Meta-analysis: breastfeeding protects against postpartum MS relapse

  • JAMA Neurol
  • 9 Dec 2019

  • International Clinical Digest
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Takeaway

  • Compared with peers who did not breastfeed, new mothers with multiple sclerosis (MS) who breastfed had a 37%-43% lower risk for relapse in the postpartum period.

Why this matters

Key results

  • Relative to nonbreastfeeding, breastfeeding conferred significant reduction in relapse risk (pooled summary OR, 0.63; P=.006).
  • Findings are similar among the 4 studies reporting adjusted HR (aHR; pooled aHR, 0.57; P=.006).
  • Analyses showed moderate heterogeneity attributable to variable prepregnancy relapse rate, postpartum follow-up duration, and publication year.
  • Association was stronger:
    • With higher prepregnancy annualized relapse rate (summary OR, 0.51; P=.002) vs lower prepregnancy annualized relapse rate (summary OR, 0.72; P=.24).
    • With exclusive breastfeeding for ≥2 months (summary OR, 0.52; P=.04) vs any breastfeeding (summary OR, 0.68; P=.07).

Study design

  • Systematic review of 24 cohort studies among 2974 women with relapsing-remitting MS, with meta-analysis of data from 16 studies.
  • Main outcome: relapse in the postpartum period.
  • Funding: Sylvia Lawry Physician Fellowship from National Multiple Sclerosis Society.

Limitations

  • Lack of individual-patient data.
  • Use of pooled ORs.
  • Moderate heterogeneity.
  • Inability to assess duration of breastfeeding that is beneficial.