Lower Adherence to Breastfeeding Recommendations in Mothers Treated With Antirheumatic and Antidepressant Medications.

This was an observational study, so it cannot prove that the medications caused the lower breastfeeding rates. The authors did not know why mothers chose not to breastfeed, to supplement, or to stop breastfeeding. Reliable medication use during the breastfeeding period was not collected, so postpartum treatment changes may have affected outcomes. The analysis started with 7,766 enrolled women and analysed 6,383 after exclusions, so the results do not cover all participants originally enrolled. The asthma medication groups were small, especially the discontinuers. The cohort had higher breastfeeding rates than national averages, and voluntary participation may have included healthier or more motivated mothers. Medication recommendations varied by source, so some exposure classification may have been imperfect. The groups differed in socioeconomic status, BMI, smoking, substance use, parity, and delivery complications, and adjustment cannot remove all differences. Delivery complications and neonatal morbidity were not adjusted for because they may be on the causal pathway, so some effect may run through these complications. Medications with unclear or contradictory lactation recommendations were excluded, so results do not cover all chronic medications.

The authors declared no potential conflicts of interest. One author received funding from The Swedish Research Council, The Söderström Königska Foundation, The Swedish Freemasons Order, The Samaritanean Foundation, The Edith and Erik Fernstrom Foundation, The Swedish Doctors Association, and Karolinska Institutet.

Do not conclude that antirheumatic or antidepressant medications directly caused lower breastfeeding. The study did not record why mothers made their choices, and illness severity, perinatal complications, and other factors may explain the pattern.