From the Department of Rheumatology, Erasmus Medical Center (MC), Rotterdam, the Netherlands.
H. Ince-Askan, MD, Department of Rheumatology, Erasmus MC; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC; R.J. Dolhain, MD, PhD, Department of Rheumatology, Erasmus MC.
J Rheumatol. 2019 Sep;46(9):1067-1074. doi: 10.3899/jrheum.180805. Epub 2019 Mar 1.
The World Health Organization recommends that infants be exclusively breastfed until the age of 6 months. The first objective was to compare breastfeeding frequencies and time of cessation between women with rheumatoid arthritis (RA) and the general population. The second objective was to identify why patients with RA discontinue breastfeeding.
This study was embedded in the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a nationwide prospective cohort study. From 2002 to 2008, a total of 249 pregnancies were followed from pregnancy until 6 months postpartum. Data on lactation and medication use were collected. Proportion tests were used to compare percentages of breastfeeding between the study population and the general/reference population.
At 4-6, 12, and 26 weeks postpartum, 43%, 26%, and 9% of the RA patients breastfed their offspring, respectively, compared with 63%, 46%, and 41% in the general population, respectively (p < 0.001). The main reason for women to discontinue breastfeeding was the restart of medication (n = 129, 57.8%). Nevertheless, more than 40% of these patients restarted medication that was considered compatible with breastfeeding.
This large prospective study demonstrates that RA is associated with lower proportions of women breastfeeding their offspring and earlier cessation compared with the general population. A considerable number of patients discontinued breastfeeding so that they could start medication, even though many of the medications are considered safe to use during lactation. Using the results of this study, intervention strategies supporting RA patients who wish to breastfeed may be developed.
世界卫生组织建议婴儿在 6 个月前纯母乳喂养。第一个目标是比较类风湿关节炎（RA）女性和一般人群的母乳喂养频率和停止母乳喂养的时间。第二个目标是确定为什么 RA 患者停止母乳喂养。
这项研究嵌入了一项全国性前瞻性队列研究，即妊娠改善类风湿关节炎（PARA）研究。2002 年至 2008 年，共随访了 249 例妊娠，随访时间从妊娠至产后 6 个月。收集了母乳喂养和药物使用的数据。采用比例检验比较研究人群和一般/参考人群的母乳喂养百分比。
产后 4-6、12 和 26 周时，分别有 43%、26%和 9%的 RA 患者母乳喂养其子女，而一般人群中分别为 63%、46%和 41%（p < 0.001）。导致女性停止母乳喂养的主要原因是重新开始用药（n = 129，57.8%）。然而，超过 40%的患者重新开始使用被认为适合母乳喂养的药物。
这项大型前瞻性研究表明，与一般人群相比，RA 患者母乳喂养子女的比例较低，停止母乳喂养的时间更早。相当多的患者停止母乳喂养以便开始用药，尽管许多药物在哺乳期被认为是安全的。利用本研究的结果，可以制定支持希望母乳喂养的 RA 患者的干预策略。
