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Prolactin, autoimmunity, and motherhood: when should women avoid breastfeeding?

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Abstract

The sexual dimorphic prevalence of autoimmunity represents one of the most alluring observations among the mosaic of autoimmunity. Sex hormones are believed to be a mainstay of this asymmetry. The greater prevalence of autoimmunity among fertile women, disease onset/relapses during pregnancy, and postpartum are some of the points that support this theory. Undeniably, motherhood represents one of the most remarkable challenges for the immune system that not only has to allow for the conceptus but also deal with extraordinary hormonal alterations. Prolactin has a recognized immune-stimulatory effect, mainly inhibiting the negative selection of autoreactive B lymphocytes. In accordance, hyperprolactinemia has been associated with several autoimmune diseases, interfering with its pathogenesis and activity. During the pregnancy and lactation period, assorted autoimmune patients experience relapses, suggesting an active interference from increased levels of prolactin. This association was found to be significant in systemic lupus erythematosus, rheumatoid arthritis, and peripartum cardiomyopathy. Furthermore, treatment with bromocriptine has shown beneficial effects specially among systemic lupus erythematosus patients. In this review, we attempt to provide a critical overview of the link between prolactin, autoimmune diseases, and motherhood, emphasizing whether breastfeeding should be avoided among women, both with diagnosed disease or high risk for its development.

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Abbreviations

HLA:

Human leukocyte antigen

IL:

Interleukin

IFN:

Interferon

MHC:

Major histocompatibility complex

PIBF:

Progesterone-induced blocking factor

PRL-GH:

Prolactin-growth hormone

RNA:

Ribonucleic acid

Th:

T helper cells

TGF:

Transforming growth factor

TNF:

Tumor necrosis factor

Treg:

T regulatory cells

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Funding

This work is supported by the grant of the Government of the Russian Federation for the state support of scientific research carried out under the supervision of leading scientists, agreement 14.W03.31.0009, on the basis of SPbU projects 15.34.3.2017 and 15.64.785.2017.

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Authors and Affiliations

  1. Department ‘A’ of Internal Medicine, Coimbra University Hospital Centre, Coimbra, Portugal

    Vânia Vieira Borba

  2. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Vânia Vieira Borba

  3. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv University, 5265601, Tel Hashomer, Israel

    Vânia Vieira Borba & Yehuda Shoenfeld

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yehuda Shoenfeld

  5. Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, Saint Petersburg, Russian Federation

    Yehuda Shoenfeld

Authors
  1. Vânia Vieira Borba
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  2. Yehuda Shoenfeld
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Correspondence to Vânia Vieira Borba.

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Highlights

a) Sex hormones, such as prolactin, are believed to be a mainstay of the genders asymmetry in autoimmune diseases.

b) Prolactin has a recognized immune-stimulatory effect, mainly inhibiting the negative selection of autoreactive B lymphocytes, promoting autoimmunity.

c) During the pregnancy and lactation period, assorted autoimmune patients experience disease relapse, suggesting an active influence of prolactin.

d) A significant association between prolactin and disease flairs was found in systemic lupus erythematosus, rheumatoid arthritis, and peripartum cardiomyopathy patients; therefore, breastfeeding should not be encouraged.

e) Exclusive breastfeeding could lead to decreased disease activity among multiple sclerosis patients.

f) Bromocriptine acts as an immunosuppressant of autoimmune phenomena via induction of natural nonspecific CD8 suppressor T cells and has shown beneficial effects specially among systemic lupus erythematosus patients.

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Vieira Borba, V., Shoenfeld, Y. Prolactin, autoimmunity, and motherhood: when should women avoid breastfeeding?. Clin Rheumatol 38, 1263–1270 (2019). https://doi.org/10.1007/s10067-018-04415-y

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