January 21, 2020
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Breastfeeding protects against postpartum MS relapses

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Kristen Krysko
Kristen Krysko

Breastfeeding provided a protective effect against postpartum multiple sclerosis relapses, according to a systematic review and meta-analysis published in JAMA Neurology.

“Therefore, women with MS should be encouraged to breastfeed exclusively when possible,” Kristen Krysko, MD, study lead author and a MS clinical research fellow at the University of California San Francisco, told Healio Primary Care. “However, it is important to note that even in the breastfeeding groups in these studies, the risk for postpartum MS relapse remained high.”

Women with MS are often diagnosed during childbearing years, according to the researchers. Although several disease-modifying therapies are available to reduce MS relapses, none are recommended for women who are pregnant or breastfeeding.

MS relapse rates decrease during the third trimester of pregnancy, but increase during the first 3 months postpartum, the researchers reported. Women are often faced with the decision to breastfeed or forgo breastfeeding so they can resume disease-modifying treatment.

Previous research has suggested that breastfeeding reduces the risk for postpartum MS relapse. However, the association remains controversial, according to Krysko and colleagues. To further investigate, the researchers reviewed and analyzed 24 studies containing 2,974 women.

“Since all the included studies are observational design, residual confounding is possible,” Krysko said, adding that “it is also possible that women with lower disease activity were those who chose to breastfeed.”

The researchers found that women who breastfed had 37% lower odds of postpartum MS relapse compared with women who did not breastfeed or did not exclusively breastfeed postpartum. The pooled summary OR for the link between breastfeeding and postpartum MS relapses was 0.63 (95% CI, 0.45-0.88) vs. not breastfeeding. The pooled adjusted HR across four studies that reported this finding was 0.57 (95% CI, 0.38-0.85). A stronger link was observed in the studies where women exclusively breastfed.

Krysko said the findings should prompt primary care physicians to have “supportive” and “important” conversations with patients who are pregnant and have MS.

“If these patients choose not to breastfeed, then her physician should support her decision, provide advice that allows for adequate nutrition to the infant and counsel on the high risk for postpartum MS relapses,” she said. “These women are also encouraged to resume MS treatments shortly after the baby is delivered with the goal of reducing risk for postpartum relapses.” – by Janel Miller

Disclosures: Krysko reports receiving grants from the National MS Society and Biogen and Idec during the conduct of the study outside the submitted work and funding by the Sylvia Lawry Physician Fellowship through the National MS Society. Please see the study for all other authors’ relevant financial disclosures.