While much of the existing literature in the field of reproductive rheumatology focuses on fertility, preconception counseling, and pregnancy, there is limited information regarding the postpartum period and lactation. Evidence suggests that many rheumatologic disorders flare after delivery, which, along with limitations in medications compatible with breastfeeding, make this time period challenging for women with rheumatologic conditions. This article discusses rheumatologic disease activity during the postpartum period and reviews the safety during lactation of commonly used medications for the management of rheumatic diseases. Fortunately, many of the commonly used medications are compatible with breastfeeding.
Key points
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Rheumatologic diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), may flare in the postpartum period.
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There are many benefits of breastfeeding to both the mother and the infant; fortunately, many but not all medications used to manage rheumatic diseases can be continued in breastfeeding women.
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Short-acting nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, glucocorticoids in doses under 20 mg a day, antimalarials, azathioprine, tacrolimus, cyclosporine, most tumor necrosis factor (TNF)-α blockers, anakinra, and intravenous immunoglobulin (IVIG) are compatible with nursing.
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Methotrexate and cyclophosphamide are not considered compatible with nursing.
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Insufficient data on the safety of leflunomide, mycophenolate mofetil, tofacitinib, rituximab, belimumab, abatacept, tocilizumab, golimumab, and secukinumab in lactation exist.
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