Breastfeeding in mothers with systemic lupus erythematosus

Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up‐to‐date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine.

show abstract

“…Treatment with SCS during lactation is safe, since <0.1% of the mother's ingested dosage is secreted into breastmilk …”

Section: Systemic Anti‐inflammatory Treatment Of Atopic Dermatitis Inmentioning

confidence: 99%

European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

Vestergaard

Wollenberg

Barbarot

et al. 2019

Acad Dermatol Venereol

173

View full text Add to dashboard Cite

show abstract

“…While pregnancy outcomes were not different between the three groups, lupus disease activity was significantly higher in the women who had stopped HCQ therapy, necessitating increase in background steroid therapy. The safety data for HCQ is also reassuring: while HCQ has been demonstrated in cord blood and breast milk, although at lower concentrations than found concomitantly in maternal blood, no increased risk of congenital defects, spontaneous abortions, retinal or otoxoticy in offspring of CTD mothers exposed to in utero HCQ has been observed [110–112]. The recommendation that HCQ be continued during pregnancy as a DMARD, steroid sparing agent was strongly confirmed by the EULAR task force recently, along with a consensus that HCQ is compatible with breastfeeding [99,110,113].…”

Section: Medications During Autoimmune Ctd Pregnanciesmentioning

confidence: 99%

“…Medications considered safe in breastfeeding include NSAIDs, glucocorticoids, cyclosporin, and HCQ due to minimal to low exposure in the breast milk and a long history of safe use [112]. Caution regarding breastfeeding during therapy with AZA is recommended in thiopurine methyltransferase deficient mothers and children [99], and with sulfasalazine in premature babies as discussed above [100].…”

Section: Medications During Autoimmune Ctd Pregnanciesmentioning

confidence: 99%

Pregnancy and autoimmune connective tissue diseases

Marder

Littlejohn

Somers

2016

Best Practice & Research Clinical Rheumatology

View full text Add to dashboard Cite

The autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before and during pregnancy and the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy.

show abstract

“…103 Most experts consider breastfeeding a strong contraindication to MTX use due to increased risk of immunosuppression in the infant, 23,104,105 but MTX secretion into breast milk is minimal, 103 and was not discouraged in a recent study of MTX-treated mothers with lupus. 106 …”

Section: Immunomodulatorsmentioning

confidence: 99%

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

Cohn

Dave

Loftus

2017

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the IBD population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.

show abstract

Breastfeeding in mothers with systemic lupus erythematosus

Abstract: Half of women with lupus breastfed and most desire to breastfeed. Hydroxychloroquine, azathioprine, methotrexate, and prednisone have very limited transfer into breast milk and may be continued while breastfeeding.

Cited by 48 publications

References 10 publications

European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

Pregnancy and autoimmune connective tissue diseases

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

Contact Info

Product

Resources

About