1.0 Introduction
Multiple Sclerosis (MS) is an autoimmune demyelinating disease that targets the central nervous system (CNS), leading to damage of the myelin protecting our nerves. Existing treatments for MS only aim to ease symptoms for patients and improve their quality of living as unfortunately there is no cure for MS. Approximately 2.3 million people are affected by MS, and it is found to be three times more common in women than in men. Individual studies have shown that MS has a prodromal stage and that breastfeeding can lead to a reduced rate of postpartum MS relapses. This prompts the question, could we predict an MS relapse before it happens by studying the prodromal phase in breastfeeding women?
1.1 What is Multiple Sclerosis
Myelin is a lipid bilayer that strengthens neural communication by shielding axons from external damage. Consequently, damage to the myelin from relapsing MS has an increasing negative impact on neurological functions because of weakened axonal tracts (Ferreira, et al., 2020). This can then result in the development of small white spots in the body that stand out from healthy tissue called focal lesions, also referred to as demyelinated matter plagues. These plaques can be detected through an MRI leading to an official diagnosis of MS (King, 2007).
Figure 1 Depiction of a healthy neuron with myelin cover intact vs a demyelinated neuron (biorender.com)
Different symptoms associated with MS can vary between individuals depending on the intensity of damage caused to the myelin as well as the position of the nerve that has been targeted (World Health Organisation, 2023).
Table 1 Symptoms of MS (National Multiple Sclerosis Society, 2025).
1.2 A Correlation Between Breastfeeding and MS
Multiple sclerosis is a disease that affects women in their reproductive years more than men. While generally, women with MS are less likely to get pregnant, nowadays with more treatment options than before such as disease modifying treatments or DMTs, more women are choosing to be mothers. Pregnancy can often be a respite from the doom of relapses: relapse rates are known to decrease during pregnancy, especially during the third trimester when oestogen and progesterone levels are at their highest. This refuge comes to an end post birth, where relapse rate is known to increase. Breastfeeding can help to reduce the chances of a relapse, but women are often held back from this because they must get back on their medications. Parts of the medication can pass into the breastmilk and onto the child, leaving women with no choice but formula. They miss out on a big part of early motherhood that has enormous benefits for both mother and child.
What we are suggesting is to come up with ways to identify a MS prodome: a stage before an official relapse starts so that doctors can find solutions to the problem, preventing or delaying a relapse by “nipping it in the bud” so that women have more options when it comes to breastfeeding.
2.0 Identifying the Prodromal Stage of MS in Breastfeeding Women
2.1 The Prodrome Phase of MS
A prodrome refers to early signs or symptoms that occur before the typical symptoms of disease develops. In recent years the prodromal phase of MS has been studied with the aim of delaying or preventing the development of MS through early detection of the disease. Studies have shown that in the years leading up to a diagnosis of MS, patients spend an increased amount of time in hospitals and have more frequent GP and pharmacy visits. Stress on mental health is also a trending factor during the prodromal period, including the diagnosis of depression or anxiety. More common symptoms of MS were also noticed in the years prior to an official diagnosis, such as bladder issues, pain and gastrointestinal problems (Helen Tremlett, 2020).
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Effects of breastfeeding on MS progression, postpartum health, and relapse rates
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Impact of breastfeeding on Long-term MS outcomes
Figure 2 Highlights the potential behind identifying prodromes during the postpartum stage
2.2 Proposed Study Approaches for MS Prodromes during Breastfeeding
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Patient observations
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Clinical info related to ms and breastfeeding
Based on an approach to capturing and phenotyping the classical MS prodromal period we have come up with a study design that applies to studying the postpartum prodromes women to potentially delay or even prevent relapsing symptoms of MS for these patients.
Table 2 Potential study approach to identify prodromes in postpartum MS patients (Helen Tremlett, 2020)
3.0 Conclusion
Although there have been no studies that have specifically examined the prodromal stage in breastfeeding women, recent advances in MS prodrome research and postpartum neuroimmunology suggest this could be a promising future direction.
