Background/Purpose: Breastfeeding has been shown to improve maternal and infant wellbeing and long-term health, but it is currently unknown how often it is pursued in the SLE population.  We sought to determine the rate of breastfeeding and factors that promote or discourage this in the postpartum period for women with SLE.

Methods: Lupus patients enrolled in a prospective pregnancy registry completed questionnaires about infant feeding intentions at enrollment and infant feeding practices post-partum.  Throughout the pregnancy and postpartum, medications and disease activity were evaluated using the SLE pregnancy disease activity index (SLEPDAI). 

Results: 86 pregnancies occurred in women who met the 2012 SLICC criteria for SLE.  Of these, 13 resulted in a miscarriage or termination and 10 were lost to follow-up; postpartum feeding data is available for 51 pregnancies. 28 (54.9%) of pregnancies were in Caucasian women, 20 (39.2%) in African-American and 3 (5.9%) in Asian women.  The average maternal age was 29.8yrs (SD 4.8), with a range from 21.5 to 42.2yrs.  At study entry, 53 (64.6%) planned on breastfeeding, 19 (23.2%) planned on using formula, and 10 (12.2%) had no feeding plan. 

By 6 weeks postpartum, 26 (51.0%) were formula feeding exclusively and 25 (49.0%) were breastfeeding.  Of the women breastfeeding, 7 (28%) were supplementing with formula.   Compared to women who formula fed only, those who were breastfeeding were older and had less disease activity post-partum (see table).  Breastfeeding mothers also had deliveries that were more likely to be at term and their infants were less likely to have spent time in the intensive care unit.

African-American women were more likely to plan to use formula (45.0% AA vs 22.2% Caucasian, p=0.12) and to only use formula (65.0% AA vs 42.9% Caucasian, p=0.15).  African-American women were also more likely to have high SLE activity post-partum (47.4% AA vs 15.6% Caucasian, p=0.04).  In multivariate logistic regression, post-partum SLE activity (p=0.02) and whether breastfeeding was planned in pregnancy (p=0.03), but not race (p=0.6), predicted breastfeeding.

The key reasons that women breastfed included to keep the baby healthy (91.7%), to bond with the baby (66.7%), to keep infant feeding costs low (66.7%), to lose weight (58.3%), and for convenience (33%).  The main reasons that women did not breastfeed were concern over medication effects on the infant (36%); 7 (27%) of the non-breastfeeding women were taking contraindicated medications (methotrexate, mycophenolate, or azathioprine) post-partum. 

Conclusion: About half of women with lupus breastfeed for at least 6 weeks.  Factors that influence this decision include pre-delivery intention to breastfeed, maternal age, SLE activity, and medications.  Given the myriad of maternal and infant benefits seen with breastfeeding, finding approaches that facilitate this choice for women with SLE is an important goal.