Pregnancy and Multiple Sclerosis Publisher



Airas L¹ ; Etemadifar M^{2, 3} ; Maghzi AH^{2, 4, 5}
Source: Neurological Disorders and Pregnancy Published:2011

Abstract

Multiple sclerosis (MS) is the most common debilitating disease of the central nervous system (CNS) of young adults, with a prevalence of approximately 1 per 1000 in the Western world. This chapter reviews how pregnancy affects the disease activity; pregnancy outcome among MS mothers; treatment of MS mothers during pregnancy and lactation; and immunologic basis of pregnancy-induced disease remission. Pregnancy typically is a stabilizing period in the clinical course of MS. During the third trimester, relapse rate can be 70% lower than the time before pregnancy, but aggravation of the disease commonly is observed after delivery. Based on studies it is has been found that mothers with MS needed operative delivery more often than healthy mothers, which might be due to MS-related symptoms such as neuromuscular perineal weakness and spasticity, in addition to fatigue and exhaustion. In a recent retrospective study in Spain, 38.6% of MS mothers on interferon-beta therapy did not discontinue the treatment until the first trimester of pregnancy. Hence, a significant proportion of MS mothers may be exposed to disease-modifying therapies (DMTs) during pregnancy. Taken together, the information on pregnancy outcomes for babies exposed to DMTs is increasing, but the study samples are still small. Thus, the safety of these medications has not been established fully and discontinuation of DMTs before pregnancy must still be recommended. © 2011 Elsevier Inc. All rights reserved.