Reciprocal Effects of Multiple Sclerosis, Childbirth, and Postpartum (original) (raw)
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The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background Pregnancy is a recent growing issue in multiple sclerosis (MS) and the update in the diagnostic criteria of MS and introduction of many disease-modifying therapies (DMTs) may cause changes in the relationship between MS, pregnancy, and breastfeeding. This study aimed to investigate the effect of pregnancy and breastfeeding on MS and vice versa. A retrospective observational study was conducted to include MS women with a history of at least one pregnancy during the last 7 years. Data were collected from the archived files in addition to a self-administrating questionnaire. The annualized relapsing rate (ARR) was calculated before, during, and after pregnancy. Results We included 116 successful pregnancies from 93 MS women with mean age 32.74 ± 5.12 years. Interferon-beta was the commonly used DMT during and after pregnancy. Despite the ARR during the two years preceding the conception was 0.36 (95% CI 0.32–0.41), this rate was significantly decreased during first, second, ...
Pregnancy and multiple sclerosis ?a 3-year prospective study
Journal of Neurology, 1994
A prospective study of the level of disability, severity and distribution of relapses in 15 women with multiple sclerosis prior to, during and up to 3 years following pregnancy was undertaken. The pregnant group was compared with 22 nulliparous women attending the same clinic and matched for age and severity and duration of disease. In the pregnant group, relapses were more frequent and severe than expected values during the first 6 months post partum, but were below expected values 6-24 months post partum. Over the total study period, therefore, there were no significant differences in relapse number, Expanded Disability Status Score or functional scores between the two groups. Babies born during the study showed normal distributions of weight and head circumference.
BMJ open
The Lebanese Multiple Sclerosis (LeMS) study aims to assess the influence of pregnancy and delivery on the clinical course of multiple sclerosis (MS) in Lebanese women. This prospective multicentre study took place in three MS referral university medical centres in Lebanon. Included were 29 women over 18 years who had been diagnosed with MS according to the McDonald criteria, and became pregnant between 1995 and 2015. Participating women should have stopped treatment 3 months before conception and become pregnant after the onset of MS. Women were followed up from 1 year preconceptionally and for 4 years postpartum. The annualised relapse rates per participant during each 3-month period during pregnancy and each year postpartum were compared with the relapse rate during the year before pregnancy using the paired two-tailed t test. p Values <0.05 were considered statistically significant for all analyses (95% CI). 64 full-term pregnancies were recorded. All pregnancies (100%) resul...
Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients
1993
The relationship between pregnancy and multiple sclerosis (MS) was assessed in a clinic-based, prospectively followed, population of 125 patients with a remittent onset of MS who had been followed for a mean (SD) of 10.3 (0.1) years. Thirty three women had a total of 49 pregnancies of which 32 had been full term and 17 terminated. There was a three-fold increase in the relapse rate per year during the first three months following delivery, compared with the baseline period of the same patients [1.62(0.38) vs 0.51(0.08) p = 0.05]. During pregnancy itself, the relapse-rate was not different from baseline. The overall relapse rate of the pregnancy group was lower than that of a control group without pregnancies after MS onset, but similar to that of patients who had children after MS onset, but no pregnancy during follow up. Pregnancy did not lead to increased disability. These results confirm that post partum increase in relapse rate is the main event related to pregnancy in MS and un...
Multiple sclerosis in pregnancy – current neurological considerations
Revista română de pediatrie, 2022
Multiple sclerosis (MS) is a neurological condition found in young women of reproductive age, and pregnancy can be a challenge. Lack of consensus on the conduct and impact of MS on pregnancy outcomes requires adequate counseling for these patients. Early initiation of treatment in MS to prevent long-term disability is extremely important because delaying treatment after the woman achieves irreversible complications may accompany reproductive goals. Aggression and disease progression requires an ideal schedule for conception. Initiation of treatment and successful pregnancy monitoring are clear goals of healthcare providers. Counseling of patients with MS before pregnancy, conduct during pregnancy, mode of delivery, and postpartum management, to which is added the choice of type of medication are important criteria that prevent complications secondary to the clinical course of this disease.
