Multiple sclerosis, pregnancy, maternity, and breastfeeding

Authors: O. Zapletalová 1;  J. Krejsek 2
Authors‘ workplace: Neurologická klinika FN Ostrava a LF OU Ostrava 1;  Ústav klinické imunologie a alergologie, LF UK a FN Hradec Králové 2
Published in: Cesk Slov Neurol N 2019; 82(2): 161-165
Category: Review Article


Conception, pregnancy and delivery are recognized today as an immune phenomena. Both local and systemic immune responses in pregnant woman are downregulated during these physiological processes to tolerate the fetus as the fetus is displaying the characteristics of a semiallograft in the context of transplantation immunology. This tolerance and physiological development of the fetus is achieved by the complex changes of immune reactivity during pregnancy. These includethe switch from Th1 reactivity to Th2 reactivity. The number and activity of Treg T cells are increased. It is not surprising that physiological pregnancy in the majority of females suff ering from MS induces remission of the disease as abnormal infl ammation in MS patients is Th1 and Th17 T cell regulator subset driven together with a decrease in Treg T cells activity. The physiological delivery could be recognized as the physiological infl ammatory reactivity terminating pregnancy which is followed by the subsequent switch to the preconception immune reactivity frequently associated with the exacerbation of MS. The profound changes in individual immune reactivity are accompanied by substantial changes in hormonal regulation. Breastfeeding is irreplaceable for optimal and proper development of the baby in the early period after birth. Only breast milk contains the whole spectrum of substances supporting all functions of the infant. Clinical studies have shown that exclusive breastfeeding is benefi cial for both the baby and the mother. The hormonal changes during breast feeding are positively modulating the infl ammation in females with MS.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


pregnancy – breastfeeding – Multiple sclerosis – immunoreactivity


1. Garg N, Smith TW. An update on immunopathogenesis, dia gnosis, and treatment of multiple sclerosis. Brain Behav 2015; 5(9): e00362. doi: 10.1002/ brb3. 362.

2. Arias L. Hormonal and gender-related immune changes in multiple sclerosis. Acta Neurol Scand 2015; 132(199): 62–70. doi: 10.1111ane.12433.

3. Houtchens MK, Kaplan TB. Reproductive issues in MS. Semin Neurol 2017; 37(6): 632–642. doi: 10.1055/ s-0037- 1608925.

4. Krejsek J, Andrýs C, Krčmová I. Imunologie člověka. 1. vyd. Hradec Králové: Garamon 2016.

5. Moulton VR. Sex hormones in acquired immunity and autoimmune disease. Fron Immunol 2018; 9: 2279. doi: 10.3389/ fi mmu.2018.02279.

6. Voskuhl R, Momtazee C. Neurotherapeutics 2017; 14(4): 974–987. doi 10.1007/ s13311-017-0562-7.

7. Hellwig K. Pregnancy in multiple sclerosis. Eur Neurol 2014; 72 (Suppl 1): 39–42. doi: 10.1159/ 000367640.

8. Coyle PK. Management of women with multiple sclerosis through pregnancy and after childbirth. Ther Adv Neurol Disord 2016; 9(3): 198–210. doi: 10.1177/ 1756285616631897.

9. Holmoy T, Torkildsen O. Family planning, pregnancy and breastfeeding in multiple sclerosis. Tidsskr Nor Legeforen 2016; 136(20): 1726–1729. doi: 10.4045/ tidsskr.16.0563.

10. Hellwig K, Rockhoff M, Herbstritt S et al. Exclusive breastfeeding and the eff ect on postpartum multiple sclerosis relapses. JAMA Neurol 2015; 72(10): 1132–1138. doi: 10.1001/ jamaneurol.2015.1806.

11. Langer-Gould A, Smith JB, Hellwig K et al. Breastfeeding, ovulatory years, and risk of multiple sclerosis. Neurology 2017; 89(6): 563–569. doi: 10.1212/ WNL.00000 00000004207. 12. Gregg C, Shikar V, Larsen P et al. White matter plasticity and enhanced remyelination in the maternal CNS. J Neurosci 2007; 27(8): 1812–1823. doi: 10.1523/ JNEUROSCI. 4441-06.2007.

13. Shingo T, Gregg C, Enwere E et al. Pregnancy-stimulated neurogenesis in the adult female forebrain mediated by prolactin. Science 2003; 299(5603): 117–120. doi: 10.1126/ science.1076647.

14. De Giglio L, Marinelli F, Prosperini L et al. Relationship between prolactin plasma levels and white matter volume in women with multiple sclerosis. Mediators Infl amm 2015; 2015: 732539. doi: 10.1155/ 2015/ 732539.

15. Moshirzadeh S, Ghareghozli K, Harandi AA et al. Serum prolactin level in patients with relapsing-remitting multiple sclerosis during relapse. J Clin Neurosci 2012; 19(4): 622–623. doi: 10.1016/ j.jocn.2011.07.032.

16. Zhornitsky S, Yong VW, Weiss S et al. Prolactin in multiple sclerosis. Mult Scler 2013; 19(1): 15–23. doi: 10.1177/ 1352458512458555.

17. Costanza M, Pedotti R. Prolactin: friend or foe in cen - tral nervous system autoimmune infl ammation? Int J Mol Sci 2016; 17(12): pii: E2026. doi: 10.3390/ ijms17122026.

18. Langer-Gould A, Beaber BE. Eff ects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin Immunol 2013; 149(2): 244–250. doi: 10.1016/ j. clim.2013.01.008.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2019 Issue 2

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account