Mothers with multiple sclerosis: Considerations for breastfeeding
During the congress of European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2021, Professor Kerstin Hellwig (Department of Neurology, Katholisches Klinikum Bochum, Germany) provided her expert insights on multiple sclerosis (MS) in pregnant and breastfeeding women. For many years, women with MS were discouraged from contemplating starting a family due to the perceived detrimental effect of pregnancy on this disease.1 However, studies now indicate that the frequency of MS-associated relapses may decrease during pregnancy, with the most significant reduction in relapses observed during the third trimester.1 Interestingly, an increase in MS relapses are likely to occur immediately post-partum, and these may be of a similar frequency to those observed prior to pregnancy.1 Indeed, women with greater disease activity the year before pregnancy and during pregnancy are believed to have a higher risk of relapse 3 months post-partum.1 Therefore, it is of interest to note that, in addition to a number of other benefits,2 breastfeeding exclusively may be associated with a reduced risk of post-partum relapses, even in women with sub-optimally controlled MS prior to pregnancy.3
The benefits of breastfeeding in MS
Professor Kerstin Hellwig discusses the general benefits of breastfeeding for women and the particular benefits for women with MS and their children. Professor Hellwig highlights the current challenges faced when managing women with MS who have experienced post-partum relapse, but wish to breastfeed, and makes recommendations as to how these challenges can be managed. The current unmet medical needs for women with MS who wish to breastfeed, and Professor Hellwig’s own current clinical practice with regards to counselling mothers who wish to breastfeed, is also discussed.
In the following video, Professor Hellwig discusses the important role that breastfeeding can have in women with MS
Vukusic S, Hutchinson M, House M, Moreau T, Cortinovis-Tourniaire P, Adeleine P, Confavreaux C, Pregnancy In Multiple Sclerosis Group. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 2004; 127:1353–60.
Victoria CG, Bahl R, Barros AJD, Franca GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387:475–90
Langer-Gould A, Smith JB, Albers KB, Xiang AH, Wu J, Kerezsi EH, McClearnen K, Gonzales EG, Leimpeter AD, Van Den Eeden SK. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology 2020; 94:e1939–49.