Breastfeeding in women affected by systemic lupus erythematosus: Rate, duration and associated factors

Abstract

Objective Breastfeeding is a crucial moment for both mothers and child, providing a beneficial effect on child survival, nutrition, development and on maternal health. Despite the prevalent involvement of childbearing women in systemic lupus erythematosus (SLE), breastfeeding is still a neglected topic. The objective of this study was to evaluate breastfeeding frequency, duration and associated factors in SLE women. Methods We consecutively enrolled SLE pregnant women reporting demographic, clinical, serological, gynaecological and obstetric data. Breastfeeding experience was evaluated by using a specific questionnaire. Disease activity was assessed before and during pregnancy as well as during postpartum. Results A total of 57 pregnancies in 43 SLE women were included in the present study. In almost all the pregnancies, mothers planned to breastfeed their child (96.5%) and forty-one (71.9%) actually did breastfeed. The median time of breastfeeding was 3 months (IQR 7). Non-breastfeeding women showed a more frequent caesarean section (p = 0.0001), IUGR occurrence (p = 0.004) and disease relapse (p = 0.0001) after pregnancy. When comparing patients according with breastfeeding duration (cut-off 6 months), we found a significant more frequent smoking habitus (p = 0.02), caesarean section (p = 0.009), and joint involvement during postpartum (p = 0.0001) in women breastfeeding for less than or equal to 6 months, together with higher median BMI (p = 0.0001). Moreover, breastfeeding duration was positively associated with disease duration and hydroxychloroquine (HCQ) treatment during disease history, pregnancy and postpartum. Conclusions SLE women didn’t show lower breastfeeding rate in comparison with general population but they presented higher prevalence of early discontinuation within three months. Early interruption was positively associated with smoking, BMI, joint involvement; meanwhile disease duration and HCQ treatment during postpartum were positively associated with a longer breastfeeding duration.

Breastfeeding in women with systemic lupus erythematosus: results from a Norwegian quality register

“…Opposite, an Italian study including 43 SLE patients with 57 pregnancies, and with self-reported data on breastfeeding during 2008 to 2019, showed no significant difference in initiation of breastfeeding between SLE mothers and women in the general Italian population [ 12 ]. This is comparable to our results.…”

“…A higher proportion of elective and emergent caesarian deliveries in non-breastfeeding women with SLE has previously been reported [ 12 ]. In our study, only delivery by emergency caesarean section was positively associated with non-breastfeeding at six weeks after delivery.…”

“…An Italian study published in 2021 showed that initiation of breastfeeding in women with SLE was similar to initiation in the general population, however a higher proportion of the patients discontinued within three months [ 12 ]. The impact of the disease on initiation of breastfeeding is still not known.…”

Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases

“…Breastfeeding rates and duration seem to be decreased in SLE patients. Orefice et al [ 42 ] in a cohort study reported that the vast majority of mothers with SLE (96.5%) were planning to breastfeed during pregnancy and 71.9% did breastfeed. However, half of these patients ceased breastfeeding after 3 months.…”

Ovarial Reserve in Systemic Lupus Erythematosus: Current Status of the Problem

“…При лечении циклофосфамидом женщинам с СКВ в пременопаузе, желающим сохранить функцию яичников и фертильность, по данным Ejaz K. и соавт., показано проведение одновременной терапии агонистами гонадотропин-рилизинг-гормона[12]. Агонисты гонадотропин-рилизинггормона уменьшают высвобождение ЛГ и ФСГ, предотвращая тем самым созревание фолликулов яичников (следовательно, токсическому воздействию циклофосфамида подвергается меньшее количество фолликулов), и снижают кровоток в яичниках, уменьшая биодоступность циклофосфамида[15]. В целом, анализ существующей в настоящее время литературы подтверждает защитное действие агонистов гонадотропин-рилизинг-гормона на функцию яичников у пациенток с волчанкой, получающих циклофосфамид[12; 16].…”