Background/Purpose: While the benefits of breastfeeding for both the mother and her infant are well established, available resources regarding medication compatibility with lactation are limited.  Thus, providers may feel ill equipped to encourage breast-feeding amongst patients on anti-rheumatic drugs.  We sought to improve knowledge of the lactation compatibility of medications used to treat rheumatic diseases amongst obstetric and rheumatology providers at an academic medical center that includes a safety net hospital.

Methods: Baseline lactation knowledge was obtained via a multiple-choice survey.  The survey was developed based on a literature review of rheumatology patients’ concerns and knowledge gaps with regards to the lactation process.  Providers were then given a laminated “lactation and rheumatic diseases” information card and asked to take the survey again. Improvement in knowledge was assessed.  The survey will be re-administered three months after the initial survey date to test the sustainability of the intervention.

Results: Twenty-two rheumatology providers were surveyed, including fellows, attendings, nurse practitioners and physician assistants. All of the providers recommended women with rheumatic diseases breastfeed their children.  Twenty-two of 22 providers responded that hydroxychloroquine (HCQ) was compatible with lactation.  In contrast, 10/22 (45%), 8/22 (36%), 10/22 (45%), 5/22 (23%), 7/22 (32%), and 4/22 (18%) of providers were unsure or unaware of the lactation compatibility of prednisone, methotrexate (MTX), leflunomide (LEF), sulfasalazine (SSZ), mycophenolate (MMF), and anti-TNF medications, respectively.  After administration of the information card, 100% of providers correctly answered questions regarding the compatibility of MTX, LEF, SSZ, and MMF with lactation.  Ninety-one percent of providers correctly answered questions regarding the compatibility of TNF therapy with lactation.

Conclusion: There are knowledge gaps among rheumatology providers with regards to medication compatibility with lactation.  Creating a simple structured information card helped to address these deficiencies.  The sustainability of this intervention will be measured.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-lactation-knowledge-among-providers-caring-for-rheumatology-patients/