medwireNews: Women with active rheumatoid arthritis (RA) who receive pregnancy counseling are as likely to breastfeed their children as women in the general population, indicate findings from the Preconceptional Counselling in Active Rheumatoid Arthritis (PreCARA) study.
“Our study highlights the importance of counselling before, during and after pregnancy,” say Nafise Ghalandari (Erasmus Medical Center, Rotterdam, the Netherlands) and co-authors in RMD Open.
The team explains that 171 PreCARA participants received a modified treat-to-target therapeutic approach aimed at inducing RA remission or low disease activity, as well as “intensive counselling” on pregnancy and breastfeeding including practical advice on positioning and appliances.
The outcomes of these patients were compared with those of 249 participants of the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study between 2002 and 2010, and 35,532 women who took part in a population-based breastfeeding study in the Netherlands in 2018.
Overall, 60.2% of the PreCARA cohort partially or exclusively breastfed their infants at 4–6 weeks postpartum, falling to 39.8% at week 12 and 26.3% at week 26. The corresponding rates for the PARA participants were 43.4%, 26.1%, and 9.2%, while the rates in the general population were 59.0%, 41.0%, and 28.0%.
Ghalandari et al observe that women with active RA are more likely to have infants with low birthweight (<2500 g) than other women and that breastfeeding in this group is “especially beneficial” to such children, being associated with reduced rates of illness and improvements in neurodevelopmental outcomes.
They report that although there was a similar proportion of low-birthweight infants in the PreCARA and PARA studies (8.8 vs 9.2%), the rates of breastfeeding were significantly higher in the PreCARA cohort at 4–6 weeks (80.0 vs 26.1%), 12 weeks (53.3 vs 17.4%), and 26 weeks (26.6 vs 4.4%). Around half (52.0%) of women in the general population initiated breastfeeding but there was no data for later timepoints, the researchers say.
The authors also highlight that medication use was cited less often as a reason for breastfeeding discontinuation among women in the PreCARA cohort than the PARA historical controls (19 vs 58%), with just one (7%) PreCARA participant discontinuing specifically for this reason versus 42% of controls.
Discussing their findings, the investigators suggest that women in the PreCARA cohort may have received more intensive treatment than earlier patients and have less physical disability during pregnancy, as reflected by the lower rate of erosive disease in the PreCARA versus PARA participants.
In addition, understanding of the safety of DMARDs during pregnancy and lactation has improved, they write.
“Consequentially, disease activity is better manageable after delivery, and less patients require the use of medication that is currently considered lactation-incompatible, such as methotrexate or biologicals other than [tumor necrosis factor] inhibitors,” Ghalandari et al conclude.
“All these factors might have contributed to a higher percentage of women that breast feed in the PreCARA cohort.”
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