哺餵母乳減少多發性硬化症的復發風險


  June 8, 2009 — 新發表的研究結果認為,罹患多發性硬化症(MS)的婦女可以藉由產後哺餵母乳來降低復發風險。主要作者、史丹佛大學的Annette Langer-Gould醫師在新聞稿中表示,我們的發現提出對於選擇不哺餵母乳或者停止哺餵母乳以恢復MS治療好處的質疑。
  
  這項研究發現線上發表於6月8日,且預計在8月版的神經學檔案期刊中刊登。首次發表於美國神經科學會第61屆年會,參與研究的作者們預期會令眾人大吃一驚。
  
  Langer-Gould醫師在4月的會議前向Medscape Neurology表示,這是有爭議性的。將近10年來,許多醫師鼓勵MS病患在產後儘快恢復服藥,許多婦女因此選擇不要哺餵母乳。
  
  這些新的結果則認為,哺餵母乳與暫停月經可以顯著降低產後MS復發的風險。
  
  研究者前溯追蹤32名有MS的孕婦以及29名年紀相仿的對照組。他們每三個月進行一次結構性訪談,以評估臨床病史、月經紀錄、母乳哺餵史,直到產後一年。研究者校正疾病嚴重度與年紀之測量的風險比。
  
  約有半數的MS婦女(52%)在產後兩個月內即未哺餵母乳或開始採用瓶餵。相較於那些全母奶哺餵至少兩個月的婦女,這些人比較多發生復發(校正風險比為7.1; 95% CI, 2.1 – 24.3; P = .002)。
  
  【根據哺乳狀態的產後復發】

哺餵母乳

復發 (%)

未使用或部份使用瓶餵

87

全母乳

36


  大部份的MS病患指出,放棄哺餵母乳的主要原因是要恢復用藥。但是全母乳哺餵的婦女比較慢恢復月經(P = .001),而這與降低產後復發風險有關(P = .01)。
  
  作者們認為,這些發現雖然有意義,但是應該以更大型的分析加以確認。我們的研究受限於樣本少,無法完全區別非全母乳對於產後復發以及產後MS治療的影響。
  
  他們指出,就我們所知,我們的研究是首次探究此問題的前溯式世代研究,彌補了隨機試驗無法陳述的相關知識。其他研究強度包括納入健康對照組、追蹤期長、嚴密的統計方法。
  
  Langer-Gould醫師等人結論表示,應該鼓勵MS婦女在產後全母乳哺餵至少兩個月,不要在產後立即開始免疫調節治療。
  
  研究者指出,這些發現強調需要對於產後及早MS治療進行嚴密的評估,特別是這些治療將導致無法哺乳時。
  
  他們也認為,需要對於產後MS進行持續的後續研究,特別是治療試驗,以分辨全母乳與非全母乳的差異,並納入分析。
  
  國家健康研究中心與Wadsworth基金會資助本研究。
  
  Arch Neurol.線上發表於2009年6月8日。
  

Breast-Feeding Reduces Risk for Multiple Sclerosis Relapses

By Allison Gandey
Medscape Medical News

June 8, 2009 — Study results are now published suggesting that women with multiple sclerosis (MS) may reduce their risk for relapses after pregnancy by breast-feeding. "Our findings call into question the benefit of choosing not to breast-feed or stopping breast-feeding early to start taking MS therapies," lead author Annette Langer-Gould, MD, from Stanford University, in California, said in a news release.

The findings are published online June 8 and are scheduled to appear in the August issue of the Archives of Neurology. First presented at the American Academy of Neurology 61st Annual Meeting, in Seattle, Washington, the authors anticipated that the study would raise some eyebrows.

This is controversial.

?

"This is controversial," Dr. Langer-Gould told Medscape Neurology before the April meeting. For nearly a decade, many physicians have encouraged MS patients to restart medication as quickly as possible after pregnancy, and many women have chosen not to breast-feed their babies for this reason.

These new results suggest breast-feeding and the suppression of menses significantly reduce the risk for postpartum relapses in MS.

The investigators prospectively followed 32 pregnant women with MS and 29 age-matched pregnant controls. They conducted structured interviews to assess clinical, menstrual, and breast-feeding history during each trimester and up to a year after the women gave birth. Investigators adjusted hazard ratios for measures of disease severity and age.

About half of the women with MS (52%) did not breast-feed or began regular supplemental bottle feedings within 2 months of giving birth. Most experienced a relapse compared with those who breast-fed exclusively for at least 2 months (adjusted hazard ratio, 7.1; 95% CI, 2.1 – 24.3; P = .002).

Postpartum Relapse Based on Breast-Feeding Status
Breast-Feeding Relapse (%)
None or some with supplemental bottle feedings 87
Exclusively 36

The majority of MS patients reported that the primary reason for foregoing breast-feeding was to resume medications. But women who breast-fed exclusively had a later return of menses (P = .001), and this was associated with a reduced risk for postpartum relapses (P = .01).

The authors suggest that these findings, although promising, should be confirmed in a larger analysis. "Our study is limited by the small sample as well as our inability to fully separate out the effects of postpartum MS treatment from nonexclusive breast-feeding on postpartum relapses."

"To our knowledge," they add, "our study is the first prospective cohort study to address this question and fills an important gap in knowledge that cannot be addressed in a randomized trial. Other strengths are the inclusion of healthy controls, the long duration of follow-up, and the rigorous statistical methods."

Dr. Langer-Gould and her team conclude that women with MS should be encouraged to breast-feed exclusively for at least the first 2 months postpartum instead of starting immunomodulatory agents shortly after delivery.

"These findings highlight the need to critically evaluate the efficacy of early postpartum treatments in MS, especially if they are not compatible with lactation," the researchers note.

They also suggest that ongoing and future studies of postpartum disease activity in MS — particularly treatment trials — should distinguish between exclusive and nonexclusive breast-feeding and account for it in their analyses.

This study was funded by the National Institutes of Health and the Wadsworth Foundation.

Arch Neurol. Published online June 8, 2009.

    
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