Longer Breastfeeding

Topic: Longer Breastfeeding May Damage Brain By Delaying DMT Use

Having at least one pregnancy may lower disability scores in women with multiple sclerosis (MS), but breastfeeding for longer than six months may worsen damage to the brain, an observational study in patients has found.

Findings support the need for careful pregnancy planning, counseling, and treatment management to ensure optimal longer-term outcomes, its researchers noted.

The study, “Effects of Pregnancy and Breastfeeding on Clinical Outcomes and MRI Measurements of Women with Multiple Sclerosis: An Exploratory Real-World Cohort Study,” was published in Neurology and Therapy.

Pregnancy is known to protect women from MS relapses, with relapse rates falling by 70% after conception. However, relapse rates increase significantly after pregnancy, especially during the first three months post-delivery.

Higher pre-pregnancy disease activity, greater disability, and frequent relapses during pregnancy are some of the factors linked to post-pregnancy relapses.

Breastfeeding may also play a role in MS activity, but existing evidence is conflicting. Current knowledge about the impact of pregnancy and breastfeeding on MS activity largely comes from short-term studies; very few long-term studies have been done.

A team of scientists at the University of Cagliari, in Italy, investigated the short- and long-term effects of pregnancy and breastfeeding on disability and brain integrity in women with MS.

Eligible patients provided demographic and clinical data, including disease-modifying treatment (DMT) use, and pregnancy and breastfeeding history. MRI images were also collected to measure whole brain, and white and grey matter volumes.

A total of 210 women, 194 with relapsing MS, were included in the study. Their mean age was 45.5 and their mean disease duration was 14.8 years. The mean Expanded Disability Status Scale (EDSS) score was 2.2, indicating minimal disability.

A total of 129 women (61.4%) reported at least one pregnancy (212 total pregnancies), 46.5% of which occurred before MS onset and 41.9% after an MS diagnosis. Fifteen other pregnancies (11.6%) were both before and after MS onset.

The researchers focused on the 90 pregnancies that occurred after MS onset to determine its effects on short-term MS outcomes. Among this group, 45% breastfed for at least two months.

About one-third (32.2%) of these women were taking a first-line disease-modifying therapy (DMT) — such as interferon-beta, glatiramer acetate, or dimethyl fumarate — during conception, and 8.8% were on a second-line DMT, such as Tysabri (natalizumab) or fingolimod (sold as Gilenya; generic forms available) before or during conception. The remainder were not using any treatment.

A total of four women experienced a relapse during pregnancy, two after stopping Tysabri and one after discontinuing fingolimod.

In the year after pregnancy, relapse rates were higher (0.54 relapses per year) compared with the year before pregnancy (0.45 annual relapses). Disability scores remained the same.

The number of relapses in the year after childbirth was significantly associated with the severity of MS symptoms in the year before conception and with breastfeeding duration.

Topic Discussed: Longer Breastfeeding May Damage Brain By Delaying DMT Use

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