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Review
. 2023 Jan 24:13:1090133.
doi: 10.3389/fneur.2022.1090133. eCollection 2022.

The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations

Sara Collorone  1 , Srikirti Kodali  1 , Ahmed T Toosy  1
Affiliations
Review

The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations

Sara Collorone et al. Front Neurol. .

Abstract

The immunoprotective role of pregnancy in multiple sclerosis (MS) has been known for decades. Conversely, there has been rich debate on the topic of breastfeeding and disease activity in MS. In clinical practice, women are often offered to restart their disease-modifying drug (DMD) soon after delivery to maintain their relapse risk protection. Limited available information about peri-partum DMD safety can discourage women to choose breastfeeding, despite the World Health Organization's recommendation to breastfeed children for the first 6 months of life exclusively. New evidence is emerging about the protective role of exclusive breastfeeding on relapse rate. Research studies shed light on the hormonal and immunological mechanisms driving the risk of relapses during pregnancy and postpartum. Finally, case reports, real-world data, and clinical trials are increasing our knowledge of the safety of DMDs for the fetus and infant. While some DMDs must be avoided, others may be considered in highly active pregnant or lactating women with MS. This mini-review conveys recent evidence regarding the protective role of exclusive breastfeeding in MS and offers clinicians practical considerations for a patient-tailored approach.

Keywords: breastfeeding; drug therapy; immune system; multiple sclerosis; pregnancy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The biological mechanisms. During pregnancy both hormonal and fetal/placental factors maintain a non-inflammatory status. A pro-inflammatory response is restored after delivery [possibly from late pregnancy (5)]. Lactational amenorrhea promoted by exclusive breastfeeding seems to decrease lymphocyte Th1 activity (9). PRL, prolactin; LH, luteinizing hormone; FSH, follicle-stimulating hormone; IL, interleukin; TGF, transforming growth factor; Treg, regulatory T cells; Th, lymphocyte T-helper; NK, natural killer; IFN, interferon; TNF, tumor necrosis factor (Images from Servier Medical Art by Servier https://smart.servier.com/).
Figure 2
Figure 2
Treatment flowchart. IFN, interferon; GA, glatiramer acetate.
See this image and copyright information in PMC

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