Breastfeeding

April 2019

Can I breastfeed my baby if I have MS?

Having MS need not affect your choices in how you feed your baby. Breastfeeding is recommended for all babies, including those who have parents with MS. Current recommendations are for exclusive breastfeeding for at least the first six months of life, and for breastfeeding to continue alongside family foods up to two years of age.

Research has shown that breastfeeding provides long term health benefits for mother and baby, and even a few days or weeks have benefits. Exclusive breastfeeding may reduce the risk of post-pregnancy relapse in some women with MS, although this cannot be relied upon in every case. Multiple sclerosis cannot be passed on to a baby through breast milk.

However, how to feed your newborn baby is, and should be, a choice. If you have concerns about breastfeeding in your own situation, you can discuss these issues with your MS nurse, midwife or health visitor so that they are able to provide appropriate support and advice.

You could consider storing supplies of breast milk in the freezer to use as a back up in case of relapse-associated disability or severe fatigue.

Will breastfeeding affect the course of my MS?

You are less likely to have a relapse during pregnancy when you have MS, although the risk of relapse increases in the six months after the birth and the number of relapses has then been shown to return to pre-pregnancy levels.

Breastfeeding may also reduce the risk of relapse, but not reliably in all cases. One study suggested that women with MS who breastfed were almost half as likely to experience a post-pregnancy relapse compared to women who did not. Exclusive breastfeeding for a period of two months may reduce your risk of having a relapse during this time.

Can I take steroids when breastfeeding?

Steroids such as methylpredisolone are used to treat relapses in MS. If you are breastfeeding and have a relapse, you can take steroids if you are advised to.

A recent study showed that methylprednisolone does cross into breast milk, but at very low levels. The amount of steroid peaks after 1 hour after infusion, and quickly reduces. Although the amount of steroid that a breastfed baby would receive is very low, you can further reduce this exposure by delaying breast feeding for 2-4 hours after each steroid treatment. You may wish to consider storing breast milk in the freezer in case this becomes necessary.

Can I re-start disease modifying drugs when I'm breastfeeding?

Disease modifying drugs vary in how likely they are to be present in breast milk or harmful to your baby. The decision whether to resume DMDs immediately after birth needs to be considered against the potential advantages of breastfeeding. If your MS is very active and you are at significant risk of relapse you may choose to stop breastfeeding in order to begin some DMDs again.

The Association of British Neurologist guidelines indicate that the injectable DMDs (Avonex, Betaferon, Copaxone, Plegridy, Rebif, Extavia) can safely be resumed during breastfeeding if required. These drugs take up to three months to reach their full efficacy after a break.

Tysabri (natalizumab) does cross into breast milk, but not in a form that is likely to be absorbed by a breastfeeding baby. The other DMDs should not usually be resumed during breastfeeding and you should discuss how and when they can be resumed with your MS team.

Should I take vitamin D when breastfeeding?

Women with MS should continue to take vitamin D while breastfeeding, and breastfed infants should be given vitamin D in line with standard advice. Being deficient in vitamin D throughout childhood can be a risk factor for health problems in later life, including multiple sclerosis.

Studies show that vitamin D levels in breast milk are affected by the level of vitamin D taken as dietary supplements in the mother. Moderate levels of vitamin D supplement, around 1000 - 2000UI per day cause a small rise in vitamin D levels in breast milk, but are not enough to match the amount given in infant supplements, or in formula milk. One study showed that if a woman chose to take supplements up to 6400IU/day, she would safely supply enough vitamin D in breast milk for her baby to be getting the recommended amount.

Infant vitamin drops, such as those available free through the Healthy Start programme in the UK, include vitamin D as well as other nutrients. You should discuss your baby's needs with a GP or pharmacist to ensure you are giving the appropriate doses of all recommended vitamins.

Find out more

Mums and MS a resource for women with multiple sclerosis who are considering having a baby , are currently pregnant or recently has a baby.
NHS Choices information on the benefits of breastfeeding.

References

Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex P UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines BMJ Practical Neurology 2019;19:106-114. Full article
Gulick EE, et al Infant health of mothers with multiple sclerosis Western Journal of Nursing Research 2004;29(5):589-602. Summary
Hellwig K, et al Multiple sclerosis and pregnancy: experience from a nationwide database in Germany. Therapeutic Advances in Neuroolgical Disorders 2012;5(5):247-53. Summary
Langer-Gould A, et al. Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clinical Immunology 2013;149(20):244-50. Summary
Pakpoor J, et al. Breastfeeding and multiple sclerosis relapse: a meta-analysis. Journal of Neurology 2012;259(10):2246-48. Summary
Almas S, et al Management of multiple sclerosis in the breastfeeding mother. Multiple Sclerosis International 2016 ID 6527458 Full article
Hollis BW et al Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics. 2015 Oct;136(4):625-34. doi: 10.1542/peds.2015-1669. Full article