Breast-Feeding, Postpartum and Prepregnancy Disease Activity in Multiple Sclerosis

Airas, Laura; Jalkanen, A.; Alanen, A.; Pirttilä, Tuula; Marttila, Riitta

doi:10.1212/wnl.0b013e3181eb5860

Cited by 82 publications

(84 citation statements)

References 10 publications

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“…There was no significant difference between the two groups in terms of the percentage of patients who breastfed, a factor that has also been implicated in reduction of relapse risk. [6][7][8] The advantages of the use of IVMP over the use of IVIG would be better tolerance, fewer side effects, and significantly lower cost.…”

Section: Resultsmentioning

confidence: 99%

“…5 Previous studies suggested a reduction in the postpartum relapse rate for MS patients after exclusive breastfeeding, 6,7 but this tendency was not shown in a more recent study. 8 Breastfeeding was also not shown to affect postpartum relapse activity in PRIMS. 4 Data published by Oliveri et al 9 showed that intravenous methylprednisolone (IVMP) reduced magnetic resonance imaging (MRI) activity, defined as the number of contrast-enhancing lesions over a 2-month period.…”

mentioning

confidence: 89%

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The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Avila-Ornelas

Avila

Stosic

et al. 2011

International Journal of MS Care

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Multiple sclerosis (MS) is most prevalent in women of childbearing age. It is well established that the relapse rate decreases during pregnancy but increases significantly during the first postpartum trimester. The objective of this retrospective study was to evaluate the effectiveness of the administration of 1 g of intravenous methylprednisolone (IVMP) after delivery in the prevention of MS relapses. The study involved 47 women with one or more documented pregnancies; each pregnancy was treated as a separate case. There were 50 cases with relapsing-remitting MS and 2 with secondary progressive MS. The cases were divided into two groups: the IVMP group (those who received 1 g of IVMP after delivery) and the no-IVMP group (those who did not receive IVMP after delivery). There were 39 cases in the IVMP group and 13 in the no-IVMP group. During the first postpartum trimester, relapses occurred in 17.9% of the IVMP group, compared with 46.2% of the no-IVMP group (P = .0448). The difference in relapse percentage between the two groups during the second and third postpartum trimesters was not statistically significant. Our study shows a statistically significant benefit of postpartum IVMP administration in reducing MS relapses. Int J MS Care. 2011;13:91-93. Multiple sclerosis (MS) is most prevalent among women of childbearing age. 1 Recent studies have shown that pregnant MS patients have the same risk of pregnancy complications as the general population. 2 The influence of pregnancy on the course of disease in MS has also been studied over the years.According to the Pregnancy in Multiple Sclerosis (PRIMS) trial, the mean ± SD number of relapses was 0.7 ± 0.9 per woman per year in the year before pregnancy; it was 0.5 ± 1.3 during the first trimester of pregnancy, 0.6 ± 1.6 during the second trimester, and 0.2 ± 1.0 during the third trimester. It increased to 1.2 ± 2.0 during the first 3 months postpartum and then returned to the pre-pregnancy rate. 3 After a 2-year follow-up analysis, the researchers described clinical factors that might predict the likelihood of relapse in the 3 months after delivery: an increased relapse rate in the pre-pregnancy year, an increased relapse rate during pregnancy, and a higher Expanded Disability Status Scale (EDSS) score at pregnancy onset. 4 The reason for the increased postpartum activity is not yet clear, but many factors have been considered, including the decrease in estrogen levels and the reduced activity of some immune-inhibitory molecules. 5 Previous studies suggested a reduction in the postpartum relapse rate for MS patients after exclusive breastfeeding, 6,7 but this tendency was not shown in a more recent study. 8 Breastfeeding was also not shown to affect postpartum relapse activity in PRIMS. 4 Data published by Oliveri et al. 9 showed that intravenous methylprednisolone (IVMP) reduced magnetic resonance imaging (MRI) activity, defined as the number of contrast-enhancing lesions over a 2-month period. Therefore, we hypothesized that a dose of IVMP in the immediate pos...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 89%

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Avila-Ornelas

Avila

Stosic

et al. 2011

International Journal of MS Care

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“…In line with these results, we show that IgG response against the self-Ag MOG was not affected by PRLR or PRL deficiency. In the MS field, PRL has gained renewed interest in recent years, because two studies showed that exclusive breastfeeding (a hyperprolactinemic physiologic condition) reduces the risk for postpartum relapses (35,36), albeit other articles reported discordant results (5,37,38). Further, another article has demonstrated that PRL mediates proliferation of oligodendrocyte progenitor cells during pregnancy and promotes myelin repair in a spontaneously remyelinating model of chemical (lysolecithin)-induced focal demyelination, suggesting PRL as a potential therapeutic agent for MS (39).…”

Section: Discussionmentioning

confidence: 99%

Prolactin Is Not Required for the Development of Severe Chronic Experimental Autoimmune Encephalomyelitis

Costanza

Musio

Abou-Hamdan

et al. 2013

The Journal of Immunology

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Predominance of multiple sclerosis (MS) in women, reductions of disease flares during pregnancy, and their increase in the postpartum period have suggested a hormonal influence on MS activity. The hormone prolactin (PRL) has long been debated as a potential immune-stimulating factor in several autoimmune disorders, including MS and its animal model experimental autoimmune encephalomyelitis (EAE). However, to date, no data clearly ascribe a pathogenic role to PRL in these diseases. Using PRL receptor–deficient (Prlr−/−) and PRL-deficient (Prl−/−) mice, we show that PRL plays a redundant role in the development of chronic EAE. In Prlr−/− and Prl−/− mice, EAE developed with a delayed onset compared with littermate control mice, but with full clinical severity. In line with the clinical outcome, T cell proliferation and production of IFN-γ, IL-17A, and IL-6 induced by myelin Ag were delayed in Prlr−/− and Prl−/− mice. Ag-specific IgG Ab responses were not affected by PRLR or PRL deficiency. We also show that mouse lymph node cells and purified CD4+ T cells express transcript for Prlr, but not for Prl. These results reveal that PRL does not play a central role in the development of chronic EAE and optimal Th1 and Th17 responses against myelin. Moreover, they also rule out a possible contribution of PRL secreted by immune cells to the modulation of autoreactive T cell response in this model.

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“…35,36 This is in stark contrast to a South-European MS population, where only 28.6% of mothers chose nursing. 25 Breastfeeding is considered beneficial for the mother -infant relationship, and it reduces the incidence of infections and allergies experienced by the infant.…”

Section: Breastfeeding and Msmentioning

confidence: 75%

“…12 -15 Placenta-derived hormones, oestrogens and progesterone can directly affect the function of the immune cells through oestrogen and progesterone-receptors. During the course of pregnancy, the placenta-derived oestriol (E3) levels increase many-fold (from 0.2 ng/mL before pregnancy up to 10 ng/ mL during gestational weeks [35][36][37]. Related to this, a dramatic decrease in MS relapse frequency is observed during the latter half of pregnancy.…”

Section: Clinical Datamentioning

confidence: 99%

Pregnancy and Multiple Sclerosis

Airas

Etemadifar

Maghzi

2011

Neurological Disorders and Pregnancy

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Breast-Feeding, Postpartum and Prepregnancy Disease Activity in Multiple Sclerosis

Cited by 82 publications

References 10 publications

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Prolactin Is Not Required for the Development of Severe Chronic Experimental Autoimmune Encephalomyelitis

Pregnancy and Multiple Sclerosis

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