Background: Breast milk is the natural and most physiological nutrition for a child from the first days of life. The benefits of breastfeeding are numerous, including psychological aspects. However, some women with rheumatic diseases are afraid that their disease or therapy is not compatible with breastfeeding.

Objectives: To describe frequency, duration and reasons for stopping lactation in women with AS, to compare the activity of AS in women with and without lactation.

Methods: 44 women with confirmed AS (modified New York criteria, 1984) were followed within 1 year after childbirth. Visits were carried out in 1, 6 and 12 months after delivery. The average age of patients was 32,5 ± 5,8 years, the duration of the disease was 149,0 ± 96,3 months. BASDAI at 1, 6 and 12 months after giving birth was: 2,4 [1,4; 4,2]; 2,6 [1,4; 4,4]; 2,7 [1,5; 4,1], respectively. ASDAS-CPR was: 2,0 [1,2; 2,7]; 1,9 [1,4; 2,5]; 1,7[1,3; 2,3], respectively.

Results: Lactation was established in 41 women (93,2%), duration – 10 [4; 12] months; in 17 patients (41,5%) lactation persisted for 12 months. Lactation was unreasonably medically suppressed in 3 women in an obstetric unit due to therapy of AS (sulfasalazine – 2, certolizumab pegol – 1); in 1 woman lactation was not established for organizational reasons. Lactation lasted less than 6 months in 16 patients (39%), 13 of them had a natural attenuation of lactation, and in 3 cases, drug-induced suppression of lactation was carried out on the recommendation of pediatricians in connection with onset of AS therapy (adalimumab).

During lactation, 51,2%, 74,1% and 88,2% of women received nonsteroidal anti-inflammatory drugs for 1, 6 and 12 months after delivery, respectively; adherence to NSAID therapy did not differ in women with and without lactation. TNF-α inhibitors (certolizumab pegol) were received by 4 women (7,3%), while the need for iTNF-α was in 13 patients (not received due to medicine unavailability).

In women who retained lactation, the severity of back pain was: 3,0 [2,0; 6,0], 3,0 [2,0; 5,0] and 3,0 [2,0; 4,5] according to NRS (numerical rating scale) after 1, 6 and 12 months since delivery, respectively; severity of night pain - 3,0 [2,0; 5,0], 3,0 [2,0; 5,0] and 2,0 [2,0; 4,0] according to NRS, respectively. BASDAI activity at 1, 6 and 12 months after delivery was 2,3 [1,0; 4,2], 2,1 [1,4; 4,1] and 2,2 [1,6; 2,8], respectively. Activity on ASDAScrp was 1,9 [1,2; 2,7], 1,6 [1,4; 2,6] and 1,6 [1,3; 1,7], respectively. CRP level was 3,4 [1,9; 8,2], 4,5 [2,0; 12,5] and 2,0 [0,8; 5,6] mg/l, respectively. The severity of back pain, BASDAI and ASDAS values of CRP did not differ in women with and without lactation.

Women with high AS activity (BASDAI≥4) maintained lactation at 1, 6 and 12 months after delivery in 84,6%, 50% and 8,3%, respectively; while patients with low activity did it in 93,6%, 66,7% and 51,6%, respectively (p < 0,05 12 months after delivery).

Conclusion: The vast majority of women with AS are set up for lactation. High AS activity becomes a risk factor for termination of lactation more than 6 months after delivery. It is necessary to conduct training for obstetricians-gynecologists and pediatricians on issues related to medicine capabilities during lactation, in order to exclude unjustified cancellation of medicines compatible with breastfeeding.

REFERENCES:

[1]N. Ikram, A. Eudy, M.E.B. Clowse. Breastfeeding in women with rheumatic diseases. Lupus Sci Med. 2020; 8(1):e000491 DOI: 10.1136/lupus-2021-000491

Disclosure of Interests: None declared