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Wednesday, October 8, 2014

MS Family Planning 201: Breastfeeding, DMTs, and the Risk of Postpartum Relapse

The risk of relapse is higher in the postpartum period, but there are conflicting suggestions for women with MS about reducing this risk. Can exclusive breastfeeding alone prevent relapses? How soon after delivery should DMTs be reintroduced? Are any DMTs safe to take while breastfeeding?

<em>Stillende Mütter</em> by Paula Modersohn-Becker (1876–1907).
Stillende Mütter by Paula Modersohn-Becker (1876–1907).
For any parent, the first few months after delivery are tumultuous—adapting to a new member of the family is tiring and stressful. These two elements make women with relapsing-remitting multiple sclerosis (RRMS) especially vulnerable to a postpartum relapse. While disease-modifying therapies (DMTs) have been shown generally to reduce relapse rates, none of them are indicated for use during lactation. Therefore, the question of when to restart DMTs postpartum remains a difficult one for physicians counseling MS patients who wish to breastfeed their children.

Trying to predict the risk of relapse for any one individual is very difficult. The risk factors for postpartum attacks include the level of disability, the prepregnancy relapse rate (Hughes et al., 2014), and the relapse rate during pregnancy (Coyle, 2014Vukusic et al., 2004). But even so, relapse rates in the prepregnancy year and during pregnancy combined only predict 21.5% (49/227) of relapses.

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