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Cimzia
Cimzia and Breastfeeding – Safety and Considerations for Nursing Mothers
Feb 26, 2025
Many new mothers with arthritis face unique challenges when it comes to breastfeeding, balancing the need for effective symptom management with concerns about medication safety. According to the Arthritis Foundation, parents with chronic inflammatory conditions often worry about how their arthritis treatments might affect their babies, all while managing their own pain and mobility issues.
One promising option is Cimzia (certolizumab pegol), a biologic medication that may help control disease activity with minimal transfer into breast milk. Early research suggests that Cimzia offers an effective treatment while maintaining a low risk of exposure to nursing infants, providing hope for mothers seeking a safe, balanced approach to treatment and breastfeeding.
In this article, we will explore the use of Cimzia while breastfeeding, reviewing scientific evidence, clinical guidelines, and practical recommendations to support informed healthcare decisions.
Key Takeaways
- Cimzia (certolizumab pegol) is a TNF inhibitor used to treat inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, and psoriatic arthritis.
- Unlike other biologic therapies, Cimzia lacks the Fc region, significantly reducing its transfer into breast milk.
- Studies indicate minimal infant exposure through breastfeeding, with low or undetectable drug levels in breast milk.
- Guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) support the use of Cimzia in lactating mothers.
- It is recommended to closely monitor infants for any signs of immune-related effects, though the risk appears low.
- Mothers should discuss concerns with their healthcare providers to effectively balance disease control and breastfeeding safety.
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Cimzia’s Safety Profile in Breastfeeding
Cimzia (certolizumab pegol) is a biologic medication used to treat autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, and ankylosing spondylitis. As a tumor necrosis factor (TNF) inhibitor, it helps reduce inflammation and manage chronic inflammatory disease symptoms. Healthcare providers typically use subcutaneous injections for Cimzia administration.
Unlike other TNF inhibitors, Cimzia is pegylated, which prolongs its action while reducing immune activation. This unique structure also limits its transfer across the placenta and into breast milk.
Studies on Cimzia’s use during lactation indicate that it is generally safe. Certolizumab pegol is excreted in minimal amounts into breast milk and is likely broken down in the infant’s gastrointestinal tract, resulting in negligible absorption. Research has found that breast milk concentrations remain low, with no significant adverse effects reported in nursing infants. As a result, experts and professional guidelines consider Cimzia an acceptable treatment for breastfeeding mothers.
Clinical Guidelines and Regulatory Recommendations
The American College of Rheumatology (ACR) supports the use of TNF inhibitors, including Cimzia (certolizumab pegol), in breastfeeding mothers due to minimal transfer into breast milk and low risk to infants. The European Alliance of Associations for Rheumatology (EULAR) also endorses Cimzia for nursing mothers, emphasizing that discontinuing treatment could worsen maternal health, indirectly affecting the infant.
Clinical studies confirm Cimzia’s safety during lactation. A study published in the Annals of the Rheumatic Diseases found undetectable or negligible drug levels in breast milk, with no adverse effects in infants. Another study monitored breastfed infants for infections and developmental concerns, reporting no increased risk compared to non-exposed infants. These findings reinforce that Cimzia can be used during breastfeeding with proper pediatric monitoring.
Monitoring and Patient Counseling for Breastfeeding Mothers
Although Cimzia is considered safe for breastfeeding mothers, physicians recommend vigilant monitoring of infants for potential immune-related effects. Parents should inform a pediatrician to ensure a comprehensive evaluation during routine check-ups if they encounter rare symptoms such as frequent infections, prolonged fever, or digestive issues.
Additionally, healthcare providers should counsel lactating mothers on the importance of maintaining effective disease control while ensuring breastfeeding safety. Discontinuing effective treatment may lead to disease flare-ups, which could negatively impact both maternal and infant health. Therefore, mothers are encouraged to discuss their concerns with their provider and make informed decisions based on scientific evidence and personalized medical advice.
Alternative Treatment Options if Cimzia Use Is a Concern
For mothers who are concerned about Cimzia exposure or experiencing side effects, they may consider alternative treatments, such as:
- Non-biologic disease-modifying anti-rheumatic drugs (DMARDs) with established safety in lactation, such as hydroxychloroquine or sulfasalazine.
- Other biologic therapies with low milk transfer, if Cimzia is not effective.
- Non-medication approaches, such as physical therapy, dietary adjustments, and lifestyle modifications for symptom management.
Patients should consult their healthcare provider to determine the best treatment strategy while breastfeeding.
Conclusion
Cimzia is one of the safer TNF inhibitors for breastfeeding mothers, as it minimally transfers into breast milk and is poorly absorbed by infants. Guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) support its use, ensuring effective maternal treatment without compromising infant safety.
While infant monitoring is recommended, studies have found no increased risks associated with Cimzia use during breastfeeding. Open communication with healthcare providers is essential to balance disease control and breastfeeding safety, allowing mothers to make informed, confident decisions about their treatment.
FAQs
1. What conditions does Cimzia treat?
Cimzia has FDA approval for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, and non-radiographic axial spondyloarthritis.
2. How do practitioners adminster Cimzia?
Cimzia is given as a subcutaneous injection. Though its schedule is every two to four weeks, this varies depending on the treated condition.
3. Can pregnant patients use Cimzia?
Yes, studies suggest that Cimzia has limited placental transfer, making it a preferred biologic therapy during pregnancy.
4. What are the common side effects of Cimzia?
Common side effects include injection site reactions, upper respiratory infections, headaches, and nausea.
References
Breastfeeding with autoimmune arthritis. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning/breastfeeding-concerns-with-arthritis
Family Planning with Arthritis. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning-pregnancy-parenting
Do you know which medications are safe to take while breastfeeding? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breastfeeding-and-medications/art-20043975
CDC. Prescription medication use. Breastfeeding Special Circumstances. Published January 27, 2025. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/vaccine-medication-drugs/prescriptions.html