[S40.004] The Curious Case of Vitamin D, Pregnancy, Breastfeeding and Postpartum Multiple Sclerosis Relapses
Annette Langer-Gould, Pasadena, CA, Rohit Gupta, Stanford, CA, Stephen Van Den Eeden, Oakland, CA, Ronald Horst, Ames, IA, Lorene Nelson, Palo Alto, CA, Bruce W. Hollis, Charleston, SC
OBJECTIVE: To determine whether low levels of 25-hydroxyvitamin D (25(OH)D) contribute to the increased risk of postpartum MS relapses and how this may be related to breastfeeding. BACKGROUND: It is well known that healthy pregnant and lactating women are at high risk of hypovitaminosis D and that pregnant women with MS are protected against MS relapses. It addition, exclusive breastfeeding may also protect against MS relapses. DESIGN/METHODS: We prospectively followed 29 pregnant women with MS through the postpartum year and assessed exposures and symptoms through structured interviews. Total serum 25(OH)D were measured using the DiaSorin Liaison Assay during the 3rd trimester and 2,4,6 month postpartum. The data were analyzed using longitudinal multivariable methods. RESULTS: Most participants (93%) were Caucasian. Fourteen (48%) women breastfed exclusively, and 13(45%) women relapsed within the first 6 months. During pregnancy, the average 25(OH)D levels were 25.4ng/mL (range 13.7-42.6) and were affected only by season (p=0.009). In contrast, in the postpartum period 25(OH)D levels were significantly affected by breastfeeding and relapse status. 25(OH)D levels remained low among the exclusive breastfeeding group yet rose significantly in the non-exclusive breastfeeding group regardless of season (p=0.007unadjusted, p=0.02 adjusted). By 4 and 6 months postpartum, 25(OH)D levels were on average 5 ng/mL lower in the women who breastfed exclusively compared with the non-breastfeeding group (p=0.001). While 25(OH)D levels rose on average by 4ng/mL around the time of relapse (p=0.02 unadjusted; p=0.005 adjusted for season) it was unclear whether this rise occurred prior to or immediately after the onset of symptoms. CONCLUSIONS/RELEVANCE: Pregnancy and exclusive breastfeeding are strongly associated with low 25(OH)D levels in women with multiple sclerosis. However, these lower vitamin D levels were not associated with an increased risk of postpartum MS relapses. These data suggest that low 25(OH)D levels are not an important risk factor for postpartum MS relapses. Supported by: NIH K23 (NS43207) and Wadsworth Foundation Young Investigator's Award (both to ALG).
Category - MS and Related Diseases - Clinical Science
Wednesday, April 14, 2010 5:00 PM
Scientific Sessions: Multiple Sclerosis: Epidemiology (4:15 PM-5:30 PM)
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