Limited research exists on breastfeeding among women with systemic lupus erythematosus, despite known benefits of human milk.
Research Aim:
To investigate reasons for breastfeeding avoidance among postpartum women with systemic lupus erythematosus.
Methods:
This is a descriptive study, conducted in January 2023, combining retrospective pregnancy outcome data collection with a structured telephone questionnaire.
Results:
Almost half of respondents (n = 22; 54.5%) experienced a disease flare within 24 months post-delivery. Reasons given by participants for breastfeeding avoidance included healthcare professional advice (n = 8; 36.4%), fear of medication harm (n = 5; 22.7%), and maternal/neonatal complications (n = 10; 45%). Most participants (n = 21; 95.5%) expressed a willingness to breastfeed if possible.
Conclusion:
Breastfeeding rates and breastfeeding specific care could be enhanced for patients with systemic lupus erythematosus through patient networks and appropriate practitioner education.
AcevedoM.PretiniJ.MicelliM.SequeiraG.KerzbergE. (2017). Breastfeeding initiation, duration, and reasons for weaning in patients with systemic lupus erythematosus. Rheumatology International, 37(7), 1183–1186. https://doi.org/10.1007/S00296-017-3750-1
2.
AndreoliL.BertsiasG. K.Agmon-LevinN.BrownS.CerveraR.Costedoat-ChalumeauN.DoriaA.Fischer-BetzR.ForgerF.Moraes-FontesM. F.KhamashtaM.KingJ.LojaconoA.MarchioriF.MeroniP. L.MoscaM.MottaM.OstensenM.PamfilC., . . . TincaniA. (2017). EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Annals of the Rheumatic Diseases, 76(3), 476–485. https://doi.org/10.1136/annrheumdis-2016-209770
3.
Ballesta-CastillejosA.Gómez-SalgadoJ.Rodríguez-AlmagroJ.Ortiz-EsquinasI.Hernández-MartínezA. (2020). Factors that influence mothers’ prenatal decision to breastfeed in Spain. International Breastfeeding Journal, 15(1), 97. https://doi.org/10.1186/S13006-020-00341-5
4.
BundhunP. K.SoogundM. Z. S.HuangF. (2017). Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001–2016. Journal of Autoimmunity, 79, 17–27. https://doi.org/10.1016/J.JAUT.2017.02.009
5.
CreswellJ. W.HiroseM. (2019). Mixed methods and survey research in family medicine and community health. Family Medicine and Community Health, 7(2), Article e000086. https://doi.org/10.1136/fmch-2018-000086
6.
del CiampoL. A.del CiampoI. R. L. (2018). Breastfeeding and the benefits of lactation for women’s health. Revista Brasileira de Ginecologia e Obstetricia : Revista Da Federacao Brasileira Das Sociedades de Ginecologia e Obstetricia, 40(6), 354–359. https://doi.org/10.1055/S-0038-1657766
7.
DeyM.ZhaoS. S. (2021). Google search data as a novel adjunct to patient and public involvement in rheumatology research. Rheumatology International, 41(4), 771–779. https://doi.org/10.1007/S00296-020-04723-0/TABLES/3
8.
Fernández-MonteroA.Bes-RastrolloM.Moreno-MontañésJ.Moreno-GalarragaL.Martínez-GonzálezM. A. (2017). Effect of pregnancy in myopia progression: The SUN cohort. Eye, 31(7), 1085–1092. https://doi.org/10.1038/EYE.2017.24
9.
Harillo-AcevedoD.Ramos-MorcilloA. J.Ruzafa-MartinezM. (2019). Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline. Birth, 46(1), 146–156. https://doi.org/10.1111/BIRT.12382
10.
HochbergM. C. (1997). Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 40(9):1725. https://doi.org/10.1002/art.1780400928. PMID: 9324032.
11.
HortaB. L.LoretdeMolaC.VictoraC. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatrica, 104(467), 30–37. https://doi.org/10.1111/apa.13133
12.
IkramN.EudyA.ClowseM. E. B. (2021). Breastfeeding in women with rheumatic diseases. Lupus Science & Medicine, 8, Artoicle e000491. https://doi.org/10.1136/lupus-2021-000491
13.
KlauningerR.SkogA.HorvathL.WinqvistO.EdnerA.BremmeK.SonessonS. E.Wahren-HerleniusM. (2009). Serologic follow-up of children born to mothers with Ro/SSA autoantibodies. Lupus, 18(9), 792–798. https://doi.org/10.1177/0961203309103188
14.
