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Breastfeeding in rheumatoid arthritis in Romania
Background. Rheumatoid arthritis (RA) is not a contraindication to pregnancy. It is only mandatory to observe several recommendations: planning pregnancy, adapting anti-rheumatic medication and monitoring disease activity every trimester. Postpartum, RA often relapses, therefore, breastfeeding can be exposed to anti-rheumatic drugs. Only Methotrexate, Leflunomide and Cyclophosphamide are fully contraindicated during lactation. TNF inhibitors are compatible with breastfeeding, while other biological therapies are not recommended, due to the lack of data.
Objectives. This study aimed to evaluate pregnancy outcomes among female patients with RA, who attended rheumatology clinics from different Romanian cities. Secondary objectives were disease course and anti-rheumatic medication post-partum, the occurrence of RA postpartum flares and the adherence to breastfeeding.
Patients and methods. This is a pilot observational, multicentric study, performed between October 2012 and July 2016. We have analyzed 41 patients diagnosed with RA before conception and who had at least one pregnancy after diagnosis. We recorded the pregnancy outcome, and, regarding the postpartum period, the occurrence of disease relapse and the antirheumatic medication exposure during lactation.
Results. The 41 patients had 72 pregnancies, with 39 deliveries resulting in 42 healthy infants; 30 patients chose to breastfeed. Postpartum, the disease relapsed in 23/30 patients after a mean of 9.56 weeks. Therefore, these infants were exposed to anti-rheumatic drugs during lactation (anti-inflammatory drugs, Sulphasalazine and Hydroxicloroquine). No biological therapy was administrated during breastfeeding.
Conclusion. The data obtained regarding the relapse risk and breastfeeding while using antirheumatic drugs are generally within international recommendations. We need more experience to be able to manage difficult situations and to take the best decision for our female patients with RA.
Keywords: rheumatoid arthritis, breastfeeding, anti-rheumatic therapy
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