Risk of Multiple Sclerosis Exacerbation During Pregnancy and Breast-feeding

Lorene M. Nelson, MS; Gary M. Franklin, MD, MPH; Monica C. Jones; George Belendiuk, MD, PhD; Barbara Kasper, RN; Diane Klatzman, RN; William Mietlowski, PhD; Suzanne Solch, RN; Gary Franklin, MD, MPH; Jack Burks, MD; Lorene Nelson, MS; Carolyn Wangaard, RN, CANP; Henry McFarland, MD; Andrew Goodman, MD; Dale, MD; Helen Krebs, RN; Heidi Maloni, RN; Joe Debronozo, PhD; Labe, MD; Ute Traugott, MD; Mindy Aisen, MD; Kate Robbins, CCOT; William Sibley, MD; Jose Laguna, MD; Joan Laguna; John, MD; David Cliford, MD; Larry Smith, MD; Jane Mclnnis, RN; Barry Arnason, MD; Raymond Roos, MD; Anthony Reder, MD; Jack Antel, MD; Mark Aguis, MD; Roberta Martia, RN; Barrie Hurwitz, MD; Steven Greenburg, MD; Louis Fredane, MD; Rebecca Herbstreith, RN; Jean Hurwitz; Kenneth Johnson, MD; Hillel Panitch, MD; Carol Lee Koski, MD; Paul Fishman, MD; Sue Haley, RN; Jack Petajan, MD, PhD; Patrick Bray, MD; John Rose, MD; David Thurman, MD; William Galster; Wallace Tourtellotte, MD, PhD; R. W. Baumhefner, MD; George Ellison, MD; Lawrence Myers, MD; Karl Syndulko, PhD; LaVona Newton, RN; Jerry Wolinsky, MD; E. Simon Sears Jr, MD; Avindra Nath, MD; Catherine Weisbrodt, RN
JAMA. 1988;259(23):3441-3443. doi:10.1001/jama.1988.03720230051029.
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Studies in the past have reported an increased risk of exacerbations in multiple sclerosis during the postpartum period; it is not known whether breast-feeding alters this risk. We interviewed 435 women regarding pregnancy and breast-feeding history, providing for analysis 191 pregnancies that had occurred during a nonprogressive phase of the disease. The exacerbation rates during the nine-month postpartum period (34%) were more than three times the exacerbation rate during the nine months of pregnancy (10%). The exacerbation risk was highest in the three-month period following childbirth and appeared to stabilize after the sixth postpartum month. The exacerbation rates in breast-feeding and non—breast-feeding pregnancies were 38% and 31%, respectively. The average time to exacerbation was similar in breast-feeding (3.0 months) and non—breast-feeding (3.1 months) pregnancies. Although differential exacerbation rates during pregnancy and the postpartum period may be related to hormonal effects on the immune system, the hormonal effects of breast-feeding do not appear to similarly affect the risk of exacerbation.

(JAMA 1988;259:3441-3443)


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