Effects of Pregnancy and Breastfeeding on Clinical Outcomes and MRI Measurements of Women with Multiple Sclerosis: An Exploratory Real-World Cohort Study

Abstract

Introduction Pregnancy represents an important event for women with multiple sclerosis (MS) and is often accompanied by post-partum disease reactivation. To date, the influence of this reproductive phase on long-term MS outcomes is still largely unexplored. The objective of the study was characterise a large real-world cohort of women with MS to evaluate the effects of pregnancy and breastfeeding on short- and long-term clinical and magnetic resonance imaging (MRI) outcomes while exploring the relationships with MRI measurements of brain atrophy. Methods MS patients with and without pregnancy were recruited. Clinical relapses and MRI activity of the year before conception versus the year after delivery were evaluated. Regression models were performed to investigate the relationships between long-term MS outcomes (EDSS score and MRI brain measurements obtained by SIENAX software) and pregnancy and breastfeeding duration. Results Two hundred ten women with MS were enrolled; of them, 129 (61.4%) had at least one pregnancy. Of all pregnancies ( n = 212), those that occurred after MS onset (90 [42.4%]) were examined to evaluate the short-term outcomes. A higher annualised relapse rate in the post-partum year versus the pre-conception year (0.54 ± 0.84 vs. 0.45 ± 0.71; p = 0.04) was observed. A regression analysis showed that clinical activity after delivery was associated with clinical activity of the year before conception ( p = 0.001) as well as duration of breastfeeding ( p = 0.022). Similarly, post-partum MRI activity was associated with pre-conception MRI activity ( p = 0.026) and shorter breastfeeding duration ( p = 0.013). Regarding long-term outcomes, having had at least one pregnancy during MS was associated with a lower EDSS score ( p = 0.021), while no relationships were reported with MRI measurements. Conversely, a breastfeeding duration > 6 months was associated with lower white matter volume ( p = 0.008). Conclusions Our study underlines the importance of considering the effects of pregnancy and breastfeeding on short- and long-term MS outcomes. In the current therapeutic landscape, pregnancy planning and treatment optimisation in the post-partum period, in particular for women who choose to breastfeed, are fundamental for the management of these biological phases so central in a woman’s life.

Pregnancy and reproductive health in women with multiple sclerosis: an update

“…Radiographic activity can be a more sensitive marker of inflammatory disease in the postpartum period, than clinical relapses alone. Several recent publications suggest that new MRI activity (new T2 and/or new T1 Gd+ lesions in brain and spinal cord), are more common than previously appreciated, with ∼60% of WwMS have new MRI disease activity in the postpartum period [76,81–83]. MRI activity preconception is a strong predictor of both active MRI postpartum, and clinical postpartum relapse risk in these studies [83].…”

“…In one study, having had at least one pregnancy during MS was associated with a lower EDSS score [76].…”

“…Although earlier evidence has been mixed, several recent publications suggest that exclusive breastfeeding may be protective against postpartum relapses and should be encouraged [55,[74][75][76]. Lactation consultants can be a helpful addition to the postpartum WwMS treatment team [77].…”

Sex Hormones as Key Modulators of the Immune Response in Multiple Sclerosis: A Review

“…The same study showed a relapse frequency in the first three months after childbirth three times greater than that before pregnancy. Moreover, in a recent retrospective observational study, 210 MS women (194 RR-MS) [ 23 ] submitted to RMI evaluations on grey and white matters and total cerebral volume estimation, and an increased relapse frequency was observed in the year following the childbirth compared to the year preceding conception [ 23 ].…”

Awareness and related factors of depressive symptoms in breastfeeding people in South Korea: a survey-based cross-sectional study

“…9 18 20 Previous studies on breastfeeding people have mainly focused on the factors affecting breastfeeding practices 17 21 or the effects of breast feeding on women's health. [22][23][24] Few studies have assessed the impact of demographic and health characteristics on depression in breastfeeding people. Breast feeding is essential for the growth and development of babies; therefore, as a topic of national health policy, 5 it is necessary to understand the depression of these women.…”