0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses

Kerstin Hellwig, MD1; Milena Rockhoff, MD1; Sandra Herbstritt, PharmD1,2; Nadja Borisow, MD3,4; Aiden Haghikia, MD1; Birte Elias-Hamp, MD5; Sylvia Menck, MD6; Ralf Gold, MD1; Annette Langer-Gould, MD, PhD7
[+] Author Affiliations
1Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
2Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Duesseldorf, Germany
3NeuroCure Clinical Research Center, University Clinic Berlin, Berlin, Germany
4Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
5private neurologic practice, Hamburg, Germany
6private neurologic practice, Barsinghausen, Germany
7Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
JAMA Neurol. 2015;72(10):. doi:10.1001/jamaneurol.2015.1806.
Text Size: A A A
Published online

Importance  Women with multiple sclerosis (MS) experience an elevated risk of relapse after giving birth. The effect of exclusive breastfeeding on postpartum risk of MS relapse is unclear.

Objectives  To determine the effect of exclusive breastfeeding on postpartum risk of MS relapse and to investigate the effect of introducing supplemental feedings on that risk.

Design, Setting, and Participants  Data on 201 pregnant women with relapsing-remitting MS were collected prospectively from January 1, 2008, to June 30, 2012, with 1 year follow-up post partum in the nationwide German MS and pregnancy registry. The effect of the intention to breastfeed exclusively (no regular replacement of breastfeeding meals with supplemental feedings) for at least 2 months compared with nonexclusive breastfeeding (partial or no breastfeeding) on the first postpartum MS relapse, using Cox proportional hazards regression model adjusted for age and disease activity, before and during pregnancy was analyzed. Data analysis was performed from August 30, 2013, to May 25, 2015.

Exposure  Exclusive breastfeeding defined as at least 2 months of breastfeeding without regular replacement of any meal by supplemental feeding.

Main Outcome and Measure  First postpartum MS relapse.

Results  Of 201 women, 120 (59.7%) intended to breastfeed exclusively for at least 2 months and 81 (40.3%) breastfed and included supplemental feeding (42 [20.9%]) or did not breastfeed (39 [19.4%]). Thirty-one women (38.3%) who did not breastfeed exclusively had a relapse within the first 6 months post partum compared with 29 women (24.2%) who intended to breastfeed exclusively for at least 2 months (unadjusted hazard ratio, 1.80; 95% CI, 1.09-2.99; P = .02; adjusted hazard ratio, 1.70; 95% CI, 1.02-2.85; P = .04). The time to first postpartum relapse after the introduction of supplemental feedings did not differ significantly between women who previously breastfed exclusively and those who did not (P = .60).

Conclusions and Relevance  The findings of this study suggest that exclusive breastfeeding is a modestly effective MS treatment with a natural end date. Our study provides further evidence that women with MS who breastfeed exclusively should be supported to do so since it does not increase the risk of postpartum relapse.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Exclusive Breastfeeding and the Risk of Postpartum Multiple Sclerosis Relapse

Relapse in the first 6 months post partum among women who did (n = 120) or did not (n = 81) breastfeed exclusively. Women who did not breastfeed exclusively were more likely to experience relapse in the first 6 months post partum and did so sooner than women who intended to breastfeed exclusively for at least the first 2 months post partum. Hazard ratio (95% CI), 1.80 (1.09-2.99), P = .02 (unadjusted), and 1.70 (1.02-2.85), P = .04 (adjusted for age and measures of disease severity); P = .002 by log-rank test.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Multiple Sclerosis Relapse After Introduction of Supplemental Feeding Among Women Who Breastfed Exclusively and Those Who Did Not

Relapse after the introduction of supplemental feeding. Women who intended to breastfeed exclusively for at least the first 2 months post partum (n = 102) had a similar risk of relapses in the 6 months after the introduction of supplemental feedings as did women who began regular supplemental infant feedings within the first 2 months post partum (n = 81). Hazard ratio (95% CI), 1.20 (0.79-1.91), P = .37 (unadjusted), and 1.10 (0.72-1.78), P = .60 (adjusted for age and measures of disease severity); P = .04 by log-rank test.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,712 Views
4 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();