Breastfeeding reduces risk of postpartum multiple sclerosis relapse: JAMA

California, San Francisco: Breastfeeding protects new mothers with multiple sclerosis (MS) against postpartum MS relapse, finds a recent study published in the journal JAMA Neurology.

In the postpartum period, MS relapses increases, and whether breastfeeding is associated with a reduction in the risk of postpartum relapses remains controversial. Kristen M. Krysko, Department of Neurology, University of California, San Francisco, and colleagues performed a systematic review and meta-analysis to evaluate whether breastfeeding is associated with a reduction in postpartum MS relapses compared with not breastfeeding.

The researchers searched the online databases for studies assessing the association between breastfeeding and MS disease activity published between January 1, 1980, and July 11, 2018. All the study designs assessing the association between breastfeeding and postpartum relapses in MS relative to a comparator group were included.

The search identified 462 unique citations, and 24 (2974 women) satisfied eligibility criteria and were included, of which 16 were included in the quantitative meta-analysis.

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Key findings of the study include:

• The pooled summary odds ratio for the association of breastfeeding with postpartum relapses was 0.63 compared with a reference of nonbreastfeeding.


• Pooled adjusted hazard ratio across 4 studies that reported this finding was 0.57.


• There was moderate heterogeneity (I² = 48%), which was explained by variable prepregnancy relapse rate, postpartum follow-up duration, and the publication year.


• A stronger association was seen in studies of exclusive rather than nonexclusive breastfeeding, although both demonstrated an association.


• Studies were rated at moderate and serious risk of bias, with concern for residual confounding, although sensitivity analysis including only moderate quality studies was consistent with a protective outcome of breastfeeding.

"These findings suggest that breastfeeding is protective against postpartum relapses in MS, 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," concluded the authors.

The study, "Association Between Breastfeeding and Postpartum Multiple Sclerosis RelapsesA Systematic Review and Meta-analysis," is published in the journal JAMA Neurology.

DOI: https://doi.org/10.1001/jamaneurol.2019.4173