Multiple Sclerosis and Breastfeeding

Multiple Sclerosis Breastfeeding

Among the seemingly endless number of decisions that new mothers are faced with is the decision to breastfeed. Trusted organizations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists strongly support breastfeeding for at least the first 6 months of a baby’s life.

Having a diagnosis of the autoimmune disease multiple sclerosis (MS) can complicate decisions surrounding breastfeeding, but many mothers with the disease are able to safely and happily nurse their babies for as long as they desire.  If you have MS, some important factors to consider and discuss with your doctor to decide if breastfeeding is right for you include medication safety, pre-pregnancy disease activity, and fatigue.

MS Medications: Restart or Avoid?

Along with the healthful host of vitamins and nutrients, it’s important to ensure that you are not also passing along any harmful substances to your baby via breast milk.  Medications approved by the Food and Drug Administration to treat MS are considered relatively new – 25 years ago there were none, now there are 14!  The novelty of these drugs poses a problem, however, because there hasn’t been much time for researchers to study medication safety during breastfeeding.

Pregnant women with MS often stop taking their disease-modifying medications because the drug could have a negative effect on their baby’s development.  Many doctors recommend that similar precautions should continue for women who choose to breastfeed, meaning if you stopped your medication during pregnancy then you shouldn’t resume taking it until after your baby stops nursing.  Some experts consider the interferons (e.g. Rebif®) moderately safe based on a study’s estimates that the dose of interferon an infant would receive from a breastfeeding mother would be 0.006% of the dose the mother received.  Other drugs, however, contain warnings from the manufacturer that specifically state that nursing mothers should not be exposed to these medications in tandem with breastfeeding, including teriflunomide (Aubagio®), mitoxantrone (Novantrone®), and fingolimod (Gilenya®).

Pre-Pregnancy Disease Activity

Overall, pregnancy doesn’t appear to have an affect on MS disease progression.  Studies have shown that women who have low relapse rates prior to pregnancy are more likely to have low relapse rates after pregnancy, and those with higher disease activity are likely to have a higher risk of relapse after pregnancy.  Discussing your disease history with your neurologist might help you estimate your relapse risk after delivery, and therefore decide how quickly you should resume your medication schedule after baby arrives.

Fatigue

There is no doubt that breastfeeding is a demanding job.  Newborns can require feedings every 2-3 hours, which leaves very little time for a tired mother to get some much-needed rest.  To compound this effect, up to 80% of all MS patients experience fatigue due to the disease – which means moms with MS might be extra tired during those first few months.  Strategies that help with fatigue can be very useful to remember during new motherhood, such as eating a nutritious diet, avoiding heat exposure, and asking for help around the house from friends and family to give you more time to focus on baby’s needs.

Weigh Risks and Benefits with your Doctor

Breastfeeding can provide many physical and psychological benefits to both you and your baby.  It is, however, a very taxing task, and compromising your health in the process could do more harm than good.  Working with your neurologist to figure out a medication plan and any necessary support strategies will not only give you the best possible shot at successfully breastfeeding your little one, but also keep you and baby in the best possible health.

Kristen Hollinger
Dr. Kristen Hollinger has a Ph.D. in molecular and cellular biology from Pennsylvania State University. She currently resides in Maryland and works as an Instructor in the Departments of Psychiatry and Neurology at Johns Hopkins University School of Medicine. Her research focuses on neurological diseases including depression and multiple sclerosis.

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