Wednesday, 13 July 2011

Breastfeeding is not related to postpartum relapses in multiple sclerosis.

This Italian study assessed the relationship between breastfeeding and risk of relapses in MS'ers having had a baby.

A total of 302 out of 423 pregnancies in 298 women resulted in full-term deliveries.

Subjects were followed up for at least 1 year after delivery. 

The relapse rate before, during, and after pregnancy did not differ between patients who breastfed and patients who did not. 

The only significant predictor of having a relapse after childbirth was an increased number of relapses in the year before pregnancy and during the pregnancy itself.

Therefore, the reported association between breastfeeding and a lower risk of relapses after delivery could not be substantiated. 


"The results of this study challenge current clinical dogma and has implications for many woman with MS who have to make a difficult decision to either give their babies the health benefits of breast feeding, or to protect themselves from further relapses by going back onto their disease-modifying therapy. Obviously, not an easy decision when society puts so much pressure on woman to breast feed."


"I typically recommend a short period of breast feeding; 2 to 6 weeks to at give the baby some of the health benefits of breast feeding."

"Anybody MS'ers out their who have experience with this and have a point of view?"

5 comments:

  1. This is a difficult subject and I know what I am about to say will be controversial, though in no way am I trying to be a provocateur.

    Bearing in mind pretty much everybody’s MS is destined to become progressive within 10 to 15 years of diagnosis, should clinicians actually be encouraging men and women with MS to have children knowing that their parent’s disease will profoundly impact on a child’s wellbeing and security?

    It can be argued that it is the right of every woman to experience the joys of motherhood. Equally I argue that if you had your children before diagnosis then in no way should you feel guilty about it. However, I think that to have children after diagnosis is a questionable act. There is an element of selfishness on the part of the MS sufferer to have had children.

    MS hits you while you’re young, at a period when you’re making plans and putting your future in place. It’s not a nice disease but the patient with MS needs to be adaptable and make sacrifices. It’s unfortunate but true. In the current climate, one’s disease will not be cured, nor will it get better.

    There was a 16-year old girl on the MS Society’s message board who wrote about how her mother died last Christmas due to complications caused by MS. She said that her mother had had her after diagnosis. Within her young life her mother’s MS progressed, affecting her legs, then her back and eventually her neck. For the last 2 years of her life her mother was bed-ridden. The 16-year old girl was bitter about he mother’s disease and also confused at why she had had her knowing she was ill and would not get better. It was a tragic story, though probably not an isolated case.

    I think that perhaps neurologists should advice against MS sufferers embarking on parenthood.

    ReplyDelete
  2. Re: "I think that perhaps neurologists should advice against MS sufferers embarking on parenthood."

    It is not my role to decide on who and who shouldn't have children. MS may be disabling, but it can take many years for that to occur and in that time woman with MS can have a very fulfilling role as a mother. Similarly, having children, at least in the modern era, typically involves a partner and their role and perspective needs to be considered.

    What about hope? I still believe that some of the emerging, more effective, disease-modifying therapies will have a major impact on the disease course. Why shouldn't one think about the future as being better than the past with regard to MS outcomes.

    One thing I do take very seriously is advising woman to plan their pregnancy and to make sure they are vitamin D replete during pregnancy. It appears that the month of birth effect relates to vitamin D's effect on the developing foetus.

    ReplyDelete
  3. Re: “What about hope? I still believe that some of the emerging, more effective, disease-modifying therapies will have a major impact on the disease course.”

    That’s a noble gesture Prof G, but right now there is no evidence to associate relapses with long term MS progression. You know that the contribution to long-term disability from relapses is minimal, given the virtually uniform survival curves seen for progression following one, multiple or no exacerbations. Hope is all well and good but truth is a more accurate principal to abide by. None can confidently say that current DMT can change the course of MS progression. Right now it is all steeped in supposition and hyperbole.

    Let’s manage expectations, not view things with rose tinted glasses. MS is incurable, and to many doctors, a largely untreatable entity, hence why the Multiple Sclerosis Risk-sharing Scheme has been called in to question over its effectiveness.

    Therefore, the advice for MS patients not to embark on parenthood is a prudent suggestion, though I’m not suggesting it is a neurologist’s job to discuss family planning. MS is a serious disease. There’s no getting around this.

    When the industry is in a position to accurately say that DMT can 100% stave off progression then you have a solid case of argument.

    ReplyDelete
  4. re "When the industry is in a position to accurately say that DMT can 100% stave off progression then you have a solid case of argument."

    I feel that way too. There's no guarantee these new DMTs will stop MS'ers from becoming progressive. I can't properly plan my future life knowing that there's a 90% chance I'll be disabled in some way. The statistical proof that I will have some form of disability because of my MS is a better percentage than what any scientist can offer about the effectiveness of DMTs in stopping MS progression.

    ReplyDelete
  5. Re: "Hope is all well and good but truth is a more accurate principal to abide by."

    The 5-year extension data of the phase 2 Alemtuzumab trial, the long-term observational data of the Cambridge Alemtuzumab cohort and the Canadian bone marrow transplant data are very impressive and suggest that disability progression is halted or at least delay beyond what you would expect from natural history studies or the IFNbeta trials. So I will hold my ground in this one. I will also do a post when I get some time on early relapses. They do matter.

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.