• In a study of 201 German women with relapsing-remitting MS, women who breastfed their infants exclusively (without supplemental feedings) for at least two months after delivery were less likely to have a relapse within six months than women who breastfed nonexclusively or not at all.
• The question of breastfeeding has been controversial because relapses are more likely to occur after delivery, and many are reluctant to take a disease-modifying therapy while breastfeeding.
• The results suggest that exclusive breastfeeding does not increase the risk of postpartum relapse in women with MS, but further study is needed to clarify whether it is protective, or whether another risk factor contributed to the study results.
• The team (Kerstin Hellwig, University Bochum, Germany, and colleagues) has published results in JAMA Neurology (published online August 31, 2015).
• Co-author Annette Langer-Gould, MD, PhD (Kaiser Permanente Southern California) is funded by the National MS Society to conduct additional research into this question.
Background: After childbirth there is a higher risk for relapse, and many women are advised to go back on their disease-modifying therapies as soon as possible. Since there is insufficient evidence to support the safety of breastfeeding while using any of these therapies, most babies born to moms with MS are bottle fed, despite known health benefits of breastfeeding for infants. Previous studies of postpartum relapse and breastfeeding have had mixed results, and more research is needed to help guide postpartum treatment decisions.
The Study: Investigators recruited 201women with relapsing-remitting MS who had voluntarily enrolled in a German MS and pregnancy registry between January 2008 and June 2012. Women completed an interview and questionnaire in each remaining trimester of pregnancy, the first 6 weeks postpartum, and at 3, 6, and 12 months postpartum.
Of these participants, 59.7% intended to breastfeed exclusively (without supplemental bottle feedings) for at least 2 months and 40.3% breastfed and included supplemental feeding or did not breastfeed. Within the first 6 months after delivery, significantly more women (38.3%) who did not breastfeed exclusively had a relapse compared with women (24.2%) who breastfed exclusively for at least 2 months. After 6 months postpartum, 22.5% of the women who breastfed exclusively for the first 2 months postpartum had their first postpartum relapse, compared with 8.6% of those who did not breastfeed exclusively. Taking the entire postpartum period into account, the overall risk of having at least one postpartum relapse was the same (about 47%) between the two groups, suggesting that any beneficial effect of exclusive breastfeeding lasts about 6 months after delivery.
The team (Kerstin Hellwig, University Bochum, Germany, and colleagues) has published results in JAMA Neurology (published online August 31, 2015). Co-author Annette Langer-Gould, MD, PhD (Kaiser Permanente Southern California) is funded by the National MS Society to conduct additional research into this question
Comment: This study contributes further evidence suggesting that exclusive breastfeeding may provide a modest protective treatment against postpartum relapses during the first six months in women with MS. It is unclear whether exclusive breastfeeding was somehow a protective factor that prevented relapses, or whether the women selected for the study shared another risk factor associated with fewer relapses. However, it indicates that exclusive breastfeeding does not increase the risk of postpartum relapse, an important consideration for women with MS of childbearing age.
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