Gestational Outcomes of Patients with Multiple Sclerosis; A Tertiary Center Experience
South African Journal of Obstetrics and Gynaecology, 2019
Background. Multiple sclerosis (MS) is a disease that predominantly affects the young female population. It is important for an obstetrician to know the effects of pregnancy on MS, and vice versa. Objective. To demonstrate the impact of MS on pregnancy outcomes. Methods. We retrospectively evaluated demographic features, clinical characteristics, and obstetric outcomes of 47 pregnancies in 24 patients with MS, between January 2007 and December 2016. Results. Patients were divided into three groups: (i) 35 pregnancies in patients with MS who were in remission at the beginning of pregnancy; (ii) 10 pregnancies in patients with MS whose disease was exacerbated at the beginning of pregnancy; and (iii) 2 pregnancies in patients with active MS whose symptoms were relieved after becoming pregnant. The overall early pregnancy loss rate was 36.2%, whereas it was 60% and 31.4% in the exacerbation and remission groups, respectively; and the overall preterm delivery rate was 30%, while it was 29.1% and 50% in the remission and exacerbation groups, respectively. Conclusion. Miscarriage and preterm delivery seem to be significant obstetric complications in pregnant women with MS.
Pregnancy and multiple sclerosis: a 2-year experience
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1999
Objective: To present our experience with management of parturients with multiple sclerosis and to examine the role of intravenous immunoglobulin (IVIg) in the prevention of postpartum exacerbations of the disease. Methods: Fifteen patients with multiple sclerosis with a relapsing-remitting course were followed during pregnancy and 6 months postpartum. To prevent postpartum exacerbations, 14 of the patients had received IVIg after delivery. Results: None of the patients who received postpartum IVIg relapsed during the 6 months after delivery. None of the observed obstetric complications nor the operative deliveries could be related to the coexistence of multiple sclerosis. Conclusion: Postpartum IVIg treatment is beneficial in preventing acute childbirth-associated exacerbations in patients with relapsing-remitting multiple sclerosis. Furthermore, this disease does not seem to increase obstetric complications.
Multiple sclerosis in pregnancy: meeting the challenges
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Multiple sclerosis being a chronic, autoimmune inflammatory disease of central nervous system with its common and uncommon semiology has a predilection for women of child bearing age. The stressful period of pregnancy is further complicated with presence of multiple sclerosis. Overall multiple sclerosis has stabilising effect on pregnancy especially in its second and third trimester but adversely affects the post-partum period with increasing relapse rate. This is related with intense immune response triggered by marked changes in levels of circulating hormones. A better understanding of anti-natal, natal and post-partum effect of multiple sclerosis helps us to decide for institution or continuation of disease modifying drugs which are generally associated with favourable outcome.
The Rate of Hospitalization of Pregnant Women with Multiple Sclerosis in Poland
Journal of Clinical Medicine
Multiple sclerosis (MS) is most often diagnosed in women of childbearing age. Therefore, it is important to examine the impact of pregnancy on the course of MS and to enable patients to make decisions about motherhood based on reliable data. The main objective of this study was to assess the impact of pregnancy on the course of MS by comparing the frequency of MS-related hospitalizations during pregnancy and 40 weeks postpartum versus 40 weeks before pregnancy. We used administrative health claims to identify female patients with MS, their deliveries, and their MS-related hospital admissions and calculated the frequency of MS-related hospital admissions before, during, and after pregnancy. We observed that MS is diagnosed approximately three times less often during pregnancy than before or after pregnancy. The number of MS-related hospital admissions decreased during pregnancy, especially in the third trimester. In contrast with other studies, we did not observe an increased level o...