Breastfeeding With Chronic Disease

It’s been well-documented that breastfeeding leads to lower risk of chronic diseases in childhood and beyond (per observational studies that suggest a connection between prevalence of chronic diseases and “suboptimal breastfeeding”). But what happens if the mother is the one affected by chronic disease?

Before you move on, please visit and read my disclaimer.  For the TLDR, this information is not to be taken as medical advice as I’m not a doctor. Always consult with your own health care provider regarding any protocols, treatments, and diagnoses related to health.

Quick Rundown on a Few Common Conditions

Arthritis & Fibromyalgia

This article by Katheen Kendall-Tackett, PhD, discusses the special challenges of breastfeeding with these painful and often disabling conditions, plus nursing adaptations that can help.

Autoimmune Diseases

From Dr. Jack Newman (emphasis mine):

“These illnesses are characterized by antibodies being produced by the mother against her own tissues. Some mothers have been told that because antibodies get into the milk, the mother should not breastfeed as she will cause illness in her baby. This is incredible nonsense. The antibodies that make up the vast majority of the antibodies in the milk are of the type called secretory IgA. Autoimmune diseases are not caused by secretory IgA. Even if they were, secretory IgA is not absorbed by the baby. There is no issue. Continue breastfeeding.”

Diabetes

Find out the connection between breastfeeding and diabetes in this article by the American Diabetes Association. It’s evidenced that women who had gestational diabetes can get long-term protection from postpartum diabetes if they breastfeed for at least three months.

Pre-diabetes affects one out of every four childbearing-aged women. A new study found:

“[E]levated body mass index, elevated fasting insulin, insulin resistance and, especially, elevated fasting plasma glucose in the pre-diabetic range, were all predictors of insufficient milk supply in women attempting to exclusively breastfeed.”

AAFP on diabetes treatment compatibility:

Insulin is not excreted into breast milk and is considered safe for use during breast-feeding. Based on studies of the distribution of first-generation sulfonylureas into breast milk, the AAP considers tolbutamide (Orinase) to be compatible with breast-feeding. Information on other diabetic agents is less complete. Glyburide (Micronase) and glipizide (Glucotrol) are highly protein-bound…therefore, they are less likely to be displaced by other drugs and unlikely to pass into breast milk. If any of the sulfonylureas are used, it is important to monitor the nursing infant for signs of hypoglycemia, such as increased fussiness or somnolence. The alpha-glucosidase inhibitors, such as acarbose (Precose), have low bioavailability, large molecular size and water solubility, so they are unlikely to be excreted into breast milk in clinically significant amounts. Because of the potential for serious side effects (e.g., lactic acidosis, hepatotoxicity) in adults, it may be advisable to avoid the use of metformin (Glucophage) and thiazolidinediones (e.g., rosiglitazone [Avandia], pioglitazone [Actos]) until more information is available on their use in breast-feeding.”

Epilepsy

Women who receive anti-epileptic drugs are more likely to formula-feed. AAFP on treatment compatibility with breastfeeding:

“Phenytoin (Dilantin) and carbamazepine (Tegretol) are compatible with breast-feeding. Although the AAP considers valproic acid and its derivatives (valproic sodium and divalproex sodium) to be compatible with breast-feeding, some experts recommend against their use during breast-feeding because of the potential for fatal hepatotoxicity in children younger than two years. During breast-feeding, anticonvulsants other than phenobarbital and primidone (Mysoline) are preferred because the slow rate of barbiturate metabolism by the infant may cause sedation. Infant serum levels may be helpful in monitoring toxicity.”

Herpes I & II

An affected person can still breastfeed as the virus itself isn’t present in breast milk. However the affected person still needs to take special care of the condition, including taking a nursing-safe medicine such as Valtrex, as necessary.

“In young babies–a month or less–herpes can have fatal consequences. This is why mothers with active genital lesions don’t deliver vaginally. Serious complications rarely happen in babies older than 4 weeks.”

Read more about herpes and breastfeeding from LLLI.

Hepatitis B & C

The CDC says it’s safe for a mother infected with Hepatitis B or C to breastfeed as Hepatitis is transmitted via blood, not breast milk. It recommends immunization for the baby, but does not believe it’s necessary to wait for complete immunization to begin breastfeeding. If an infected mother has cracked and bleeding nipples, it’s best to err on the side of caution and temporarily “pump and dump” while feeding the baby stored breast milk in other ways until the affected areola has healed.

Human Immunodeficiency Virus (HIV)

It used to be that if other feeding methods were available, affordable, feasible and safe, alternatives were recommended over breastfeeding for an HIV-infected mother. However, the newest evidence is showing that breastfeeding may still be best.

Facts from UNICEF:

  1. “Without preventive interventions, approximately one-third of infants born to HIV-positive mothers contract HIV through mother-to-child transmission, becoming infected during their mothers’ pregnancy, childbirth or breastfeeding.”
  2. “Between 15 and 25% of children born to HIV-infected mothers get infected with HIV during pregnancy or delivery, while about 15% of the children get infected through breastfeeding.”
  3. Factors that decrease a child’s risk of contracting the virus: exclusive breastfeeding, preventing cracked nipples, early treatment of sores/thrush, and breastfeeding for at least 3 months but not as long as the current minimum of 2 years for other women.

WHO changed its protocol in 2009, based on research showing that:

“[A] combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmitting HIV to babies through breastfeeding.”

WHO’s protocol is for the HIV-positive mother or the infants to:

“[T]ake antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old.”

Keep in mind, exclusive breastfeeding (no other solids or liquids) is key here:

“Prior research had shown that exclusive breastfeeding in the first six months of an infant’s life was associated with a three- to fourfold decreased risk of HIV transmission compared to infants who were breastfed and also received other milks or foods.”

LLLI makes another point for affected women in developing countries:

“The social costs of not breastfeeding also must be considered. When a woman gives breast milk substitutes in a culture where breastfeeding is traditional, her community may suspect that she is HIV-positive, potentially putting her at risk for physical abuse, ostracism, and abandonment. In most parts of the world women do not know their HIV status, therefore ongoing support of exclusive breastfeeding is most appropriate and much needed.”

The CDC, on the other hand does NOT recommend that a baby with an HIV-positive mother should breastfeed. The AAP says that the pros and cons should be weighed for women in developing nations, but does NOT recommend breastfeeding for women in industrialized nations. Currently, the research into HIV infections and the antiretroviral drug effects on breastfed children is largely inconclusive, thus warranting the careful consideration of individual cases.

Hyperthyroidism

June Isis Evasco shares her inspiring story of determining to breastfeed with Diffuse Toxic Goiter. Among many other benefits to her and the baby, she even found that breastfeeding alleviated her medication’s side effects.

Lyme Disease

In a paper from the US Centers for Disease Control website (Cooper & Feder, 2004), it is found that no babies have developed lyme disease from breastfeeding. Learn more about this condition as related to breastfeeding here.

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Other Resources:

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