How soon after delivery should a new mother resume Avonex? If she chooses to breast feed and withholds treatment for several months, do the possibilities of exacerbations increase?
The decision on when to resume disease modifying therapy (DMT) after delivery should be taken on a case-by-case basis. Although there is evidence that exclusive breast feeding may be protective against MS disease activity, there appears to be an increased risk of relapse in the immediate post-partum period. The best indicator of risk is how active your disease was the year prior to becoming pregnant and during pregnancy. If a patient had a very active disease course leading up to pregnancy and/or an eventful MS course during pregnancy (this is less common), then it may be advisable to get back on DMT immediately while using formula for infant feeding.
A protocol we use to determine the likelihood of problems around the corner is to schedule an MRI of the brain with contrast at the 6 week mark after delivery. Because contrast is given, we err on the side of caution and have the mother "pump and dump" the breast milk for 24 hours after the scan. If there are signs of return of disease activity, I typically recommend returning to DMT at that point. Otherwise, we feel morre comfortable that exclusive breast feeding may be all that is needed during the post-partum period.
This should be discussed with your MS health provider to determine the best course of action for your particular form of MS. Hope this helps.
A. Scott Nielsen, MD
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