindset echoes the results of a survey of 66 women published in ACR Open Rheumatology in July 2021, which found that women were often given conflicting advice about medication safety and that “most women with inflammatory arthritis discontinued medications around pregnancy and lactation because of concerns about medication risks.”

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Most Rheumatoid Arthritis Medicines Are Safe to Take While Breastfeeding

But for almost all rheumatoid arthritis medication, this concern is unfounded, says Megan Clowse, MD, MPH, the director of the Duke Autoimmunity in Pregnancy Clinic and an associate professor of medicine at Duke University in Durham, North Carolina. Dr. Clowse coauthored the study in Lupus Science & Medicine. New mothers can safely nurse on many RA drugs in use today.

That’s because medicines like Enbrel (etanercept) and Remicade (infliximab) don’t readily pass to a baby through mother’s milk, and any that do get through, especially with full-term infants, are not well absorbed by their gut, according to Mother to Baby, a website created by experts on birth defect risks.

Methotrexate, notes Mother to Baby, does pass into breast milk in small amounts. While some experts suggest that weekly low-dose methotrexate won’t cause problems, the ACR conditionally recommends against the use of methotrexate while breastfeeding. The ACR says it’s unable to make a recommendation regarding small-molecule Janus kinase (JAK) inhibitors, such as Xeljanz (tofacitinib); the small molecular size suggests it will transfer to breast milk, but there’s not yet enough data on its nursing safety.

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Get Your Doctor On Board With Breastfeeding

Clowse admits that she is especially enthusiastic about allowing patients to breastfeed, because she knows firsthand that it can be an important part of a mother’s experience. She also knows that her encouragement is likely more pronounced than that of other rheumatologists.

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If your doctor erroneously tells you that you cannot nurse on any of the medicines you are taking, you can show them the information from Mother to Baby. “There’s actual data, so you don’t have to base the decision on myth,” Clowse says.

“The reality is you can breastfeed on almost all RA medication. You don’t have to pick between taking care of your disease and breastfeeding your baby,” she asserts.

Find Lactation Support to Help You Breastfeed

Whether you have RA or not, breastfeeding can be difficult for a number of reasons — from supply issues to soreness. But when your joints flare, it may be especially hard to breastfeed because of the challenges of holding the baby in a nursing position. A lactation consultant is the best person to help you figure out ways you can nurse that protect your joints. They might suggest using a nursing pillow to take the weight off your hands or recommend other positions, such as nursing your baby while you both are lying down.

You can find a lactation consultant near you on the website of the International Lactation Consultant Association.