Introduction
Entering parenthood brings many emotions and complicated decisions. For mothers who are living with Multiple Sclerosis, entering parenthood also involves a major medical decision, to breastfeed or restart treatment? Breastfeeding for a least two months may reduce postpartum MS relapse’s by up to 50% (Kerstin Hellwig et al, 2015). This is major. It indicates that something biologically important happens in the brains of breastfeeding mothers, potentially something that can be harnessed for treatment. This blog will explore how breastfeeding interacts with MS, what the current medications do, and a new hypothesis that can help remove the fears for women entering parenthood who have MS.
What is MS?
MS is a neurological autoimmune disease, meaning the body’s immune system attacks itself by mistake. The immune system targets the myelin which is the protective coating on the nerve and fibres and also attacks the oligodendrocyte’s which are the cells that make new myelin (Guoda Varyte et al, 2019). When this attack on the myelin happens the brain signals slow down, muscles weaken, vison becomes blurry and extreme fatigue occurs. 2.8 million people are living worldwide with MS (Wexler, 2020). The majority being women aged 20-40 (Guoda Varyte et al, 2019).
Figure 2: This image displays the many systems affected by MS.
How is MS effected during pregnancy?
During pregnancy, the immune system slows down to protect the foetus hence MS symptoms ease. However, after birth, hormones shift drastically, inflammation arises. The risk of relapse increases in the first 3-6 months postpartum (Gil Mor, 2011). This leaves the mother with a difficult decision weather to restart medication or focus on breastfeeding.
Traditionally, breastfeeding is viewed as only benefiting the baby, however there are biological reasons as to why it may help mothers with MS too. The prolactin hormone promotes repair and also drives milk production. This repair mechanism encourages the myelin making cells to grow. (Kim, 2020) The immune system eases and slows down, breastfeeding reduces the activity of inflammatory immune cells and keeps estrogen from dropping drastically (Alberto Camacho-Morales, 2021). As menstruation does not occur during breastfeeding, this results in slower hormonal fluctuations.
Figure1: This graphic shows how antibodies are produced and secreted into the breast milk through local and systemic pathways.
This immune response is mediated by lactation related hormones, prolactin, and can reduce inflammation and support myelin repair in the mother’s brain (Gil Mor, 2011). It highlights a biological explanation for why exclusive breastfeeding may lower relapse risk after childbirth.
Current treatment and research gaps.
Medications have been improved to slow the progression of the disease however, the myelin that is already gone cannot be repaired. Treatment that will prevent postpartum relapse’s without limiting breastfeeding is crucial for example using hormone immune biology strategically to prevent relapse.
So why cant MS medication and breastfeeding go hand in hand?
MS medication works by lowering inflammation and prevents permanent damage, however, these drugs can pass into the breast milk, dangerously weaken the mothers immune system and cause unknown effects on the baby (Stephen L Hauser, 2021).
A new approach; A targeted Prolactin signalling amplification for OPC driven postpartum remyelination.
Breastfeeding can activate a natural repair system in the mothers brain, strengthening this system could help prevent postpartum MS worsening without harm to the baby. Prolactin stimulates oligodendrocyte precursor cells, postpartum brain shows increased plasticity and breastfeeding reduces certain inflammatory signals (Alberto Camacho-Morales, 2021). This approach doesn’t focus on stopping the disease but helps regenerate myelin faster.
Prolactin helps boost neuron survival signals and reduces oxidative stress this mechanism ultimately protects existing neve cells. Prolactin supports immune balance, lowers the activation of T cells and creates more regulatory t cells which lowers attacks caused my the immune system (Kim, 2020).
This treatment would only act in the brain, enhance prolactin’s myelin repair effect, not pass into the breast milk and would be safe to combine with exclusive breastfeeding. It supports both the mothers health and feeding of the baby. This treatment would involve a targeted delivery to oligodendrocyte precursor cells (OPCS). It would direct prolactin like molecules to damaged areas and repair exactly where MS caused damage. This new approach can be measured through tracking postpartum relapse rates and MRI markers of remyelination, highlighting whether the myelin is being restored effectively.
The future
Right now the reality for mothers with MS face many emotions and choices as breastfeeding may help, but stopping medication could worsen the MS. We must find a treatment that enables mothers with MS to protect their brain and support their feeding choice. By better understanding prolactin new ways to repair myelin will emerge offering a brighter outlook for mothers with MS.
References
Alberto Camacho-Morales, M. C. M. G.-J. e. a. M. D. C.-F. ,. R. V.-C. C. M.-V., 2021. Breastfeeding Contributes to Physiological Immune Programming in the Newborn. National Library of Medicine.
Gil Mor, I. C., 2011. The Immune System in Pregnancy: A Unique Complexity. National Library of Medicine.
Guoda Varyte et al, J. Z. D. R., 2019. Multiple Sclerosis. National Institue of Neurological disorders and Stroke.
Karla Rio-Aige et al, I. A.-B. M. C. M. S.-R., 2021. The Breast Milk Immunoglobulinome. MDPI.
Kerstin Hellwig et al, M. R. S. H., 2015. Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses. JAMA neurology.
Kim, Y. J., 2020. Pivotal roles of prolactin and other hormones in lactogenesis and the nutritional composition of human milk. National Library of Medicine.
Lifer, H. S., 2024. How MS Affects the Myelin Sheath. Health central .
Stephen L Hauser, B. A. C., 2021. Treatment of Multiple Sclerosis: A Review. National Library of medicine.
Wexler, M., 2020. MS Prevalence at Over 2.8 Million Worldwide, Update to Atlas Reports. Multiple Sclerosis news today.
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Comments
I especially like that the outlined therapy is re-purposing something that is already something that a lot of pregnant MS-patients would consider doing anyways. Also a side note to breast feeding in Ireland - it has one of the lowest breast feeding rates in Europe (~44%, Unicef as source) - so maybe especially for Irish women who might come across this blog post it could emphasize the importance of it - for them and their baby.
Thank you Paula, I completely agree. It is very promising to be able to build on something many mothers are already considering. The breastfeeding rates in Ireland is such a good point to highlight. Hopefully sharing evidence that breastfeeding may also benefit the mothers neurological healthy might empower more women to breastfeed.
Hi guys, that's a really interesting concept for your blog! Just wondering, as part of your research, did you look into the role of Estradiol on Prolactin secretion during pregnancy? I found this paper that highlights that increased Estradiol concentrations could be partially involved in the activation of prolactin secretion from the pituitary gland. (Gregg et al. 2007) Do you think that you could use the steroid hormone Estradiol to stimulate Prolactin secretion which could potentially lead to prolactin's therapeutic effects?
Gregg, C., Shikar, V., Larsen, P., Mak, G., Chojnacki, A., Yong, V.W. and Weiss, S., 2007. White matter plasticity and enhanced remyelination in the maternal CNS. Journal of Neuroscience, 27(8), pp.1812-1823.
I didn't realize that breastfeeding could greatly affect the risk of MS relapses. It's impressive how female hormones influence the outcomes of the disease. This highlights the need for more research on women's health specifically.