# Breastfeeding in women with juvenile idiopathic arthritis: results from a Norwegian quality register

## TL;DR

This study examines breastfeeding rates and health outcomes in women with juvenile idiopathic arthritis in Norway, finding higher breastfeeding rates and better outcomes in those who breastfed.

## Contribution

The study provides new insights into breastfeeding patterns and health outcomes specific to women with juvenile idiopathic arthritis.

## Key findings

- 86% of women with JIA were breastfeeding at six weeks postpartum, with notable differences in education, birth outcomes, and pain levels.
- Breastfeeding women had lower cesarean section rates, higher birth weights, and lower pain and fatigue scores compared to non-breastfeeding women.
- Non-breastfeeding women used more disease-modifying antirheumatic drugs at all postpartum time points.

## Abstract

Limited research exists on the challenges women diagnosed with juvenile idiopathic arthritis (JIA) can face during pregnancy and breastfeeding, and if breastfeeding affects disease related factors.

This study aimed to explore the proportion of women with JIA breastfeeding at six weeks, six months, and 12 months postpartum, as well as examining demographic and disease related factors and the use of medications, comparing the breastfeeding and the non-breastfeeding groups.

Data on women with JIA regarding pregnancy and breastfeeding were collected prospectively from the Norwegian nationwide quality register RevNatus in this observational study. The data included demographics, disease activity, self-reported health status, medication, obstetric and neonatal outcome, and were collected from clinical documentation and self-reported material during visits at the outpatient clinic between January 2016 and July 2023. In this study, we used data from the inclusion visit and from the follow-up at six weeks, six months and 12 months postpartum.

Amongst 304 births in 227 women, 86% of the patients were breastfeeding at six weeks, 70% at six months and 39% at 12 months postpartum. Breastfeeding women differed from non-breastfeeding women in several aspects. At six weeks postpartum, 79% of breastfeeding women had a higher education level compared to 49% of non-breastfeeding women (p-value < 0.001). Additionally, breastfeeding women experienced longer pregnancy duration (40 weeks versus 38 weeks, p-value 0.004), had a lower prevalence of cesarean section (CS) (21% versus 45%, p-value 0.007) and premature birth (5% versus 22%, p-value < 0.001), and gave birth to newborns with a mean higher birth weight (3512 g versus 3175 g, p-value 0.011). In terms of health status, the breastfeeding women had lower Visual Analog Scale (VAS) scores for pain (24 compared to 38 mm, p-value 0.002), fatigue (25 compared to 40 mm, p-value 0.030) and total (29 compared to 38 mm, p-value 0.023) six weeks postpartum. At all registrations, a larger proportion of non-breastfeeding women used conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (at six weeks: 29% compared to 21%, p-value 0.021; at six months: 30% compared to 27%, p-value 0.002; at twelve months: 38% compared to 30%, p-value < 0.001).

In the present study, we observed a high proportion of women with JIA breastfeeding at six weeks and six months postpartum. Based on our findings, health professionals should encourage women with JIA to breastfeed when taking compatible medications.