How an Autoimmune Condition Might Affect Your Breastfeeding Decision: Part 2

In a previous post, I outlined some autoimmune conditions commonly seen in women of childbearing age. Here, I’ll outline additional conditions and highlight the pros and cons that may affect the decision to start or continue breastfeeding.

Fibromyalgia (FM)

Fibromyalgia is a chronic disorder that causes heightened pain and tenderness throughout the body. It can also cause fatigue, trouble sleeping, and so-called “fibro fog.” Like many of the disorders mentioned here, it’s more common in women than in men, and often overlaps with other autoimmune conditions.

Cons: By definition, pain sensitivity will be greater in the breastfeeding mother who has fibromyalgia. But often, the pain is less debilitating than the “fibro fog” where one can feel like “… being under water – where your senses are dulled and movement is slow and clumsy.” One of the strategies to minimize fibro fog is keeping a strict bedtime each night, and that’s not likely to happen for a mother with a young infant – breastfed or formula-fed.

Pros: Breastfeeding is the normal postpartum state. That means that hormones such as oxytocin are likely to create a more normal body response, and that same hormone also lessens pain sensations. It’s easy to find reports of women who are affected with FM but have had very rewarding breastfeeding experiences. These reports square with my clinical experience, too.

Hyperthyroidism

There are different forms of hyperthyroidism. Graves’ disease is a common example but there are others, and they are caused by an overactive thyroid gland.

Cons: Diagnostic scans may necessitate temporary weaning. Just be aware of that possibility. 

Pros: Typically, milk production is adequate. Most of the medications that are commonly prescribed for Graves’ disease are compatible with breastfeeding. Commonly prescribed medications for treatment, such as Methimazole (Tapazole) and propylthiouracil, are considered to be generally compatible with breastfeeding. But, as always, be sure to have an informed discussion with your physician or licensed prescriber.

Hypothyroidism

A few of these conditions, including Hashimoto’s disease occur when the body is not producing enough of the thyroid hormone.

Pros: There’s no overall contraindication to breastfeeding in individuals who have this condition. Levothyroxine is commonly prescribed to treat hypothyroidism, and LactMed indicates that there is no adverse effects in infants.

Cons: Low milk supply is likely to be part of this condition. However, it can be managed. Check out a post where I discussed low milk supply.

Listen to my podcast with Dr. Jolene Brighten who shares her own story about Hashimoto’s thyroiditis.

Multiple sclerosis (MS)

Multiple sclerosis is an autoimmune neurological disease where there’s inflammation of the brain and spinal cord. 

Cons: This depends on the type and severity of the symptoms. Vision impairment could be a problem, although in most cases, corrective lenses make that a non-issue. Mobility limitations, if severe, could affect the mother’s ability to carry the baby or perform normal baby care. Medications? I’m hesitant to say as it seems that new MS medications are frequently being developed.

Pros: A major advantage of breastfeeding is that, often, the symptoms of MS decrease or possibly disappear while the mother is breastfeeding, according to studies by Conradi et al., and Langer-Gould et al.

Many mothers affected with MS have successfully and happily breastfeed. I know of at least one woman who breastfed twins for two years! This lengthy article discusses treatment options for MS during breastfeeding and lactation.

Myasthenia gravis

From the Greek “grave muscle,” myasthenia gravis is a condition of weak muscles throughout the body. 

Cons: Medications given for myasthenia gravis could perhaps have adverse effects on the baby. For example, commonly-prescribed medications including cholinesterase inhibitors (e.g., pyridostigmine) and immunosuppressive drugs (e.g., cortisone) could cause diarrhea in the breastfed infant.

Pros: There’s no contraindication to breastfeeding if you have this condition.

Rheumatoid arthritis

Rheumatoid arthritis is an inflammation of the joints. (This should not be confused with the more common osteoarthritis experienced by most aging people.) Individuals with rheumatoid arthritis are at higher risk for Sjogren’s syndrome.

Cons: Joints, especially in the hands and fingers, are often affected. That may create some difficulties with positioning and latch. 

Pros: Multiple studies have shown that breastfeeding protects against (that is, lowers risk for) developing rheumatoid arthritis. Many or most of the medications given for maternal pain and inflammation are compatible with breastfeeding, but as always, pharmacologic treatments should be thoroughly discussed with the prescriber.

Raynaud’s phenomenon

Raynaud’s phenomenon is a disorder that’s caused by decreased blood flow to a body part. 

To be clear, Dr. Raynaud discovered a disorder that was related to poor circulation in the hands and feet. Later, others observed that nipples can also have this bluish-purple-red-white discoloration and pain. Hence, it is better termed as “nipple vasospasm.”

About 30% of women who have Raynaud’s phenomenon also have systemic lupus erythematosus (SLE).

Cons: Breastfeeding may be excruciatingly painful for some women who are affected with the condition.  

Pros: Some women have very mild symptoms and breastfeed their infants with very little discomfort. In fact, some have breastfed for prolonged periods.

I have interacted with many women who have experienced nipple vasospasm. It’s tough to predict who will be affected, and to what degree. But in general, it’s fair to say that the benefits outweigh the risks. 

Scleroderma

Scleroderma is a tightening and thickening of the skin of a body part. It often begins with Raynaud’s phenomenon.

Cons: Feeding a baby, by breast or bottle, may be painful if skin and joints of the fingers are involved as is often the case. I’ve never seen a thickening of the nipple or areola, but I suppose that’s possible.

It’s tough to say how or if treatment modalities or medications will be compatible with breastfeeding, as the treatment is usually specific to the exact problem. A few studies have shown that exercise, including range of motion exercises and stretching, can help improve the joints. Working with an occupational or physical therapist may help. 

Meanwhile, keep in mind that women who have scleroderma often have Raynaud’s phenomenon.

Pros: There’s no evidence to prohibit if you’ve been diagnosed with scleroderma. There are multiple anecdotes attest to the fact that breastfeeding, including extended breastfeeding, is possible and encouraged.

Whether you decide to breastfeed with an autoimmune condition greatly depends on any prescribed medications, as well as milk supply. Consult with your physician or primary healthcare provider for specifics to your own situation.

Have you breastfed with an autoimmune condition? How did it impact you?