From the Department of Neurology (A.I.C., S.T., R.G., K.H.), St. Josef Hospital, Ruhr-University Bochum; Institute of Clinical Pharmacy and Pharmacotherapy (A.I.C.), Heinrich-Heine-University, Dusseldorf, Germany; Department of Neurology (A.L.-G.), Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles Medical Center; Department of Paediatrics (A.S.), St. Josef Hospital, Ruhr-University Bochum; and Centre of Paediatrics and Youth Medicine (A.Q.-W.), Johannes Gutenberg University of Mainz, Germany.
Neurol Neuroimmunol Neuroinflamm. 2020 May 20;7(4). doi: 10.1212/NXI.0000000000000757. Print 2020 Jul.
To determine whether potential breast milk exposure to interferon-beta (IFN-β) or glatiramer acetate (GA) is safe for the infant.
We identified 74 infants born to 69 women with MS who breastfed under IFN-β (n = 39), GA (n = 34), or both (n = 1). Women had been enrolled into the German Multiple Sclerosis and Pregnancy Registry during pregnancy. Data were obtained from standardized, telephone-administered questionnaires completed by the mother during pregnancy and at 1, 3, 6, and 12 months postpartum and the infant's take-home medical record.
The median duration of exposed breastfeeding was 8.5 months (wide interquartile range: 4.9-12.7 months). Physical growth curves during the first year of life were consistent with national, sex-specific growth curves. Median body measurements were consistent with national medians. Most children (n = 71, 96%) had normal motor and language development. Gross motor delay was reported in 3 children, of whom 1 remained delayed at last follow-up (3.9 years old) and 2 were normal by 0.9 and 4.1 years old. The proportion of children hospitalized at least once (girls n = 2, 7%, and boys n = 6, 14%) and the proportion of children with at least one episode of systemic antibiotic use during the first year of life (girls n = 7, 23%, and boys n = 8, 18%) are consistent with national averages.
Potential breast milk exposure to IFN-β or GA did not increase the risk of common adverse infant outcomes in the first year of life. Taken together with the benefits of breastfeeding and low biological plausibility of risk, women with MS who wish to resume IFN-β or GA postpartum can be encouraged to breastfeed.
确定婴儿潜在的母乳中摄入干扰素-β(IFN-β)或醋酸格拉替雷(GA)是否安全。
我们确定了 74 名出生于多发性硬化症(MS)女性的婴儿,这些女性在哺乳期内接受了 IFN-β(n=39)、GA(n=34)或两者(n=1)的治疗。这些女性在怀孕期间被纳入德国多发性硬化症和妊娠登记处。数据来自于母亲在怀孕期间和产后 1、3、6 和 12 个月通过标准化电话问卷调查以及婴儿的出院病历中获得。
暴露于母乳喂养的中位持续时间为 8.5 个月(广泛的四分位间距:4.9-12.7 个月)。婴儿在生命的第一年的身体生长曲线与国家特定性别的生长曲线一致。中位数身体测量值与国家中位数一致。大多数儿童(n=71,96%)的运动和语言发育正常。有 3 名儿童出现粗大运动发育迟缓,其中 1 名在最后一次随访(3.9 岁)时仍存在发育迟缓,另外 2 名在 0.9 和 4.1 岁时正常。至少住院一次的儿童比例(女孩 n=2,7%,男孩 n=6,14%)和在生命的第一年至少使用过一次全身抗生素的儿童比例(女孩 n=7,23%,男孩 n=8,18%)与全国平均水平一致。
婴儿潜在的母乳中摄入 IFN-β 或 GA 并没有增加生命第一年常见不良婴儿结局的风险。考虑到母乳喂养的益处和低风险的生物学可能性,希望在产后恢复 IFN-β 或 GA 的 MS 女性可以被鼓励进行母乳喂养。