MoscaF.GiannìM. L. (2017). Human milk: Composition and health benefits. La Pediatria Medica e Chirurgica : Medical and Surgical Pediatrics, 39(2), Article 155. https://doi.org/10.4081/PMC.2017.155
15.
NovianiM.WassermanS.ClowseM. E. B. (2016). Breastfeeding in mothers with systemic lupus erythematosus. Lupus, 25(9), 973–979. https://doi.org/10.1177/0961203316629555
16.
PetriM.OrbaiA.-M.AlarcónG. S.GordonC.MerrillJ. T.FortinP. R.BruceI. N.IsenbergD.WallaceD. J.NivedO.SturfeltG.Ramsey-GoldmanR.BaeS.-C.HanlyJ. G.Sánchez-GuerreroJ.ClarkeA.AranowC.ManziS.UrowitzM., . . . MagderL. S. (2012). Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism, 64(8), 2677–2686. https://doi.org/10.1002/art.34473
17.
RadinM.SchreiberK.CecchiI.SignorelliF.de JesúsG.AsoK.KonoM.UrbanM. L.BaccoB.Gallo CassarinoS.Lo SardoL.FoddaiS. G.BarinottiA.Gómez-GarcíaI.QuagliaM. I.TisseraY.GervasoniF.Aguirre-ZamoranoM. Á.AlbaP., . . . SciasciaS. (2022). Disease activity at conception predicts flare up to 2 years after birth: A multicentre long term follow-up study. Seminars in Arthritis and Rheumatism, 57, Article 152113. https://doi.org/10.1016/j.semarthrit.2022.152113. Epub 2022 Oct 22.
18.
SammaritanoL. R.BermasB. L.ChakravartyE. E.ChambersC.ClowseM. E. B.LockshinM. D.MarderW.GuyattG.BranchD. W.BuyonJ.Christopher-StineL.Crow-HercherR.CushJ.DruzinM.KavanaughA.LaskinC. A.PlanteL.SalmonJ.SimardJ., . . . D’AnciK. E. (2020). 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis & Rheumatology, 72(4), 529–556. https://doi.org/10.1002/art.41191
19.
ShamirR. (2016). The benefits of breast feeding. Nestlé Nutrition Institute Workshop Series, 86, 67–76. https://doi.org/10.1159/000442724
20.
SharmaA. J.DeeD. L.HardenS. M. (2014). Adherence to breastfeeding guidelines and maternal weight 6 years after delivery. Pediatrics, 134, S42–S49. https://doi.org/10.1542/PEDS.2014-0646H
21.
SkorpenC. G.HoeltzenbeinM.TincaniA.Fischer-BetzR.ElefantE.ChambersC.Da SilvaJ.Nelson-PiercyC.CetinI.Costedoat-ChalumeauN.DolhainR.FörgerF.KhamashtaM.Ruiz-IrastorzaG.ZinkA.VencovskyJ.CutoloM.CaeyersN.ZumbühlC.ØstensenM. (2016). The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Annals of the Rheumatic Diseases, 75(5), 795–810. https://doi.org/10.1136/ANNRHEUMDIS-2015-208840
22.
SkorpenC. G.LydersenS.GilboeI. M.SkomsvollJ. F.SalvesenK.PalmØ.KoksvikH. S. S.JakobsenB.WalleniusM. (2018). Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population-based study. Annals of the Rheumatic Diseases, 77(2), 264–269. https://doi.org/10.1136/ANNRHEUMDIS-2017-211641
TincaniA.NalliC.KhizroevaJ.BitsadzeV.LojaconoA.AndreoliL.ShoenfeldY.MakatsariyaA. (2019). Autoimmune diseases and pregnancy. Best Practice and Research: Clinical Endocrinology and Metabolism, 33(6), Article 101322. https://doi.org/10.1016/j.beem.2019.101322
25.
VerduciE.FioreG.AgostinelliM.ZuccottiG. (2025). Feeding Practices in the Introduction of Complementary Feeding and Implications for Future Healthy Eating. Annals of Nutrition & Metabolism. Advance online publication. https://doi.org/10.1159/000543126
26.
WaltersD. D.PhanL. T. H.MathisenR. (2019). The cost of not breastfeeding: Global results from a new tool. Health Policy and Planning, 34(6), 407–417. https://doi.org/10.1093/HEAPOL/CZZ050
WuL.LiX.IsmailH. N.GuoP.YangJ. (2025). Understanding the psychosocial dilemma in breastfeeding: A narrative review of extended theory of planned behavior and its intervention strategies. Reproductive Health, 22(1), 46. https://doi.org/10.1186/s12978-025-02001-5
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