To the Editor.
—The 1994 article by Drs Levine and Ilowite1 concluded, "A relationship appears to exist between breast-feeding by mothers with silicone [breast] implants and abnormal esophageal motility," a feature of systemic sclerosis. Letters in response2 detailed deficiencies in the science and reporting of the study.It is known that the children of mothers with connective tissue diseases are at greater risk of contracting these diseases. The term familial scleroderma refers to the increased incidence of systemic sclerosis among first-degree relatives of patients with scleroderma. The human lymphocyte antigen haplotypes, autoantibodies, and clinical features associated with systemic sclerosis are more prevalent among first-degree relatives of patients with systemic sclerosis.3 Maternal autoantibodies can transfer to the child via cord blood and breast milk.4 The phenomenon of "neonatal scleroderma" has been described.5Therefore, it was correct that Drs Levine and Ilowite excluded mothers with scleroderma from