Breastfeeding is important in providing crucial immunities and nutrients to newborns. Furthermore, it helps to strengthen the mother-baby bond through closeness and cuddling. However, it should be recognized that there are challenges with breastfeeding; nipple engorgement, pain, injury, fatigue, mastitis, and many more.
When it comes to women living with IBD, breastfeeding can feel extra challenging and stressful. Many women have voiced that they often feel helpless, hopeless, stressed out, anxious, and alone. The concerns that are mainly vocalized are medication transfer through breastmilk, the safety of transferred medication for infants, altered vaccination schedule for breast-fed infants exposed to IBD treatments, quality of the breastmilk, the possibility of IBD being transferred via breastmilk, and what to do when a mother experiences flare-ups while breastfeeding.
We would also like to stress that we are aware of some patients may choose not to breastfeed or use formula. This is okay. Everyone’s situation is different, and the choice should be made that is best for you. We support all mothers’ choice of breastfeeding and hope to provide some guidance on the topic.
This page will address the concerns and provide guidance and resources. We hope these will help you find answers to your questions, provide you with helpful information, and alleviates the stress you may have been experiencing on the topic.
There are many benefits to breastfeeding for both mother and baby:
Motherhood is challenging. As a new mom, breastfeeding may not be the first thing that worries you. Many moms indicated that they thought breastfeeding would be easy and natural; however, they were surprised by the difficulties they faced.
As a person living with IBD, breastfeeding may feel extra challenging. It might cause more stress affecting your chronic condition. One study published in November 2020 reported that one-third of women with IBD may experience flare-ups in their first postpartum year2. Moms also voiced that having flare-ups highly affected their ability to breastfeed, as they have had to frequently visit the washroom and felt fatigued while breastfeeding.
To ensure your condition is well-controlled, it’s important to consult your healthcare team to formulate a plan, ideally before pregnancy. This may include optimizing your medication regimen, ensuring you are in remission for a minimum of 3 months, and checking your condition through colonoscopy or imaging.
If you are already pregnant, start discussing your plans for breastfeeding. They will be able to provide you with some guidance and refer you to specialists such as lactation consultants.
While breastfeeding, try to increase your caloric intake by 450-500 kcal daily. Adding 200-300mg of omega-3 fatty acids either from food or supplements is also recommended. You may wonder how to increase your food intake – this may be challenging as some foods may trigger your symptoms. Try to eat food groups that you know are processed well by your digestive system. For omega-3 fatty acid-rich food, try to consume the following:
If you are not sure which food would work for you, consult a dietician who may be able to guide you through the process.
Staying hydrated is an important factor in breastfeeding. It is recommended that a person drink 1.5-2L of water daily. However, as you are breastfeeding, you are losing more liquid than usual and may feel thirstier. Try to increase another 1L of liquid intake. Although water is the best liquid, this may feel excessive. If you have difficulty drinking more water, try eating some watery fruits such as watermelon, oranges, blueberries, peaches, and plums.
You may feel anxious, stressed, and overwhelmed with breastfeeding while trying to control your chronic condition. Talk to your healthcare team (gastroenterologist, IBD nurse, dietician, pharmacists, OB/GYNs, lactation consultants, etc.,) and voice your concerns. They are there to help you!
Lastly, try to build your support network. Having peer support can be substantially helpful by sharing difficulties you experience and offering support to each other.
Many of the medications – 5-ASAs, biologics, and immunomodulators are considered to be safe for breastfeeding even though they are detected in breast milk. Oftentimes, the medications are detected at low levels and considered to be not absorbed in the infant’s body. One study from PIANO registry reported low concentrations of infliximab, adalimumab, certolizumab, natalizumab, and ustekinumab in breast milk samples of women receiving these treatments1. Additionally, the infection rates of breastfed infants of mothers on biologics, immunomodulators, or combo therapies were similar to non-breastfed infants or infants whose mothers were not on these medications. The list of infections that were studied included pneumonia, sepsis, abscess, bladder infection, otitis media infection, and upper respiratory tract infections. Finally, the milestone achievement rates were also similar between the two groups.
Some medications, such as methotrexate and tofacitinib, should not be taken while breastfeeding. You might wonder why methotrexate is contraindicated when it’s secreted at low level in breastmilk, similar to other medications that are considered safe. Although in low concentration, methotrexate can possibly suppress the immune system of a breastfed infant, as it can stay in the system for a long time. Additionally, methotrexate is contraindicated for pregnancy. Other medications, such as risankizumab, prednisone, cyclosporine, and upadacitinib, should be taken with caution and consulted with a gastroenterologist prior to starting.
If you are wondering if your IBD medication is safe to take during breastfeeding, consult your gastroenterologist.
Green: Safe to use
Yellow: Use with caution; consult GI
Red: Do not use while breastfeeding
One study showed that one in three women may experience flare-ups in their first year of postpartum. The mode of delivery, type of IBD, or duration of IBD did not seem to be related to the flare-ups. However, the study showed that the therapy de-escalation during and after the pregnancy showed a relationship in developing flare-ups.
There is no evidence that points to breastfeeding as a risk factor for flare-ups. As mentioned above, it provides many benefits to both mother and baby.
So what do you do when you are experiencing a flare-up?
Breastfeeding while trying to take control of your chronic illness is challenging. You have a newborn to take care of, and your condition. IBD is a condition in which stress can worsen the symptoms. If you are feeling overwhelmed and stressed, it is okay to take a break.
Vaccines can be given to your infant as advised by the local health authority. However, if you were receiving any of the biologics (i.e. infliximab, adalimumab, vedolizumab, and ustekinumab. Certolizumab not applicable) in your third trimester, it is recommended to avoid administering live vaccines (weakened form of a germ that causes diseases) to your infant in first 12 months. Live vaccines include MMR, rotavirus, chickenpox, and smallpox vaccine. If you are concerned about the biologic level in your infant and its effects on the vaccination, you can consult a specialist (infectious disease or immunology).
For a patient with a chronic digestive illness, an endoscopy is an uncomfortable but necessary medical procedure that you need to have regularly. It comes with fasting, bowel prep, and anesthesia which you may be concerned about their effects on breastfeeding. In this section, some of these concerns will be addressed.
If you are at the early stage of breastfeeding where your baby needs to be fed every few hours, bring a breast pump to express your milk. You can ask for privacy at the clinic.
Bowel Prep: bowel prep is required to clean the gut for an endoscopic procedure. Although many prep medications are fine to be taken while breastfeeding, ensure that you are staying hydrated.
Anesthesia: although anesthetic drugs transfer to breastmilk, only small amounts are present and in very low concentrations, and considered clinically insignificant.
We are developing to improve the care provided to people with IBD who are postpartum. We need study participants in order to complete these studies. We showcase some current research opportunities below. If you are interested or if you would like more information on participating in research, please click the JOIN study or Learn More! Click on the button below or contact firstname.lastname@example.org