Breastfeeding and Risk of Relapse in Women with Multiple Sclerosis

Abstract

Multiple Sclerosis (MS) is a chronic, inflammatory disease of the central nervous system (CNS), affecting
predominantly young, childbearing women. Although gestation has proven protective effects on MS
activity, the effects of breastfeeding during postpartum period have not been elucidated. We performed
a critical appraisal of studies relevant to the effects of breastfeeding on postpartum relapses of MS. The
results of the studies examined were conflicting. This was due to significant heterogeneity regarding
the number of subjects recruited, the methodology, the outcome measures and due to patient selection
bias. Postpartum relapse rate seems to be determined by disease activity prior and during pregnancy.
Women with active disease (increased relapse rate prior and during pregnancy, higher EDSS scores
at the beginning of pregnancy) are more likely to have increased postpartum relapse rates, and are
thus more likely to avoid breastfeeding in order to start or resume immunomodulatory treatment.
Until large, properly designed clinical trials that clarify this issue are available, it seems reasonable to
encourage MS female patients with mild disease activity to breastfeed their infants, providing them all
the benefits of breastfeeding, always under close supervision by their physicians.