Breastfeeding

Current recommendations for the general population suggest giving nothing but breast milk for about the first six months of your baby's life. After that, giving your baby breast milk alongside family foods for the first two years. Only one study has looked at the children of women with MS, and this showed that their breastfed babies, when followed for a year, had been less prone to health problems such as ear infections than babies that had been formula fed.  However how to feed a newborn baby is, and should be, a choice. Many women with MS may have concerns about breastfeeding and fatigue can be a real issue. You can discuss these issues with your MS nurse and midwife or health visitor so that they are able to provide appropriate support and advice. 

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. Studies on the course of MS suggest either no effect or a possible decrease in the relapse rate is associated with breastfeeding. A meta-analysis found that women with MS who breastfed were almost half as likely to experience a post-pregnancy relapse compared to women who did not. A further study suggests that breastfeeding exclusively for a period of two months lowers your risk of having a relapse at this time. 

Steroids have been shown to cross into breast milk. There is very little research that has explored the high doses used in treating MS relapse, so currently women are advised not to breastfeed whilst taking this medication. However you can express as much milk as possible before starting the course of treatment and store this for use during the treatment - usually five days for oral methylprednisolone or three days if taken intravenously. Milk may be expressed and discarded during the actual treatment period. Breastfeeding can then be recommenced between one and two days after the end of treatment – you can work with your MS nurse and neurologist to determine the exact timings that are best for you.

Disease modifying drugs can be present in breast milk so are not usually started whilst breastfeeding. 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 and opt for bottle feeding to begin DMDs again. You can discuss breastfeeding and your treatment options after delivery with your MS team during your pregnancy to consider the options for preventing relapses, and resuming disease modifying drugs.