Clinical study data and 5 years of postmarketing experience sandra vukusic, patricia k coyle, stephanie jurgensen, philippe truffinet, myriam benamor, salman afsar, annie purvis, elizabeth m poole, and christina chambers. Multiple sclerosis ms is more common in women than men and is most. Pregnancyrelated issues in women with multiple sclerosis taylor. When should women discontinue their diseasemodifying therapies. Multiple sclerosis this sheet talks about multiple sclerosis during pregnancy and while breastfeeding. Thats because pregnancy naturally protects many women from new flareups, especially after the. The us fda has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of. Multiple sclerosis ms commonly occurs in women in childbearing years, 1 and although several diseasemodifying therapies dmts reduce ms relapses, 2 none are recommended in pregnancy or breastfeeding. Does having multiple sclerosis affect my fertility. The course of multiple sclerosis ms is influenced by sex, pregnancy and. Ms does not affect the ability to conceive, and does not seem to affect fertility. New guidelines for pregnancy care in multiple sclerosis, drawn up by a panel of uk experts, have been published this week. Depending on your specific symptoms, there are modifications, like specific. Management of multiple sclerosis during pregnancy and the reproductive years.
Pregnancy seems to be associated with clinical ms stability or improvement, while the postpartum period. The good news for couples is that women and men with multiple sclerosis ms can be effective, involved parents of healthy, happy children. Pregnancy and natalizumab multiple sclerosis research blog. Multiple sclerosis ms is a chronic, degenerative disease of the cns that is caused by an immunemediated inflammatory process. Endorsed by the american association of neuroscience nurses, the consortium of multiple sclerosis centers, and the international organization of multiple sclerosis nurses. In a large prospective study of 254 pregnant women with multiple sclerosis, the rate of relapse was 0. More than half of patients with ms develop the disease in their fertile period of. It is said that pregnancy does not alter or worsen the intensity of sclerosis rather it improves the condition of the mother in the third trimester. She developed severe disease rebound which responded poorly to steroids. Multiple sclerosis ms is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. Many women who have ms are diagnosed in their twenties and thirties, at a time when they may be thinking about starting a family. Although pregnancy is potentially protective against relapses of multiple sclerosis, severe rebound of disease activity after withdrawal of fingolimod may occur.
Pregnancy outcomes in patients with multiple sclerosis treated with teriflunomide. As the complexity and range of available diseasemodifying drugs increase, further data gathering via a ukwide ms pregnancy register is recommended. The etiology of multiple sclerosis, an autoimmune disease of the central nervous system, is still unknown, but some risk factors have been implicated in its pathogenesis, including an association of genetic susceptibility and environmental agents. Introduction multiple sclerosis ms is most commonly. Management of women with multiple sclerosis through pregnancy. In fact, the national multiple sclerosis society says that ms is more prevalent in women of childbearing age than in any other group. O b s t e t r i c a n a e s t h e s i a tutorial 359. Pregnancy registries for the ms diseasemodifying medications the manufacturers of the fdaapproved diseasemodifying medications establish pregnancy registries to monitor pregnancy outcomes in women who take one of these drugs within a week of becoming pregnant or while they are pregnant. Pregnancy and the use of diseasemodifying therapies in. Multiple sclerosis ms is a condition that causes nerve damage that interferes with how the brain. For most women, the disease course itself will not be affected by pregnancy or breastfeeding. The burden of multiple sclerosis ms in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female. Luciana parente costa seguro, sandra gofinet pasoto, in infection and autoimmunity second edition, 2015. Although the message prior to about 1950 was that women with ms shouldnt even consider having kids, the research since then has confirmed repeatedly that ms and motherhood can go together just.
Women are at least twice as likely as men to suffer from ms, with a mean age of onset of 30 years. Unfortunately there are no recognized and implemented guidelines. In romania, it is estimated that this disease has a prevalence of 3540 per 100,000 inhabitants. National multiple sclerosis society, pediatric ms, february 2019. The reasons for the increased postpartum activity are not entirely clear, but factors such as the abrupt decrease in oestrogen levels immediately after the delivery and the loss of the immunosuppressive state of pregnancy are. Retrospective studies strongly suggest that pregnancy is an example of a naturally occurring human condition that consistently and predictably affects the course of multiple sclerosis ms. New guidelines for pregnancy in multiple sclerosis ms trust. Multiple sclerosis ms is most commonly diagnosed in young women, many of whom will still wish to have children. Pregnancy is considered to be protective for multiple sclerosis ms but little is known about asian ms women. Pregnancy outcomes in patients with multiple sclerosis. The influence of pregnancy in multiple sclerosis has been a matter of controversy for a long time.
