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MS research update - Can low vitamin D levels increase the likelihood of having a relapse after giving birth? - 1 December 2014

Summary

Previous research has shown that a woman with MS is less likely to have a relapse during pregnancy, but the risk of relapse increases in the six months after the birth. Why the risk of relapse increases in this time is not exactly known. This study investigated levels of vitamin D in pregnant women with MS to see if levels were related to relapses.

43 women with relapsing remitting MS and 21 healthy control women were assessed at several points during and after their pregnancies. At each assessment, as well as undergoing a medical assessment, blood samples were taken to measure levels of vitamin D.

The study found that there were no differences in blood vitamin D levels between participants with MS and controls. In both groups vitamin D levels increased in the third trimester of pregnancy and then decreased after delivery.

The researchers noted that MS activity decreased during pregnancy, but there was a significant increase in the number of relapses experienced in the first 3 months after delivery. However there was no relationship found between low levels of vitamin D and relapse. Relapses were also not related to whether or not the woman had taken a vitamin D supplement or breastfed their child.

The researchers conclude that low vitamin D is not associated with these relapses and suggest that further research is needed to work out what causes this increase in relapses shortly after pregnancy.

Background

Vitamin D has several important roles in the body, including keeping bones and teeth healthy. Pregnant women are at particular risk of having low vitamin D levels. In the UK it is recommended that pregnant and breastfeeding women take a supplement to ensure that their baby has enough vitamin D for the first few months of its life.

Previous research has shown that a woman with MS is less likely to have a relapse during pregnancy, but the risk of relapse increases in the six months after the birth. Why the risk of relapse increases in this time is not exactly known. Some previous research has shown that in people with relapsing remitting MS low vitamin D levels are associated with higher relapse rates. This study investigated levels of vitamin D in pregnant women with MS to see if levels were related to relapses.

How this study was carried out

This study was part of The Rotterdam Study on Pregnancy in MS which has investigated several other measures in pregnant women previously. 43 women with relapsing remitting MS and 21 healthy control women were included in this study. They were assessed at several points during and after their pregnancies. At each assessment, as well as undergoing a medical assessment, blood samples were taken to measure levels of vitamin D.

Of the 43 participants with MS, 20 were taking a vitamin D supplement, in the control group, 7 of the 21 participants were taking a supplement.

What was found

The study found that there were no differences in blood vitamin D levels between participants with MS and controls. In both groups vitamin D levels followed the same pattern, increasing in the third trimester of pregnancy and then decreasing again after delivery.

The researchers noted that MS activity decreased during pregnancy, but there was a significant increase in the number of relapses experienced in the first 3 months after delivery, where 11 women experienced a relapse. A total of 31 relapses occurred during the period of the study. However there was no relationship found between low levels of vitamin D and relapse.

When the researchers looked at the results from women who experienced relapses and compared them to those women who did not have a relapse, they could not find any differences. Both groups had a similar blood level of vitamin D, a similar number of women taking vitamin D supplements and similar numbers that breastfed their babies, so no relationships or patterns could be found.

What does it mean?

The main finding of the study was that the occurrence of a relapse was not related to levels of vitamin D during pregnancy or after the baby was born. Relapses were also not related to whether or not the woman had taken a vitamin D supplement or breastfed their child. The researchers suggest that further research is needed to work out what causes the increase in relapses shortly after pregnancy, but speculate that it could be related to hormones having an effect on the immune system.

Runia TF, Neuteboom RF, de Groot CJ, et al.
The influence of vitamin D on postpartum relapse and quality of life in pregnant multiple sclerosis patients..
Eur J Neurol. 2014 Nov 28. [Epub ahead of print]
abstract

More about pregnancy and MS

MS is most often diagnosed between the ages of 20-40, the age at which many people may be thinking of having a family. Deciding whether to start or add to a family is often a complicated process, and MS raises a host of other questions to consider. For most women, MS does not make any significant difference to their pregnancy. A woman with MS is no more likely to experience miscarriage or birth defects in their baby than a woman who does not have MS.

A woman with MS is less likely to have a relapse during pregnancy, although the risk of relapse increases in the six months after the birth. Despite the fluctuation in the relapse rate, research has shown that pregnancy has no adverse effect on MS in the long-term and that it does not hasten or cause disease progression. After the period of higher risk, the number of relapses will remain around the same as it would have been if there had not been a pregnancy.

Although this current study could find no relationship between levels of vitamin D and the mother experiencing a relapse in the months after giving birth, a number of studies have drawn a connection between vitamin D levels in mothers during pregnancy and the subsequent risk of their children developing MS. More people with MS are born in spring than autumn, which suggests that mothers getting less sunshine in pregnancy results in lower vitamin D levels, which in some way increases the risk of developing MS later in life for children who are genetically susceptible. Though there are many studies in progress, the exact role of vitamin D in MS is still not clearly understood. The Department of Health recommends a daily 400 IU (10 micrograms) vitamin D supplement for pregnant and breastfeeding women. Although some MS neurologists are now recommending that pregnant women with MS take 4000-5000 IU (100-125 micrograms) vitamin D per day.

A number of medications for MS, both disease modifying drugs and those for individual symptoms, are not recommended for use by women during pregnancy or when breastfeeding. Women who are planning a family or who find they are pregnant should discuss their medications and requirements for supplements with their MS nurse or doctor.

You can read more about pregnancy and parenthood in our A-Z of MS or in two recent articles in Open Door which covered pregnancy in MS and childbirth and caring for a newborn baby.

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Read the full text of this paper (PDF)

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