Pregnancy and multiple sclerosis (MS): breastfeeding management

Benefits of breastfeeding

• Women with MS should be encouraged to breastfeed
• Exclusive breastfeeding is associated with a reduced relapse rate
• Prolonged breastfeeding may reduce the risk of developing MS

Treatment of relapse during breastfeeding

High risk DMTs during breastfeeding: to avoid

Low risk DMTs during breastfeeding: can be used

Low risk DMTs during breastfeeding: to avoid

Monoclonal antibody DMTs during breastfeeding: update

Low risk DMTs during breastfeeding: conditional

Management of post-partum relapses whilst breastfeeding

Other recommendations

References

1. Tisovic K, Amezcua L. Women's health: contemporary management of MS in pregnancy and post-partum. Biomedicines. 2019; 7 pii: E32.
2. Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex PA. UK consensus on pregnancy in multiple sclerosis: 'Association of British Neurologists' guidelines. Pract Neurol 2019; 19:106-114.
3. Graham EL, Bove R, Costello K, et al. Practical considerations for managing pregnancy in patients with multiple sclerosis: dispelling the myths. Neurol Clin Pract 2024; 14:e200253.
4. Scolding N, Barnes D, Cader S, et al. Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis. Pract Neurol 2015; 15:273-279.
5. Hsu S, Balan A, Bove R. Topical review: Lactation and use of DMTs in women with MS. Mult Scler 2024; 30:1578-1591.
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Related checklists

• Pregnancy and multiple sclerosis (MS): pre-conception management
• Pregnancy and multiple sclerosis (MS): drug safety
• Pregnancy and multiple sclerosis (MS): relapse management