Doctors do not recommend that women with multiple sclerosis (MS) undergo treatment of their disease with immunomodulatory drugs during pregnancy or lactation. As a result, women have had to choose between breastfeeding and resuming treatment with the drugs after births -- a difficult decision for many.

Thanks to a study recently conducted by investigators from Stanford University, new moms with MS who want to breastfeed, but are concerned that it might cause their disease to relapse, can rest a bit easier. The study, which was published in the June 8 issue of Archives of Neurology, has found that nearly two-thirds of women with MS who breastfed exclusively for two months or more, but were not taking their MS medications, did not experience a relapse of their disease during breastfeeding. While previous studies had been conducted to determine the relationship between breastfeeding and postpartum relapses, with little benefit found, this was the first of its kind to look at exclusive breastfeeding.

"Our findings call into question the benefit of forgoing breastfeeding to start MS therapies and should be confirmed in a larger study," Annette Langer-Gould, M.D., Ph.D., who was at Stanford University at the time of the study. "The most important thing for patients and physicians to know is that there's no evidence that breastfeeding is harmful for women with MS. If mothers decide to breastfeed and do what's best for baby, we couldn't see any evidence of risk, and it may even be better for mothers to breastfeed," emphasizes Dr. Langer-Gould, who is now a neurologist and research scientist with Kaiser Permanente Southern California in Pasadena.

The study involved 32 pregnant MS patients and a control group of 29 age-matched pregnant women who did not have the disease. Women in both groups participated in interviews during each trimester, as well as at five different times during the first 12 months following the birth of their babies. Information on MS patients' neurological status was collected from their treating physicians. A total of 14 of the 29 MS patients breastfed exclusively for at least two months postpartum, and five (36%) had postpartum relapses of their disease. In comparison, 13 of the 15 (87%) women who did not breastfeed exclusively had one or more postpartum relapses.  "Our findings suggest that women with MS should be encouraged to breastfeed exclusively for at least the first two months postpartum in lieu of starting immunomodulatory treatment shortly after delivery," the authors of the study wrote. "These findings highlight the need to critically evaluate the efficacy of early postpartum treatments in MS, especially if they are not compatible with lactation."

As Dr. Langer-Gould notes, it is well known that women with MS often go into remission during pregnancy. "This might indicate that hormones play some role in dampening the immune response that causes damage to the myelin," she says. But as she emphasizes, the study's finding of continued MS remission during breastfeeding would suggest that pregnancy hormones cannot be the only reason for the suppression of their disease, as those hormones decrease dramatically once the baby is born. "Previous research has ignored the postpartum factor, and what our study suggests -- if these findings can be repeated -- is that it's probably a factor that's common to pregnancy and lactation," she says.

News Release: Breastfeeding reduces postpartum relapses   www.medpagetoday.com  June 8, 2009

News Release: Breastfeeding ok for most moms with MS  www.health.usnews.com   June 8, 2009