References
Ferreira, H. B., Domingues, R. M., Neves, B., Guerra, I. M., Moreira, A., Melo, T., & Paiva, A. (2020). An Overview of Lipidomic Analysis in Different Human Matrices of Multiple Sclerosis. Multiple Sclerosis ans Related Disorders, Volume 44. Retrieved from Multiple Sclerosis and Related Disorders.
Helen Tremlett, R. A. (2020). The Multiple Sclerosis Prodrom: Emerging Evidence, Challenges, and Oppertunities. Multiple Sclerosis Journal, Volume 27, Issue 1.
King, T. C. (2007). Multiple Sclerosis. Elsevier's Integrated Pathology , Chapter: Nervous System.
National Multiple Sclerosis Society. (2025, August). Exploring Symptoms of MS. Retrieved from Multiple Sclerosis Symptoms : https://www.nationalmssociety.org/understanding-ms/what-is-ms/ms-symptoms
Tobin, O. (2024, November 01). Multiple Sclerosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
World Health Organisation. (2023, August 07). Multiple Sclerosis. Retrieved from World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/multiple-sclerosis
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Comments
This is a really innovative perspective on the topic. Approaching this from the pre-onset stages would be highly beneficial for women who end up facing irreversible neurological damage from developing MS.
However, due to the prodromal phase generally occurring in young, developing women, there may be a variety of factors influencing or overlapping the symptoms mentioned above such as depression and anxiety and more frequent healthcare visits, like PMDD diagnosis, psychosocial stressors, fluctuating hormones, availing of contraception etc, I wonder how could symptoms be diagnosed as MS-related? Furthermore, some MS-associated symptoms such as numbness or pain in specific body regions may overlap with gynaecological disorders or endometriosis.
There may potentially be key identifier symptoms that could be isolated from those mentioned.
That's a great point to consider, overlapping symptoms between MS and other hormonal and psychological symptoms in women is something that needs to be differentiated between as it is currently difficult to isolate prodromal symptoms as MS-specific due to limited research on the topic. Finding specific biomarkers that can distinguish these symptoms from those caused by other health conditions as you've mentioned is certainly an area of research worth investing in to benefit patients before they are officially diagnosed with MS.
Hi Sarah,
Thank you so much for taking the time to read and comment. I agree with you yes there may be some overlapping factors. When looking for symptoms, you would have to include tests that are MS specific such as carrying out MRIs to check for RIS and test for biomarkers in blood and CSF over a long period of time in order to not rule out the possibility that it could be MS. MS is a disease that also is more likely to affect women especially during their reproductive age so it should be looked out for as well.
This is a compelling idea, one which I think could provide a lot of relief for breastfeeding mothers. Do you have a specific set of tests you would conduct to distinguish prodromal markers after delivery?
Hormonal changes occur very quickly after birth, do you think this would present as a limitation to further study in this area?
Hi Andrea, thank you so much for you interest on the topic and appreciation of the article. There would be several things that you could monitor and track such as fatigue, depression, anxiety and low mood and headache to see if its a sign of MS. I understand that these are also normal post partum but even looking at just fatigue specifically, its when despite getting adequate rest there is still no relief that it could be a sign. In terms of specific biomarkers to look out for, first you could check for a section of a gene called Delernium HLADRB1*1501 as those who have this gene are 10 percent more likely to end up with MS in the future. Blood tests include checking Serum neurofilament light chain (sNFL) in the pre pregnancy stage , regularly during pregnancy itself and post partum. Checking levels of lymphocytes in the blood may also provide signs as well.
Thank you for the insight on the hormone changes after birth changing quickly. It could present as a limitation early on but when identifying a prodrome, everything is looked at in long term. Hormone changes will occur and it would be important to account for that in future studies.