How Autoimmune Disorders Affect Breastfeeding (and Vice Versa)

by Katie Black

Choosing to breastfeed is a lot easier said than done. The reality is many moms would prefer to breastfeed but simply can’t. This can happen because they’re physically unable to, or don’t have enough support from their healthcare team or community.

For moms with an autoimmune disorder, they often have to choose between their own health or breastfeeding either because their symptoms are too much, or their treatment isn’t safe for a breastfeeding baby.

But having an autoimmune disorder doesn’t automatically mean you can’t breastfeed. In this scientific review published in 2023, researchers went through hundreds of the latest studies on breastfeeding and chronic diseases to clarify what we currently do and don’t know.

Not only do different autoimmune disorders affect the ability to breastfeed, breastfeeding can also affect autoimmune disorders.

Prolactin is a hormone that gives mammals the ability to lactate. It also plays an important role in maternal behavior (things mothers do to increase the chance of her child’s survival). And it helps regulate stress from pregnancy and childcare.

Autoimmune disorders affect a lot more women than men, and some researchers point to the female endocrine system being part of the reason. For example, there’s evidence that suggests the uptick in prolactin during pregnancy and breastfeeding can affect different autoimmune diseases.

Let’s take a closer look at some of the more common autoimmune disorders, and what treatments are considered safe while breastfeeding.

Note: All of the information contained in this article is purely educational and should not be taken as medical advice. Always consult your doctor and pediatrician before starting or stopping any medications.

Systemic lupus erythematosus (SLE)

Lupus is an autoimmune disease that typically affects young women. The immune system attacks its own tissue, leading to acute inflammation and tissue damage in different organs. Recent studies show a strong correlation between prolactin and more SLE symptoms.

Understandably then, moms with SLE are less likely to breastfeed. One study showed that 96% of moms with SLE planned on breastfeeding, 71% did breastfeed, but half stopped after three months. Interestingly, the main reason for stopping breastfeeding isn’t a flare up in the disease, (though that is a large factor). It’s actually starting a new medication to treat SLE. Even though certain drugs are categorized as safe for breastfeeding, like HCQ, moms aren’t given enough info on what exactly is safe and what isn’t. In order for moms with SLE to keep breastfeeding, health professionals need to give clear information and support.

Women with SLE who also have hyperprolactinemia (abnormally high prolactin levels), often have even more inflammation in the linings of the lungs, heart, and stomach, plus higher rates of anemia. Dopamine agonists are a possible treatment, but there aren’t enough studies to say if these medications are safe for a breastfeeding baby.

Rheumatoid arthritis (RA)

With rheumatoid arthritis the immune system attacks tissue that lines the body’s joints. If a mom is at risk for RA, prolactin can trigger the disorder to develop and if she already has the condition prolactin can cause flare ups.

Data shows women who developed RA within a year of their first pregnancy were five times more likely to have breastfed. After accounting for factors like treatment, moms who breastfed had more flare ups than moms who didn’t breastfeed. Researchers now wonder if breastfeeding plays a role in increasing the risk of developing RA or flare ups. Yikes.

Some good news, there’s less chance of developing RA while breastfeeding a second child, and no increased risk at all with a third.

It’s no surprise that only a fraction of moms with RA breastfeed exclusively for six months compared to the general population, but the majority of moms with RA do breastfeed! Whether or not a mom is getting treatment during breastfeeding pretty much decides if her condition will improve or not. It’s important that moms with RA who want to breastfeed have access to safe and effective treatment from empathetic healthcare professionals.

Idiopathic Inflammatory bowel diseases (IBDs)

IBDs are autoimmune disorders involving the intestines.

Studies differ on the likelihood of moms with IBDs breastfeeding. However, moms who take an immunomodulator or steroid for treatment compared to those only taking the drug 5-ASA seem to be less likely to breastfeed even though most drugs used to treat IBDs are considered safe while breastfeeding.

Interestingly, the rates of flare ups during the year after giving birth were lower for moms who breastfed than those who didn’t. Researchers think breastfeeding may actually help protect against flare ups.

Multiple sclerosis (MS)

MS is an autoimmune disease involving the central nervous system where the immune system attacks the myelin sheath around nerves. Right now, none of the drug treatments for MS are compatible with breastfeeding.

This means moms are forced to choose between breastfeeding or restarting treatment after giving birth.

Currently, there isn’t a consensus on the relationship between breastfeeding and postpartum flare ups.

Type 1 Diabetes

Type 1 diabetes is when the immune system attacks cells in the pancreas that make insulin leading to high blood sugar.

The likelihood of a mom with type 1 diabetes breastfeeding is very low. For one, starting breastfeeding is often difficult due to higher rates of complicated labors, C-sections, the baby being born prematurely, ill, having an abnormality, or an immature breastfeeding reflex. This often means there’s early separation between a mom and her newborn making breastfeeding more difficult.

Another factor is diabetes often causes a delay in a mother’s milk coming in, plus glucose levels constantly going up and down can lead to poor supply. Some hospitals also don’t provide enough support and guidance when a mom wants to try breastfeeding.

Moms who want to breastfeed need to closely monitor their diet and insulin levels, and should work closely with their doctors to come up with a plan.

Conclusion

The decision and ability to breastfeed is always very personal. Moms with autoimmune disorders who want to breastfeed should seek to have as much support and guidance as possible. Too often women with autoimmune disorders are discouraged from breastfeeding because they’re given advice or information that’s not backed by science, or their healthcare providers don’t give them the time and attention they deserve and need. And that needs to change.