[S40.003] Breastfeeding Is Not Related with the Risk of Post-Partum Relapses in Women with Multiple Sclerosis

Emilio Portaccio, Florence, Italy, Angelo Ghezzi, Gallarate (VA), Italy, Bahia Hakiki, Valentina Zipoli, Lorenzo Razzolini, Florence, Italy, Vittorio Martinelli, Lucia Moiola, Milano, Italy, Francesco Patti, Catania, Italy, Loredana La Mantia, Milan, Italy, Gianluigi Mancardi, Claudio Solaro, Genova, Italy, Maria Rosaria Tola, Ferrara, Italy, Carlo Pozzilli, Laura De Giglio, Rome, Italy, Rocco Totaro, Aquila, Italy , Alessandra Lugaresi, Milan, Italy, Valeria Di Tommaso, Chieti, Italy, Damiano Paolicelli, Bari, Italy, Maria Giovanna Marrosu, Cagliari, Italy, Giancarlo Comi, Milan, Italy, Maria Trojano, Bari, Italy, Maria Pia Amato, Florence, Italy

OBJECTIVE: To assess the relationship between exclusive breastfeeding and the risk of post-partum relapses in multiple sclerosis (MS) patients. BACKGROUND: a recent study (Langer-Gould et al. Arch Neurol. 2009) suggested that exclusive breastfeeding may significantly reduce the risk of post-partum relapses in MS women. DESIGN/METHODS: in this prospective, observational study, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a semi-structured interview dealing with pregnancy, fetal outcomes and breastfeeding. Time to first relapse in the first year after delivery was assessed through the Kaplan-Meier curves and Cox regression analysis. RESULTS: 302 out of 423 pregnancies in 298 women (mean age 31.5+/-4.7 years, mean disease duration 7.1+/-4.9 years, mean Expanded Disability Status Scale EDSS score 1.5+/-1.0 ) resulted in full-term deliveries. Patients were followed-up for at least 1 year after the delivery. In the univariate analysis, exclusive breastfeeding was marginally related to a lower risk of post-partum relapses (HR=0.72; 95%CI 0.51-1.01; p=0.052). In the multivariate analysis adjusting for possible confounders (age at onset, age at pregnancy, disease duration, EDSS, relapses in the year prior to pregnancy and during pregnancy, treatment with disease modifying drugs DMDs-), the association between breastfeeding and post-partum relapses disappeared. The only significant predictors of post-partum relapses were the presence of relapses in the year before pregnancy (HR=2.06; 95%CI 1.46-2.91; p<0.001)and during pregnancy (HR=3.01; 95%CI 1.95-4.66; p<0.001) and previous treatment with DMDs (HR=1.48; 95%CI 1.04-2.10; p=0.029). CONCLUSIONS/RELEVANCE: the apparent association between breastfeeding and lower risk of post-partum relapses may be due to the higher probability that women with lower disease activity before and during pregnancy breastfeed their infants. In fact, in our sample, post-partum relapses were predicted only by previous DMDs therapy (a possible indicator of higher disease activity) and relapses before and during pregnancy.
Category - MS and Related Diseases - Clinical Science

Wednesday, April 14, 2010 4:45 PM

Scientific Sessions: Multiple Sclerosis: Epidemiology (4:15 PM-5:30 PM)