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  Vol. 66 No. 8, August 2009 TABLE OF CONTENTS
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Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women With Multiple Sclerosis

Annette Langer-Gould, MD, PhD; Stella M. Huang, MS; Rohit Gupta; Amethyst D. Leimpeter, MS; Eleni Greenwood; Kathleen B. Albers, MPH; Stephen K. Van Den Eeden, PhD; Lorene M. Nelson, PhD

Arch Neurol. 2009;66(8):958-963. Published online June 8, 2009 (doi:10.1001/archneurol.2009.132).

Objective  To determine if exclusive breastfeeding protects against postpartum relapses of multiple sclerosis (MS) and, if so, whether this protection is related to prolonged lactational amenorrhea.

Design  We conducted structured interviews to assess clinical, menstrual, and breastfeeding history during each trimester and 2, 4, 6, 9, and 12 months postpartum and collected neurological examination findings from the treating physicians of women with MS. Hazards ratios (HRs) were adjusted for measures of disease severity and age.

Setting  Kaiser Permanente Northern California and Stanford University.

Participants  We prospectively enrolled 32 pregnant women with MS and 29 age-matched, pregnant controls.

Main Outcome Measure  Postpartum relapse.

Results  Of the 52% of women with MS who did not breastfeed or began regular supplemental feedings within 2 months postpartum, 87% had a postpartum relapse, compared with 36% of the women with MS who breastfed exclusively for at least 2 months postpartum (unadjusted HR, 5.0; 95% confidence interval, 1.7-14.2; P = .003; adjusted HR, 7.1; 95% confidence interval, 2.1-24.3; P = .002). Sixty percent reported that the primary reason for foregoing exclusive breastfeeding was to resume MS therapies. Women who breastfed exclusively had a later return of menses (P = .001) than women who did not, and lactational amenorrhea was associated with a reduced risk of postpartum relapses (P = .01).

Conclusions  Our findings suggest that exclusive breastfeeding and concomitant suppression of menses significantly reduce the risk of postpartum relapses in MS. Our findings call into question the benefit of foregoing breastfeeding to start MS therapies and should be confirmed in a larger study.


Author Affiliations: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California (Drs Langer-Gould and Nelson, Mss Huang and Greenwood, and Mr Gupta); and Division of Research, Kaiser Permanente Northern California, Oakland (Mss Leimpeter and Albers and Dr Van Den Eeden). Dr Langer-Gould is now with the Departments of Research and Evaluation and Neurology, Kaiser Permanente Southern California, Pasadena. Ms Huang is now with Touro University College of Osteopathic Medicine, Vallejo, California. Ms Greenwood is now with Cornell University School of Medicine, Ithaca, New York.



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RELATED LETTERS

Breastfeeding and Multiple Sclerosis
Raffaele Iorio, Viviana Nociti, Giovanni Frisullo, Agata Katia Patanella, Pietro A. Tonali, and Anna Paola Batocchi
Arch Neurol. 2009;66(12):1580.
EXTRACT | FULL TEXT  

Protective Effect of Breastfeeding in Postpartum Relapse Rate of Mothers With Multiple Sclerosis
Kerstin Hellwig, Aiden Haghikia, Heike Agne, Christian Beste, and Ralf Gold
Arch Neurol. 2009;66(12):1580-1581.
EXTRACT | FULL TEXT  

Protective Effect of Breastfeeding in Postpartum Relapse Rate of Mothers With Multiple Sclerosis—Reply
Annette Langer-Gould
Arch Neurol. 2009;66(12):1581.
EXTRACT | FULL TEXT  

RELATED ARTICLE

This Month in Archives of Neurology
Arch Neurol. 2009;66(8):929-930.
FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Interferon-{gamma}-Producing T Cells, Pregnancy, and Postpartum Relapses of Multiple Sclerosis
Langer-Gould et al.
Arch Neurol 2010;67:51-57.
ABSTRACT | FULL TEXT  

Breastfeeding and Multiple Sclerosis
Iorio et al.
Arch Neurol 2009;66:1580-1580.
FULL TEXT  

Protective Effect of Breastfeeding in Postpartum Relapse Rate of Mothers With Multiple Sclerosis--Reply
Langer-Gould
Arch Neurol 2009;66:1581-1581.
FULL TEXT  

Protective Effect of Breastfeeding in Postpartum Relapse Rate of Mothers With Multiple Sclerosis
Hellwig et al.
Arch Neurol 2009;66:1580-1581.
FULL TEXT  

Multiple sclerosis and pregnancy: What should we be telling our patients?
Franklin and Tremlett
Neurology 2009;73:1820-1822.
FULL TEXT  





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