Does breastfeeding affect MS relapses?

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    MS typically onsets between 20-40 years of age and is more common in women than men. Coming to terms with the disease and its clinical manifestations will therefore often coincide with decisions of child-bearing facing young women.

    Relapse risk decreases during pregnancy, however, relapses tend to subsequently increase in the few months immediately after child-birth. 
    (Confavreux 1998, NEJM)

    Women with MS currently make a difficult decision between restarting their therapy after childbirth and not breastfeeding, delaying the use of disease therapy in order to breastfeed or alternatively curtailing the duration of breastfeeding in order to restart therapy sooner.

      
    A recent meta-analysis found that women with MS who breastfeed are almost half as likely to experience a post-partum relapse compared to women who do not. In 8 prospective studies the odds ratio of having a relapse in women who breast-fed compared to women who did not was 0.46 (0.30-0.70).


    Exclusive breastfeeding (compared to combining breastfeeding with formula use) is thought to have a particularly strong effect in reducing relapses as the state of exclusive breastfeeding results in greater hormonal and immunological changes. 

    The protective role of breastfeeding on MS relapses may be in part explained by the possibility that MSers who choose to breastfeed may have had less clinically active disease and lower disability at the start of the pregnancy. This has nonetheless been estimated to account for only some of the reduced risk of a post-partum relapse in those who breastfeed, and the majority of the risk of a post-partum relapse remains potentially modifiable through for example breastfeeding. 

    So, breastfeeding lowers your risk of having a relapse in the 6 months post-partum period by approximately 50% compared to the risk if you did not breastfeed. Given that six months is plenty of time to provide a child with the numerous health benefits of breastfeeding, MSers who want to breastfeed should not feel discouraged from doing so! 
    Coi: I am an author on the meta-analysis on this topic.

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  • Breast-feeding for at least 4 months after delivery reduces a baby’s risk of developing MS by around 50% and the mother’s risk of relapse. – http://www.overcomingmultiplesclerosis.org/About-MS/Pregnancy-and-MS/

    "Historically, neurologists have discouraged women with MS from nursing, feeling that it posed an additional physical burden to a woman already at increased risk for an exacerbation," writes Dr. Kalb. "However nursing is now widely encouraged if you have adequate dexterity, strength, and stamina."

    Breast milk not only provides optimal nutrition, but also eliminates the nuisance of bottle preparation. If you do choose to breastfeed, be consistent with all feedings during the first two weeks. This should generate a steady and sufficient milk flow. After this initial period, you can pump and store your milk or use formula so that your partner can handle the nighttime feedings. This is the best way for you to get the sufficient, uninterrupted rest that is so crucial for a new mother with MS. According to current medical information, there is no elevated risk of exacerbation caused by breastfeeding. – http://www.msfocus.org/article-details.aspx?articleID=29

    Meds –

    Levels of gadolinium in breastmilk are exceedingly low and oral absorption (ability to absorb through the GI system) is minimal. Dr. Hale recommends to pump and discard at three hours after your dose to eliminate most risk. If you would like to wait until all of the drug is out of your system, the half-life is one and one-half hours so waiting five half-lives which would be eight hours would eliminate any risk.
    We do not have data on the amount of glatiramer (Copaxone) in breastmilk, but it is highly unlikely to enter breastmilk because of its large molecular weight (size of the molecule), and the oral absorption is minimal. Some infants scratch their faces when breastfeeding shortly after mother's dose of glatiramer. Dr. Hale suggests pumping and discarding milk after glatiramer administration (within one hour) and then waiting another hour before breastfeeding. A suitable alternative is Interferon Beta-1a, which is an even larger molecule. Let me know if you have further questions.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center
    Glatiramer (Copaxone) is a mixture of polymers of four amino acids. They are large polymers which limits their ability to enter breastmilk. There are no data on how much glatiramer gets transferred into breastmilk, but Dr. Hale states it is highly unlikely due to its large molecular weight and is probably compatible with breastfeeding. He suggests pumping and discarding milk after glatiramer administration and then waiting an hour before breastfeeding. The interferons beta 1 A and B have been studied and transfer into breastmilk is essentially nil. Their molecular weight is even larger than glatiramer; and therefore are compatible with breastfeeding. The Copaxone study is still in the early stages; therefore, no results to report at this time. Let me know if you have further questions.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

    (http://www.infantrisk.com/forum/showthread.php?84-Breastfeeding-and-MS/page2)

    Dr. Thomas Hale from Texas Tech University Health Sciences Center and the Infant Risk Center is doing ongoing work on MS meds and breastfeeding. He can be reached for questions on specific medications and safety. (806)352-2519 http://www.infantrisk.com/

    AKC a Certified Lactation Counselor with Moms who want to know the latest information.

  • I was diagnosed with possible MS last year October (2013). Changed my whole life around to accommodate the illness. Then fell pregnant end of October. Everyone said that I will be having relapses right after giving birth. My baby girl is 3 weeks old on Wednesday and I haven't had a symptom or relapse yet? I am exclusively breastfeeding. Should I worry that the relaps will be coming in shortly with all guns blazing or even that my daughter will be getting MS because I breastfeed?

    • Don't worry but it is possible that you will indeed have a relapse after giving birth. The work above suggests that breast feeding may reduce this risk.

      Although I do not usually give advice I think it is fair to say that there is no evidence that breast feeding is going to give your daughter. So don't worry about that.

  • I have a 4 year old boy and a little boy that will be 1 next week. I have been exclusively breastfeeding the 1 year old (for a year) and have not had a relapse. I feel that breastfeeding is my savoir in many ways and will continue for as long as I can. Was diagnosed with MS in March 2009.

  • i have been diagnosed by MS 2010 and i was under beta interferon for last years now i am 8 month pregnant and my doctor tell me that i will immunoglobulin injection direct after week from delivery to avoid any relapse within 6 month.any one hear about immunoglobulin injection?

  • Nice blog. If you have problems in decreasing breast milk try to use home remedies like applying Peppermint Essential Oil on both breast.

  • Is/has anyone continued a therapy (any medications) while breastfeeding? My nuro wants to start me back on medication. I have a 4 month old son and would really like to continue nursing him for as long as possible. I nursed my daughter for 16 months, I just decided to no take any medication. However, my most recent MRI showed new lesions and a mildly active one. Nuro wants me on medication, but I'd like to hear of other moms experience if any.

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