Women with MS are known to have higher relapse rates in the year following childbirth, and several studies have offered conflicting evidence about the role of breastfeeding in reducing the risk of such flare-ups. The new study, conducted at MS centers throughout Italy, shows that breastfeeding does not reduce the risk.
"It's a well-designed study that does a nice job of resolving the controversy," says neurologist Dennis Bourdette, MD, director of the Multiple Sclerosis and Neuroimmunology Center at Oregon Health and Science University in Portland, who reviewed the study for WebMD. "It resolves from my standpoint that breastfeeding is not protective."
The study is published in the online edition of Neurology.
Between 2002 and 2008, the researchers, led by Emilio Portaccio, MD, of the University of Florence, followed 298 women during their pregnancies and for the first year after giving birth. Of those, 104 women breastfed for at least two months. The rest of the women breastfed for less than two months or not at all.
The researchers report that 112 women had one relapse in the first postpartum year, while 20 women had two or more relapses. Such relapses led 39 of the women to stop breastfeeding altogether.
After analyzing the data, the researchers found that breastfeeding did not determine the risk of relapse. Instead, the most reliable predictor of a flare-up following childbirth was the number of flare-ups both before and during pregnancy. In other words, the more active a woman's disease during those periods, the more likely she was to have relapse in the months after delivery.
MS and Pregnancy
An estimated 2.5 million people worldwide have multiple sclerosis. An autoimmune disease, MS impairs the nervous system by damaging the myelin sheath, a protective substance that surrounds nerve fibers.
Much more common among women than men, MS has no known cause or cure. However, drugs and other therapies can help manage the disease course and control its symptoms, which include vision problems, fatigue, weakness, tremors, and trouble with coordination.
For women seeking to get pregnant, Bourdette says, the standard practice is to stop taking MS drugs, some of which can cause spontaneous abortions. While pregnancy does not affect the course of the disease over the long term, Bourdette says that the risk of flare-ups goes down during pregnancy.
The risk of flare-ups goes up after giving birth, particularly during the first three months after delivery. Mothers who choose to breastfeed must stay off MS drugs because they may affect the baby.
"A decision has to be made about whether or not to breastfeed," says Bourdette. "It's a highly personal and individual decision. In my practice, most women choose to breastfeed for three to six months, but if they have a relapse, they may change their minds."