Rheumatoid Arthritis, Breastfeeding Moms and Cortisone
Rheumatoid arthritis is an inflammatory autoimmune condition that affects various joints, and depending on severity, it can impact a patient’s life significantly. As a potent anti-inflammatory agent, cortisone is often injected directly into the affected joint space to combat the inflammation and relieve symptoms. Below we consider the safety of breastfeeding while receiving cortisone treatments.
Are there studies about the safety of cortisone shots while breastfeeding, in terms of risk to the infant? How often can I get the shots without jeopardizing my baby?
No studies were found regarding cortisone injections and breastfeeding. Most information and research about steroid use during lactation is focused on oral steroids, which have been deemed safe in limited quantities according to Medscape and UpToDate. In fact, they are considered a good alternative to some of the stronger drugs used for rheumatoid arthritis, as a means of continuing to nurse. Since medication in local injections is unlikely to enter the bloodstream in significant amounts, it stands to reason that cortisone shots would also be considered safe.
As far as the frequency of shots, assuming breastfeeding is not an issue, most doctors will inject specific joints no more than three to four times per year, to avoid possible deterioration of the cartilage according to Mayo Clinic.
If I needed a shot and it was not safe to breastfeed, should I “pump and dump” breast milk for a certain amount of time?
As noted above, all available evidence and clinical experience reveals no issue with cortisone shots and breastfeeding. Thus there should be no reason to “pump and dump” when taking cortisone shots. Even if you are taking oral steroids, the usual advice is to wait several hours before feeding your baby, with no indication of a need to discard breast milk. But as always, if you are a rheumatoid arthritis sufferer contemplating breastfeeding while on any form of steroid, it is important that you consult your physician for his or her recommendation.
Are there any studies about side effects found in the baby, immediately or in the future, as a result of the cortisone?
No studies are available demonstrating any negative effects on infants who are breastfed while the mother is taking steroids, whether orally or via injection. There is one paper that suggests consulting a clinician when taking oral steroids, but without any sort of conclusion regarding adverse effects on the baby.
But the fact that even oral cortisone and other steroids are generally considered non-problematic during lactation and breastfeeding strongly supports the assertion that injections are also not an issue in terms of infant morbidity (the rate at which an illness or abnormality occurs). In significant amounts, steroids can be toxic to an infant, but based on the reviewed research available at this time, this does not seem to apply to those who are breastfed while the mother takes oral or injectable corticosteroids.
Questions for your doctor:
- Is it safe for me to breastfeed after receiving a cortisone injection? What about when taking oral steroids?
- How much of the steroid I am taking will end up in my breast milk?
- Do you know of any research indicating benefits and/or risks of steroid use during lactation?
- What’s the best source of information for rheumatoid arthritis mothers considering breastfeeding?
- What other rheumatoid arthritis medications are considered unsafe during breastfeeding?
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@example.com.
This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Oct 27, 2012.
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