Breastfeeding and multiple sclerosis Review article
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Published:
Mar 31, 2019
Keywords:
breastfeeding, multiple sclerosis, disease modifying drugs, interferons, glatiramer acetate, dimethyl fumarate, terflunomide, alemtuzumab, natalizumab, fingolimod, determinidumab, cladribine, methylprednisolone
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Abstract
In women with multiple sclerosis, pregnancy is a factor reducing the risk of the next relapse, however, later the risk increases again. Recently, there have been studies suggesting that breastfeeding may play a protective role during the disease. However, in the case of necessity to use disease-modifying drugs it may be dangerous for the child. We still do not know exactly what part of these drugs is penetrated to breast milk. Data, especially about new drugs, are very limited, although one can estimate the degree of passage of a given molecule in milk. Disease-modifying drugs treatment during breastfeeding generally is not recommended, however, it is known that some substances are safer in this respect, and the health and psychological benefits of breastfeeding cannot be overestimated. The paper discusses the possibilities of using first and second line treatment in breastfeeding women in Poland.
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References
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6. Houzen H., Niino M., Kikuchi S. et al.: The prevalence and clinical characteristics of MS in Northern Japan. J. Neurol. Sci. 2003; 211: 49-53.
7. Houzen H., Niino M., Hirotani M. et al.: Increased prevalence, incidence, and female predominance of multiple sclerosis in northern Japan. J. Neurol. Sci. 2012; 323: 117-122.
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9. Weinshenker B.G., Hader W., Carriere W. et al.: The influence of pregnancy on disability from multiple sclerosis: a population-based study in Middlesex County, Ontario. Neurology 1989; 39(11): 1438-1440.
10. Confavreux C., Hutchinson M., Hours M.M. et al.: Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N. Engl. J. Med. 1998; 339(5): 285-291.
11. Miller D.H., Fazekas F., Montalban X. et al.: Pregnancy, sex and hormonal factors in multiple sclerosis. Mult. Scler. 2014; 20(5): 527-536.
12. Ponsonby A.L., Lucas R.M., van der Mei I.A. et al.: Offspring number, pregnancy, and risk of a first clinical demyelinating event: the AusImmune Study. Neurology 2012; 78(12): 867-874.
13. Jokubaitis V.G., Spelman T., Kalincik T. et al.: Predictors of long-term disability accrual in relapse-onset multiple sclerosis. Ann. Neurol. 2016; 80(1): 89-100.
14. Langer-Gould A., Beaber B.E.: Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin. Immunol. 2013; 149(2): 244-250.
15. Pakpoor J., Dsanto G., Lacey M.V. et al.: Breastfeeding and multiple sclerosis relapses: a meta-analysis. J. Neurol. 2012; 259(10): 2246-2248.
16. Rowe H., Baker T., Hale T.W.: Maternal medication, drug use, and breastfeeding. Ped. Clin. North Am. 2013; 60(1): 275-294.
17. Almas S., Vance J., Baker T., Hale T.: Management of multiple sclerosis in the breastfeeding mother. Mult. Scler. Inter. 2016; 2016: 6527458.14.
18. Ito S.: Drug therapy for breast-feeding women. N. Engl. J. Med. 2000; 343(2): 118-126.
19. Anderson P.O., Sauberan J.B.: Modeling drug passage into human milk. Clin. Pharmacol. Ther. 2016; 100(1): 42-52.
20. Hellwig K., Gold R.: Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J. Neurol. 2011; 258(3): 502-503.
21. Halle T.W., Siddiqui A.A., Baker T.E.: Transfer of interferon-beta-1a into human breastmilk. Breastfeed. Med. 2012; 7(2): 123-125.
22. Fumaran dimetylu – charakterystyka produktu leczniczego [online].
23. Teryflunomid – charakterystyka produktu leczniczego [online].
24. Alemtuzumab – charakterystyka produktu leczniczego [online].
25. Baker T.E., Cooper S.D., Kessler L., Hale T.W.: Transfer of natalizumab into breast milk in a mother with multiple sclerosis. J. Hum. Lact. 2015; 31(2): 233-236.
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27.Fingolimod – charakterystyka produktu leczniczego [online].
28. Okrelizumab – charakterystyka produktu leczniczego [online ].
29. Kladrybina – charakterystyka produktu leczniczego [online].
30. Cooper S.D., Felkins K., Baker T.E., Hale T.W.: Transfer of methyleprednisolone into breast milk in a mother with multiple sclerosis. J. Hum. Lact. 2015; 31(2): 237-239.
31. Voskuhl R., Momtazee C.: Pregnancy: effect on multiple sclerosis, treatment considerations, and breastfeeding. Neurotherapeutics 2017; 14: 974-984.