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How an Autoimmune Condition Might Affect Your Breastfeeding Decision

Woman sitting on chair near window breastfeeding a baby.

If you’ve got an autoimmune condition, you might be wondering if you can or should breastfeed. There are over 100 autoimmune diseases. Here, I’ve described some that are more common in women of childbearing age, and I won’t cover the specifics. Instead, I’ll give a brief overview of just a few of the many facts to consider about how an autoimmune condition might affect your breastfeeding decision

Keep in mind, nearly all the conditions that I’m mentioning here are more common in women than in men. And some of these women (or their close relatives) are likely to also have another autoimmune condition, too.

Celiac disease

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley, and rye. Over time, that reaction damages the small intestine and prevents it from absorbing some nutrients. Typically, this results in diarrhea, fatigue, weight loss, and perhaps anemia or other complications.

Cons: I’m not aware of any true downside to breastfeeding with celiac disease. That said, a study by Olivares and colleagues showed that there are lower levels of immunoglobulins in milk of mothers affected with the disease than among healthy controls. However, even low levels of immune factors in human milk offer better immune factors than formula!

Pros: It has often been thought that breastfeeding or perhaps prolonged breastfeeding is protective against celiac disease in the infant. However, studies do not confirm that. On the other hand, there’s no evidence that it increases the likelihood of the infant developing celiac disease.

There are only a handful of small studies, so there’s little solid evidence to guide practice. And, I’ve personally never had any clinical experience with a mother who has celiac disease. 

Inflammatory bowel syndrome (IBS)

Inflammatory bowel syndrome (IBS) causes tissues in the digestive tract to swell, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and poor nutrition. A common example is Crohn’s disease.

Cons: Mothers with IBS should be aware that having severe and recurring diarrhea can deplete their own nutritional stores. Poor postpartum nutrition isn’t likely to affect the quality of their milk. Meaning, the body will rob nutrients from the lactating mother’s body.       

Pros: Moffatt’s 2009 study showed that some mothers experienced fewer symptoms of IBS during lactation. And it appears that breastfed babies may have a lower risk for developing IBS later, compared to formula-fed infants.

Milk supply does not seem to be a problem with IBS. And I can recall one mother with IBS who had plenty of milk, and had a highly rewarding breastfeeding experience.

Sjogren’s Syndrome

Sjogren’s syndrome is a condition where the immune system attacks the secretory glands. In other words, it affects glands that secrete substances.

For example, salivary glands secrete saliva, pyloric glands secrete gastrin, lacrimal glands secrete tears and … oh, mammary glands secrete milk! Hence, it just makes sense that milk production would be impaired, right? But in fact, that’s not the case.

Cons: Low milk supply is possible, but there’s no scientific evidence to say that will happen. I know a woman who has Sjogren’s syndrome and she breastfed without any issues.

Pros: As always, the benefits of breastfeeding outweigh any possible risks.

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune disease in which there’s widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. 

Cons: Perhaps the biggest downside of breastfeeding for women who have SLE is that they frequently have co-existing autoimmune conditions, including the nipple vasospasms associated with Raynaud’s phenomenon. Those may impact their breastfeeding experience.

Pros: Although it remains controversial, there is some evidence that breastfeeding protects the infant against developing SLE. But having SLE with or without any other co-existing autoimmune conditions does not contraindicate breastfeeding.

The typically prescribed drugs – hydroxychloroquine, azathioprine, methotrexate, and prednisone have very limited transfer into the mother’s milk.

Curiously, however, one study showed that women diagnosed with SLE were advised not to initiate or continue breastfeeding because of their medications, even though the risk to the infant is very low. While it’s true that most drugs “go through the milk,” that doesn’t mean they will automatically have an adverse effect on the baby. It’s much more complicated than that.

Yet, it’s possible that those medications may contribute to a low milk supply. Remember, toxic risk is one thing, but impact on milk supply is quite another thing.

Bottom line is that it’s important to speak with your doctor about any medications associated with treatment and management of your disorder and how your autoimmune condition might affect your breastfeeding decision.

Stay tuned for another post highlighting more autoimmune conditions you should be aware of.

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  1. Marcia

    Thank you for the overview. I’ll pass this article on at our next provider mtg of midwives, bfg educators and OB/Gyn

    • Marie Biancuzzo

      Oh, yes, Marcia, that would be grand. I’ve found that there’s very little to guide us on these autoimmune diseases and how they affect breastfeeding, but this was my best attempt to pull together what I knew from the existing evidence, as well as some anecdotal information. Thank you for your kind comment.

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