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Lorene M. Nelson, MS; Gary M. Franklin, MD, MPH; Monica C. Jones; the Multiple Sclerosis Study Group; George Belendiuk, MD, PhD; Barbara Kasper, RN; Diane Klatzman, RN; William Mietlowski, PhD; Suzanne Solch, RN; Gary Franklin, MD, MPH; Jack Burks, MD; Lorene Nelson, MS; Carolyn Wangaard, RN, CANP; Henry McFarland, MD; Andrew Goodman, MD; Dale, MD; Helen Krebs, RN; Heidi Maloni, RN; Joe Debronozo, PhD; Labe, MD; Ute Traugott, MD; Mindy Aisen, MD; Kate Robbins, CCOT; William Sibley, MD; Jose Laguna, MD; Joan Laguna; John, MD; David Cliford, MD; Larry Smith, MD; Jane Mclnnis, RN; Barry Arnason, MD; Raymond Roos, MD; Anthony Reder, MD; Jack Antel, MD; Mark Aguis, MD; Roberta Martia, RN; Barrie Hurwitz, MD; Steven Greenburg, MD; Louis Fredane, MD; Rebecca Herbstreith, RN; Jean Hurwitz; Kenneth Johnson, MD; Hillel Panitch, MD; Carol Lee Koski, MD; Paul Fishman, MD; Sue Haley, RN; Jack Petajan, MD, PhD; Patrick Bray, MD; John Rose, MD; David Thurman, MD; William Galster; Wallace Tourtellotte, MD, PhD; R. W. Baumhefner, MD; George Ellison, MD; Lawrence Myers, MD; Karl Syndulko, PhD; LaVona Newton, RN; Jerry Wolinsky, MD; E. Simon Sears, Jr, MD; Avindra Nath, MD; Catherine Weisbrodt, RN

JAMA. 1988;259(23):3441-3443.

Abstract
Studies in the past have reported an increased risk of exacerbations in multiple sclerosis during the postpartum period; it is not known whether breast-feeding alters this risk. We interviewed 435 women regarding pregnancy and breast-feeding history, providing for analysis 191 pregnancies that had occurred during a nonprogressive phase of the disease. The exacerbation rates during the nine-month postpartum period (34%) were more than three times the exacerbation rate during the nine months of pregnancy (10%). The exacerbation risk was highest in the three-month period following childbirth and appeared to stabilize after the sixth postpartum month. The exacerbation rates in breast-feeding and non—breast-feeding pregnancies were 38% and 31%, respectively. The average time to exacerbation was similar in breast-feeding (3.0 months) and non—breast-feeding (3.1 months) pregnancies. Although differential exacerbation rates during pregnancy and the postpartum period may be related to hormonal effects on the immune system, the hormonal effects of breast-feeding do not appear to similarly affect the risk of exacerbation.

(JAMA 1988;259:3441-3443)

Author Affiliations
Sandoz Research Institute, Sandoz Pharmaceutical Corp, East Hanover, NJ; Rocky Mountain Multiple Sclerosis Center, University of Colorado Health Sciences Center, Denver; Neuroimmunology Branch, National Institutes of Health, Bethesda, Md; Albert Einstein College of Medicine, Bronx, NY; Arizona Health Sciences Center, Tucson; Washington University School of Medicine, St Louis; University of Chicago; Duke University Medical College, Durham, NC; University of Maryland School of Medicine, Baltimore; University of Utah Medical Center, Salt Lake City; Neurology Service, Wadsworth Veterans Administration Medical Center, Los Angeles; University of Texas Health Science Center at Houston

From the Rocky Mountain Multiple Sclerosis Center (Mss Nelson and Jones and Dr Franklin), and the Departments of Neurology, Preventive Medicine, and Biometrics (Dr Franklin), University of Colorado Health Sciences Center, Denver. Ms Nelson is now with the Departments of Epidemiology and Neurology, School of Public Health and Community Medicine, University of Washington, Seattle. Dr Franklin is now the medical director of the Department of Labor and Industries, State of Washington, Olympia. The members of the Multiple Sclerosis Study Group are listed in the acknowledgments.

Footnotes
Reprint requests to Rocky Mountain Multiple Sclerosis Center, University of Colorado Health Sciences Center, Box B-181, 4200 E Ninth Ave, Denver, CO 80262 (Ms Nelson).

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