Last update: Feb. 12, 2020
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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In disorders grouped under the term "inflammatory bowel disease" (IBD) there is a chronic inflammation of the digestive tract which is considered of autoimmune origin, in which the immune system mistakenly attacks cells of the digestive tract. Risk factors are family history, smoking, consumption of nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac or naproxen, or a high-fat diet. Not having been breastfed increases the risk of IBD (Piovani 2019, Xu 2017, Huang 2014, Ponder 2013, Barclay 2009).
IBD mainly comprises two diseases:
1. Ulcerative colitis. There is inflammation and ulcers in the large intestine (colon) and rectum.
2. Crohn's disease or regional ileitis. The inflammation and ulcers are at the end of the small intestine, the ileum.
The symptoms of both can be severe, watery and bloody diarrhea, abdominal pain, loss of appetite, weight loss, fatigue and fever. There may be periods of active disease and periods of remission.
IBD without surgical interventions in the pelvis does not affect the reproductive capacity of women (Mahadevan 2015, van der Woude 2015, Hendy 2015, Schulze 2014). There is no greater frequency of relapse during breastfeeding, which could have a protective effect during the first year after delivery (Julsgaard 2016, Hendy 2015, Huang 2014).
Most treatments used in IBD are compatible with breastfeeding (Buchner 2019, Paizis 2019, Bell 2019, Buchner 2019, Matro 2018, Bermejo 2018, Lahat 2018, Mottet 2016, Huang 2016, Nguyen 2016, van der Woude 2015, Hosseini 2015, Mahadevan 2015, Damas 2015, Hendy 2015, Chaparro 2014, Nielsen 2014, Huang 2014, Schulze 2014, Cury 2014, Yarur 2013):
- Anti-inflammatories: corticosteroids, sulfasalazine, mesalazine, balsalazide and olsalazine.
- Immunosuppressants: azathioprine, mercaptopurine, cyclosporine and low doses of methotrexate.
- "Biological" medications such as tumor necrosis factor alpha inhibitors: infliximab, adalimumab, certolizumab and golimumab. Other biological treatments: natalizumab, vedolizumab and ustekinumab.
- Antibiotics: ciprofloxacin and metronidazole.
- Antidiarrheals and fibre: plantago or ispaghula, methylcellulose and loperamide.
- Analgesics: paracetamol.
- Iron, calcium and vitamin D supplements.
Breastfeeding in women with IBD is possible and recommended (Schulze 2014, de Meij 2013). Serious complications such as malnutrition, surgical resections and the need for parenteral nutrition require multidisciplinary support for breastfeeding (Borbolla 2016).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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