The role of breastfeeding in postpartum disease activity in women with inflammatory bowel disease.

BACKGROUND

Women with inflammatory bowel disease (IBD) have an increased risk of experiencing a flare in the postpartum period. Work in other autoimmune disorders has found that breastfeeding may be associated with an increased risk for developing postpartum disease relapse.

AIM: To assess the association between breastfeeding behavior and postpartum disease activity.

METHODS

Women with IBD followed at a tertiary care center with a history of childbirth within the past 5 yr were recruited. Medical records were reviewed for disease type, disease activity during and after pregnancy, medication use, smoking, and breastfeeding behavior. The exposure of interest was breastfeeding prior to the onset of disease activity following a successful asymptomatic pregnancy.

RESULTS

One hundred and twenty-two consecutive women who fit eligibility criteria were studied. Overall, only 44% (54/122) of the women had breastfed their infant. Reasons included physician recommendation, fear of medication interactions, and personal choice. Forty-three percent (23/54) of those who breastfed experienced a postpartum flare of their disease. The unadjusted odds ratio for disease activity with a history of breastfeeding was 2.2 (95% CI 1.2-3.9, p= 0.004). When stratified by disease type, the OR for ulcerative colitis was 0.89 (0.29-2.7, p > 0.05) and Crohn's disease 3.8 (1.9-7.4, p < 0.05). When adjusted for medication cessation, the OR became nonsignificant.

CONCLUSIONS

A significant number of women with IBD do not breastfeed their children. Any relationship between breastfeeding and disease activity may be more a consequence of discontinuation of IBD therapies.