The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations

The immunoprotective role of pregnancy in multiple sclerosis (MS) has been known for decades. Conversely, there has been rich debate on the topic of breastfeeding and disease activity in MS. In clinical practice, women are often offered to restart their disease-modifying drug (DMD) soon after delivery to maintain their relapse risk protection. Limited available information about peri-partum DMD safety can discourage women to choose breastfeeding, despite the World Health Organization's recommendation to breastfeed children for the first 6 months of life exclusively. New evidence is emerging about the protective role of exclusive breastfeeding on relapse rate. Research studies shed light on the hormonal and immunological mechanisms driving the risk of relapses during pregnancy and postpartum. Finally, case reports, real-world data, and clinical trials are increasing our knowledge of the safety of DMDs for the fetus and infant. While some DMDs must be avoided, others may be considered in highly active pregnant or lactating women with MS. This mini-review conveys recent evidence regarding the protective role of exclusive breastfeeding in MS and offers clinicians practical considerations for a patient-tailored approach.

Automated summary

The immunoprotective role of pregnancy in multiple sclerosis (MS) has long been recognized, but there is ongoing debate regarding the impact of breastfeeding on disease activity in MS. Limited information on the safety of disease-modifying drugs (DMDs) during the peri-partum period can discourage breastfeeding despite recommendations to exclusively breastfeed for the first 6 months. New evidence suggests that exclusive breastfeeding may protect against disease relapse. Research is shedding light on the hormonal and immunological mechanisms behind relapse risk during pregnancy and postpartum. Furthermore, case reports, real-world data, and clinical trials are contributing to our understanding of the safety of DMDs for the fetus and infant. While some DMDs should be avoided, others may be considered for highly active pregnant or lactating women with MS. This mini-review presents recent evidence on the protective role of exclusive breastfeeding in MS and provides practical considerations for clinicians.