Highlights from

AAN 2019

American Academy of Neurology annual meeting

Philadelphia, USA 4-10 May 2019

No increased MS relapse risk postpartum

“Women with MS should be allowed to breastfeed.” Dr Annette Langer-Gould (Kaiser Permanente Southern California, Pasadena, USA) said she has spent the better part of the last 15 years on this matter.

In a plenary review session, she said an increased relapse risk in the first 3 months postpartum was found in a well-known study by Confavreux et al. [1], but this was before disease-modifying treatments were available and before MRI scans could help diagnose MS after just one attack. Dr Langer-Gould initiated a study to see if the relapse risk in the early postpartum period is still augmented today [2].

She identified 466 pregnancies among 375 women with MS and fond no rebound disease activity directly after giving birth. “This is likely due to the inclusion of women from a population-based setting and of women diagnosed after a single relapse, and high rates of exclusive breastfeeding.” Of the participants, 38.0% were not on any treatment in the year prior to conception, 14.6% had clinically isolated syndrome and 8.4% relapsed during pregnancy. In the postpartum year, 26.4% relapsed and 41.2% resumed disease-modifying treatments. Annualised relapse rates declined from 0.39 pre-pregnancy to 0.14-0.07 (P<0.0001) during pregnancy. In the first 3 months postpartum, annualised relapse rate was 0.27 (P=0.02), and returned to pre-pregnancy rates (0.37) at 4-6 months.

Dr Langer-Gould was “pleasantly surprised” to find that 87% breastfed and 35% breastfed exclusively. Exclusive breastfeeding reduced the risk of postpartum relapses (adjusted HR 0.58; P=0.01), but resuming modestly effective disease-modifying treatments had no effect. “Times have changed”, she concluded. In her opinion, advising against breastfeeding because of MS is overly conservative and unnecessary.

  1. Confavreux C, et al. N Engl J Med. 1998;339(5):285-91.
  2. Langer-Gould A, et al. AAN 2019, S6.007.

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