Last update: Feb. 11, 2020

Lupus

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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An autoimmune disease where the immune system mistakenly attacks cells and tissues, and can damage joints, kidneys, heart, skin, lungs, arteries, veins and the brain. It is more common in women than in men as well as in African-American and Hispanic women. The disease usually occurs in the form of outbreaks with intermediate periods without symptoms (MedlinePlus 2019).

Maternal lupus increases the risk of prematurity, temporary neonatal lupus and congenital heart block in the newborn (Saavedra 2015, Goldsmith 1989).

Mothers with lupus have lower rates and shorter duration of breastfeeding (Acevedo 2017).
Breastfeeding figures improve if the disease is not very active in the postpartum period, if the pregnancy is at term and if the decision to breastfeed was taken and prepared early in pregnancy (Noviani 2016).

There are no known effects of breastfeeding on lupus (Francis 2109); Breastfeeding is not associated with worsening of lupus.

There are so many benefits of breastfeeding for mothers and infants that expert authors and medical associations agree that mothers with lupus should be supported so they can breastfeed, as well as to know and disseminate which medication to use that is compatible with breastfeeding (Francis 2019, Phillips 2018, Acevedo 2017, Götestam 2016).

Prolactin levels are elevated in lupus and correlate with the disease’s activity (Song 2017, Wang 2017) although these results are not always found (Wang 2017, Aulestia 2016).

Non-steroidal anti-inflammatories, low doses of aspirin, corticosteroids (prednisone, methylprednisolone), antimalarials (hydroxychloroquine, chloroquine), azathioprine, cyclosporine and immunoglobulins can be used safely during breastfeeding (Bitencourt 2018, Nahal 2018, Bermas 2017, Bălănescu 2017, Götestam 2016, Noviani 2016, Flint 2016). Calcineurin inhibitors such as tacrolimus are well tolerated and their excretion in breastmilk is insignificant (Hiramatsu 2018, Flint 2016, Izumi 2014).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Tradenames

Main tradenames from several countries containing Lupus in its composition:

  • Chill Pill™. Contains other elements than Lupus in its composition

References

  1. Francis A, Nusbaum J, Melendez Torres A, Spruill T, Buyon J, Mehta-Lee S. Breastfeeding in the systemic lupus erythematosus patient. Lupus. 2019 Jun;28(7):914-915. Abstract
  2. MedlinePlus. Lupus eritematoso sistémico. Información de salud para usted. 2019 Full text (link to original source) Full text (in our servers)
  3. MedlinePlus. Systemic lupus erythematosus. Trusted Health information for you 2019 Full text (link to original source) Full text (in our servers)
  4. Phillips R, Williams D, Bowen D, Morris D, Grant A, Pell B, Sanders J, Taylor A, Choy E, Edwards A. Reaching a consensus on research priorities for supporting women with autoimmune rheumatic diseases during pre-conception, pregnancy and early parenting: A Nominal Group Technique exercise with lay and professional stakeholders. Wellcome Open Res. 2018 Jun 20;3:75. Abstract
  5. Hiramatsu Y, Yoshida S, Kotani T, Nakamura E, Kimura Y, Fujita D, Nagayasu Y, Shabana K, Makino S, Takeuchi T, Arawaka S. Changes in the blood level, efficacy, and safety of tacrolimus in pregnancy and the lactation period in patients with systemic lupus erythematosus. Lupus. 2018 Dec;27(14):2245-2252. Abstract
  6. Bitencourt N, Bermas BL. Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding. Paediatr Drugs. 2018 Dec;20(6):511-521. Abstract
  7. Nahal SK, Selmi C, Gershwin ME. Safety issues and recommendations for successful pregnancy outcome in systemic lupus erythematosus. J Autoimmun. 2018 Sep;93:16-23. Abstract
  8. Bălănescu A, Donisan T, Bălănescu D. An ever-challenging relationship: lupus and pregnancy. Reumatologia. 2017;55(1):29-37. Abstract
  9. Bermas BL. Lactation and Management of Postpartum Disease. Rheum Dis Clin North Am. 2017 May;43(2):249-262. Abstract
  10. Wang P, Lv TT, Guan SY, Li HM, Leng RX, Zou YF, Pan HF. Increased plasma/serum levels of prolactin in systemic lupus erythematosus: a systematic review and meta-analysis. Postgrad Med. 2017 Jan;129(1):126-132. Abstract
  11. Song GG, Lee YH. Circulating prolactin level in systemic lupus erythematosus and its correlation with disease activity: a meta-analysis. Lupus. 2017 Oct;26(12):1260-1268. Abstract
  12. Acevedo M, Pretini J, Micelli M, Sequeira G, Kerzberg E. Breastfeeding initiation, duration, and reasons for weaning in patients with systemic lupus erythematosus. Rheumatol Int. 2017 Jul;37(7):1183-1186. Abstract
  13. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016 Sep;55(9):1693-7. Abstract Full text (link to original source) Full text (in our servers)
  14. Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. Abstract Full text (link to original source) Full text (in our servers)
  15. Aulestia C, De Zubiría A, Granados C, Suárez J, Cervera R. Prolactin and Estradiol Profile in a Cohort of Colombian Women with Systemic Lupus Erythematosus. Isr Med Assoc J. 2016 Sep;18(9):537-541. Abstract
  16. Noviani M, Wasserman S, Clowse ME. Breastfeeding in mothers with systemic lupus erythematosus. Lupus. 2016 Aug;25(9):973-9. Abstract
  17. Saavedra Salinas MÁ, Barrera Cruz A, Cabral Castañeda AR, Jara Quezada LJ, Arce-Salinas CA, Álvarez Nemegyei J, Fraga Mouret A, Orozco Alcalá J, Salazar Páramo M, Cruz Reyes CV, Andrade Ortega L, Vera Lastra OL, Mendoza Pinto C, Sánchez González A, Cruz Cruz Pdel R, Morales Hernández S, Portela Hernández M, Pérez Cristóbal M, Medina García G, Hernández Romero N, Velarde Ochoa Mdel C, Navarro Zarza JE, et al. Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I. Reumatol Clin. 2015 Sep-Oct;11(5):295-304. Abstract
  18. Izumi Y, Miyashita T, Migita K. Safety of tacrolimus treatment during pregnancy and lactation in systemic lupus erythematosus: a report of two patients. Tohoku J Exp Med. 2014 Sep;234(1):51-6. Abstract Full text (link to original source) Full text (in our servers)
  19. Goldsmith DP. Neonatal rheumatic disorders. View of the pediatrician. Rheum Dis Clin North Am. 1989 Abstract

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