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Should I Breastfeed As An Autoimmune Mom?

Three babies sitting indoors holding handsBreastfeeding offers many benefits, for both mother and child.  New moms get to experience the undeniable bonding that occurs between themselves and their newborns during each session; and their babies receive breast milk, a natural product that delivers not only sustenance, but also important vitamins, minerals and immune factors.

For expectant mothers who carry one or more autoimmune disease diagnoses, there is often concern, understandably, about whether their autoantibodies will be transmitted to their child during breastfeeding, and what this might mean for the baby.  Here we examine some of these issues for soon-to-be mothers.

Is it possible for autoimmune antibodies to be transferred from mother to baby during breastfeeding?

Yes, this occurs with antibodies and a wide range of other substances during breastfeeding, many of which are beneficial while others (often medication-based) may be problematic.

Especially for the first few weeks of life, transmission of regular antibodies is an important component contributing to the immunocompetence of the newborn.  The larger and more important question, of course, is whether the transfer specifically of autoantibodies has any negative impact on the nursing baby (covered below).

It should be noted that during its time as a fetus, and for around six months postpartum, the baby relies quite heavily on the maternal immune system – particularly IgG, which crosses the placenta – for protection, while its own immune system develops and matures.  Because of this phenomenon, it is rather likely, though not definite, that the newborn/infant was already exposed to such antibodies in utero, prior to breastfeeding.

Are there any risks to breastfeeding in a mom who has an autoimmune condition prior to pregnancy?

The answer to this question is not entirely certain, but fortunately, it doesn’t appear that breastfeeding is much of a concern for most mothers with autoimmune disease.  However, this is not an absolute and may depend on the condition, which is why all patients who are concerned with potential risks should consult their physicians.

While maternal autoantibodies are frequently found in breast milk, the larger question is what the presence of such antibodies means for children being breastfed, immediately postpartum or in the future.  For the most part, it doesn’t appear that the existence of such antibodies in breast milk is well correlated with any significant risks for the baby.  There are, as noted, certain exceptions, such as the possibility of neonatal thyroid disease derived from maternal autoantibodies.

But from the majority of available studies and information – which are admittedly not all that complete or helpful – it seems that in the vast majority of cases, there is little to no reason for concern regarding risks to the child.  In light of the clear benefits to breastfeeding, and in the absence of any obvious evidence that maternal autoantibodies cause problems or disease in the majority of children, it is almost always recommended that new mothers with autoimmune disease breastfeed, assuming they are not taking any medications that directly contradict this advice.

However, there are certain disorders that can rarely cause problems for the newborn in the immediate postpartum period, though even most of these generally resolve relatively quickly.

Two such examples of rare exceptions to the rule are in mothers with myasthenia gravis and lupus, where the newborn can infrequently develop temporary disease secondary to the mother’s autoantibodies affecting neonatal tissues.

Still, at least in the case of neonatal lupus, this condition is not seen as a reason to discontinue breastfeeding.  And in immune thrombocytopenia of the mother, though breastfeeding does not generally increase the risk of this condition within the child, it is recommended that this be monitored during and after pregnancy, since anti-platelet antibodies may be circulating and have the (low) potential to react with the baby’s platelets.

Also, it is believed that the presence of autoimmune conditions (not specifically autoantibodies in breast milk) in the mother may genetically predispose the child to having a higher chance of developing autoimmune disease at some point in the future.  But it’s very important to note that this is not viewed as likely being the result of breast milk antibodies; rather, it is a reflection of the poorly understood genetic mechanisms that often result in offspring having a higher chance of being diagnosed with many different conditions (heart disease, cancer, etc.) seen in the parents and extended family, including autoimmune conditions.

In a somewhat related matter of limited concern, it has been postulated that breast milk proteins do indeed induce the formation of autoantibodies in the infant, and that these antibodies may last into adulthood.  However, this is not the same as the child developing autoimmune secondary to maternal antibody transmission, since the milk proteins are not technically self-derived (being from the mother), and removal of such proteins would likely nullify any related immune problems.  In this sense, such antibodies might be seen more as the source of milk intolerance or allergy rather than actual autoimmune disease.

What are other ways that antibodies develop in babies and children with childhood onset of an autoimmune condition such as juvenile rheumatoid arthritis and juvenile diabetes? Is it always that they were born with them?

One of the reasons a mother’s autoantibodies are usually of little concern in terms of impact on the child is that they are uniquely her own, directed toward her own internal tissues, rather than the baby’s (which may display antigenic commonalities with the mother’s tissues, but are still distinct in terms of cross-reaction with most maternal antibodies).  That is, while it’s possible, the likelihood of maternal antibodies from a mother with an autoimmune disease finding a specific target in her offspring is relatively low, especially in the immediate postpartum period.  For this reason, maternally derived antibodies, whether during gestation or breastfeeding, are generally not viewed as risk factors for subsequent autoimmune disease the child may develop, as far as we know at this time (see above for some exceptions).

It follows then that although these children are indeed possibly born with maternal autoimmune disease antibodies circulating, in most cases they are likely of little significance in clinical terms.  Instead, in cases of future autoimmune conditions in the child, at some point after birth (exactly when is unclear, and of course variable by disease and individual), for reasons that aren’t fully understood, the child’s own immune system most likely detects his or her tissues as foreign, forms its own autoantibodies and begins to attack them as if they were pathological.

Therefore, if and when such autoantibodies develop, resulting in disease, this is a process that, just as is the case with the mother, is unique to that particular child.  In technical terms, these antibodies are produced just like any other antibody, via B cells and plasma cells; but why they then turn against one’s own tissues is unfortunately still very much a mystery, in people of all ages with autoimmune conditions.

There is even some evidence from animal studies concerning diabetes, that both fetal and postnatal exposure to maternal autoantibodies may in fact provide a protective effect against the offspring developing type-1 diabetes in the future.  In addition, researchers believe that cow’s milk or soy-based formulas (as opposed to breast milk) may indeed contribute to an increased risk of diabetes or thyroid disease in the future.

It should be noted that some researchers believe that low-level infections of sites such as pancreatic islet cells may, through a self-perpetuating mechanism, spark an autoimmune reaction that could possibly result in such conditions as type-1 diabetes.  But this appears to be mostly theoretical at this point, and not much of a major concern in terms of the effects of breastfeeding and breast milk.

Questions for your doctor:

  • What are some clear reasons to stop, delay or avoid breastfeeding, in terms of autoimmune conditions in general?
  • Should I be concerned with breastfeeding my infant, given my specific autoimmune disease?
  • Is it true that formula feeding may actually increase the risk of certain autoimmune diseases in the future for the child?  What are your thoughts on this, in the event that breastfeeding is problematic?
  • What signs and symptoms, if any, should I be watchful for in terms of detecting possible autoimmune issues in the newborn/child?
  • Where can I get good and reliable information regarding these issues?

 

About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians.  After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time.  He may be reached at [email protected].

This post contains opinions of the author.  AutoimmuneMom.com is not a medical practice and does not provide medical advice, diagnosis, or treatment.  It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances.  Camino Real Ventures, Inc., the company that makes AutoimmuneMom.com available to you, does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website.  Your use of the website is subject to our Terms of Use and Privacy Policy

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