by Anne Eglash MD, IBCLC, FABM
Does breastfeeding protect from the onset of pediatric multiple sclerosis (MS)? There is evidence that individuals who were breastfed as children may have a lower risk of MS in adulthood, but the effect of breastfeeding on adult-onset MS has been hard to measure, mainly because of poor recall of breastfeeding specifics as a child.
A group of researchers decided to study the relationship between breastfeeding and childhood-onset of MS, since breastfeeding recall may be more accurate. They evaluated 36 children with a diagnosis of MS, and compared their breastfeeding rates, along with several environmental and other demographic factors, with 72 children with a diagnosis of migraine headaches, all of whom were known to have normal brain MRIs. The 2 groups had very similar childhood demographics, including a non-significant difference in family history rates of autoimmune disease.
Breastfeeding was defined as breastfeeding for at least 1 week.
What do you think they found regarding the relationship between breastfeeding and risk of childhood-onset MS? Choose 1 or more:
- 36% of children with MS were breastfed, vs 71% of the control group with migraines.
- The average duration of breastfeeding was significantly shorter for the children with MS as compared with the average duration of breastfeeding in the control (migraine) group.
- When obese children were excluded from both groups, there was no different in breastfeeding rates.
- Non-breastfed children were 4.43 times more likely to develop pediatric-onset MS compared to breastfed children.
See the Answer
Answers: A, B, D - C is incorrect
Breastfeeding During Infancy Is Associated With a Lower Future Risk of Pediatric Multiple Sclerosis.
Brenton JN, Engel CE, Sohn MW, Goldman MD.
Pediatr Neurol. 2017 Sep 14. pii: S0887-8994(17)30719-1. doi: 10.1016/j.pediatrneurol.2017.09.007.
Risk of multiple sclerosis (MS) is influenced by environment and genetics. Infant breastfeeding appears protective against some childhood autoimmune disorders, but its impact on risk of MS in childhood is unknown. The objective of this study is to analyze the association of breastfeeding in infancy on future risk of pediatric-onset MS.
Biological mothers of 36 consecutive pediatric-onset MS patients completed a questionnaire on history of breastfeeding and various birth and demographic factors. The control group consisted of 72 otherwise healthy patients with a diagnosis of migraine and normal brain magnetic resonance imaging obtained less than 12 months before enrollment. Inverse probability of treatment weighting was used to reduce selection bias and balance the covariates between breastfed and non-breastfed children.
Demographics (with the exception of body mass index) and birth factors were not significantly different between groups. Whereas 36% of cases were breastfed, 71% of controls were breastfed (P = 0.001). The median duration of breastfeeding was 0 weeks (range: 0 to 40 weeks) for cases and 16 weeks (range: 0 to 216 weeks) for controls. Lack of infant breastfeeding was associated with future diagnosis of pediatric-onset MS (odds ratio = 4.43; 95% confidence interval, 1.68 to 11.71; P = 0.003). This association remained significant after correcting for covariates, such as body mass index and age at diagnosis.
These data demonstrate that absence of infant breastfeeding has an association with an increased risk of pediatric-onset MS diagnosis.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Usually I avoid using a small study for the Clinical Question of the Week, but this study was well-controlled. In addition, we already know that children who are not breastfed have an increased risk of autoimmune disease, such as inflammatory bowel disease and type 1 diabetes. So, if that is the case, we should see lower rates of other autoimmune illnesses in breastfed children, such as MS, and this is what the researchers found.
Infants who receive breastmilk have a different balance of gut bacteria as compared to artificially fed infants, and the difference in the gut microbiome, along with the presence of various immune modulating factors in breastmilk, are likely responsible for reducing the risk of autoimmune diseases, particularly in children who have genetic markers or environmental risk factors for these diseases. Interestingly, obese children have a higher risk of multiple sclerosis, but when obese children were excluded from this study, there were still significantly lower rates of MS among breastfed infants.
Breastfeeding also appears to play a role in reducing the severity of multiple sclerosis symptoms among women with MS, while they are breastfeeding postpartum.