Breastfeeding in multiple sclerosis woman Review article
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Published:
Dec 31, 2024
Keywords:
multiple sclerosis, breastfeeding, disease-modifying therapies
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Abstract
Pregnancy-related issues in women with multiple sclerosis have been receiving increasing attention, with particular interest for the use of disease-modifying therapies before conception, during pregnancy, and postpartum, including breastfeeding. Breastfeeding provides unmatched health benefits for babies and mothers, and is recommended as the best source of nutrition for infants. These findings suggest that breastfeeding is protective against postpartum relapses in multiple sclerosis, although high-quality prospective studies to date are limited and well-designed observational studies that aim to emulate a randomized trial would be of benefit.
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References
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16. Anderson PO. Monoclonal Antibodies During Breastfeeding Breastfeed Med. 2021; 16(8): 591-93.
17. Jasion VS, Burnett BP. Survival and digestibility of orally-administered immunoglobulin preparations containing IgG through the gastrointestinal tract in humans. Nutr J. 2015; 14: 22.
18. Atyeo C, Alter G. The multifaceted roles of breast milk antibodies. Cell 2021; 184(6): 1486-1499.
19. Hellwig K, Rockhoff M, Herbstritt S et al. Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses. JAMA Neurol. 2015; 72(10): 1132-8.
20. Bove R, Oreja-Guevara C, Hellwig K et al. B-cell levels and breastmilk transfer in infants of lactating women with multiple sclerosis treated with ocrelizumab: Primary results of the prospective, multicentre, open-label, phase IV study SOPRANINO. ECTRIMS 2024; Sep 17 – Sep 20, 2024 | Copenhagen, Denmark.
2. Roehr B. Unlocking the Power of Breast Milk – with Help from Cows. Scientific American. 2016; April 22.
3. Kalinowska A, Kułakowska A, Adamczyk-Sowa M et al. Neurologia i Neurochirurgia Polska 2020; 54(2): 124-137.
4. Confavreux C, Hutchinson M, Hours MM et al. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998; 339(5): 285-91.
5. Finkelsztejn A, Brooks JB, Paschoal FM Jr et al. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG. 2011; 118: 790-7.
6. Krysko KM, Rutatangwa A, Graves J et al. Association between breastfeeding and postpartum multiple sclerosis relapses: a systematic review and meta-analysis. JAMA Neurol. 2020; 77: 327-38.
7. Hellwig K, Shi X, Vostiar I et al. Evaluating Ofatumumab Excretion in Breastmilk of Women With RMS: Phase 4 Study Design. [Poster Presented at the 9th Joint ECTRIMS-ACTRIMS Meeting, 11–13 October 2023, Milan, Italy P1648].
8. Hsu S, Balan A, Bove R. Topical review: Lactation and use of DMTs in women with MS. Mult Scler. 2024; 30(13): 1578-91.
9. Hemmer B, Gehring K et al. Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie, 2024, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie.
10. Kalinowska A, Adamczyk-Sowa M, Bartosik-Psujek H et al. Stanowisko Sekcji Stwardnienia Rozsianego i Neuroimmunologii Polskiego Towarzystwa Neurologicznego w sprawie optymalizacji diagnostyki i leczenia stwardnienia rozsianego w Polsce. Styczeń 2025.
11. Kułakowska A, Mirowska-Guzel D, Kalinowska A et al. Leczenie modyfikujące przebieg stwardnienia rozsianego. Rekomendacje Sekcji Stwardnienia Rozsianego i Neuroimmunologii PTN. Pol. Przegl. Neurol 2023; 19(3): 163-189.
12. Hurley WL, Theil PK. Perspectives on immunoglobulins in colostrum and milk. Nutrients. 2011; 3(4): 442-74.
13. Langer-Gould AM et al. Pregnancy and Family Planning in Multiple Sclerosis. Continuum (Minneap Minn). 2019; 25(3): 773-792.
14. Ciplea AI, Langer-Gould A, de Vries A et al. Monoclonal antibody treatment during pregnancy and/or lactation in women with MS or neuromyelitis optica spectrum disorder. Neurol Neuroimmunol Neuroinflamm. 2020; 7(4): e723.
15. Kelsey JJ. Drug Principles in Lactation
16. Anderson PO. Monoclonal Antibodies During Breastfeeding Breastfeed Med. 2021; 16(8): 591-93.
17. Jasion VS, Burnett BP. Survival and digestibility of orally-administered immunoglobulin preparations containing IgG through the gastrointestinal tract in humans. Nutr J. 2015; 14: 22.
18. Atyeo C, Alter G. The multifaceted roles of breast milk antibodies. Cell 2021; 184(6): 1486-1499.
19. Hellwig K, Rockhoff M, Herbstritt S et al. Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses. JAMA Neurol. 2015; 72(10): 1132-8.
20. Bove R, Oreja-Guevara C, Hellwig K et al. B-cell levels and breastmilk transfer in infants of lactating women with multiple sclerosis treated with ocrelizumab: Primary results of the prospective, multicentre, open-label, phase IV study SOPRANINO. ECTRIMS 2024; Sep 17 – Sep 20, 2024 | Copenhagen, Denmark.