This sheet talks about multiple sclerosis during pregnancy and while breastfeeding. This damage disrupts the ability of parts of the nervous system to transmit signals, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Pdf management of multiple sclerosis during pregnancy and the. Our study aimed to investigate whether pregnancy affects the course of. Outcomes of pregnancy for women with ms are not substantially different than for other women. Multiple sclerosis knowledge for medical students and. Multiple sclerosis causes disability in young adults and, like most autoimmune diseases, affects women more commonly than men.
Management of women with multiple sclerosis through. Having ms shouldnt stop you from having a baby, but careful planning with family, friends and your doctor is important. March of dimes, multiple sclerosis and pregnancy, january 2014. Multiple sclerosis is a type of immune disease that affects the nervous system. Ema has recommended that the multiple sclerosis medicine gilenya fingolimod must not be used in pregnant women and in women able to have children who are not using effective contraception. Canadian multiple sclerosis pregnancy study canpregms. Pdf to examine the evidence guiding management of multiple sclerosis ms in reproductiveaged women. Dessa sadovnick, robert carruthers, maria houtchens, alice schabas, penelope smyth. This information should not take the place of medical care and advice from your healthcare provider. Pdf the objective of this study was to evaluate exposure to diseasemodifying therapies dmts during pregnancy in 335 pregnancies of.
Cleveland clinic mellen center for multiple sclerosis a. It doesnt keep you from getting pregnant or hurt your unborn baby. Women with ms have a normal fertility rate and no increase in fetal. Until a few decades ago, women were discouraged from having a baby, fearing that pregnancy would worsen the course of disease. It is good to know that proper care and essential precautions from the very beginning help in the conception and delivery of a healthy child.
Multiple sclerosis may make carrying a pregnancy more challenging in some women. Multiple sclerosis ms is a chronic neurological disease that manifests with clinical and subclinical attacks of central nervous system demyelination. You may get a break from your multiple sclerosis ms symptoms. Will multiple sclerosis ms make it hard to get pregnant. Pregnancy and multiple sclerosis pubmed central pmc. Multiple sclerosis ms is an autoimmune disorder that affects the central nervous system. Assessment of their clinical and radiographic impact. We report a woman with multiple sclerosis who discontinued fingolimod in the first month of her pregnancy. All forms of anesthesia are considered safe and well tolerated for women during labor and delivery. Multiple sclerosis ms is a chronic inflammatory, demyelinating disorder of the central nervous system that is characterised by neurological relapses and frequent progressive neurological dysfunction and disability. Multiple sclerosis is the most common neurological disease of young adults that causes major disability.
Multiple sclerosis ms is a condition that causes nerve damage that interferes with how the brain communicates with the rest of the. Bove r, alwan s, friedman jm, hellwig k, houtchens m, koren g, lu e, mcelrath tf, smyth p, tremlett h, sadovnick ad. Having multiple sclerosis ms does not seem to affect fertility in any significant way. The study showed a significant decline in the relapse rate during pregnancy, in. There is evidence that the clinical course of ms may be influenced by pregnancy. It is a disease that begins at the age of 2040 years and is 23 times more common in women than in men. The influence of pregnancy on the course of multiple sclerosis ms has long been a topic of considerable interest to patients and health care practitioners because ms strikes most often in women of childbearing age. Multiple sclerosis is two to three times more common in women 1, 2 than in men, with a. Relapsingremitting ms at the time of onset is the most common form and accounts for approximately 80% of all cases of ms 1. Association between breastfeeding and postpartum multiple. Ms is the most common acquired neurologic disorder of young adults, short of trauma, with at least 2.
The relapse rate of multiple sclerosis ms is typically reduced during late pregnancy but increases in the postpartum period. The pregnancy in multiple sclerosis prims study was the first large prospective study which aimed to assess the possible influence of pregnancy and delivery on the clinical course of multiple sclerosis. Fatigue is the most common symptom of ms, and pregnant ms women may experience greater fatigue women with ms who have preexisting problems walking or balance problems may find these symptoms worsen later in pregnancy as they gain baby weight and their center of gravity shifts. If you want to start a family, having multiple sclerosis ms doesnt have to stop you. There is no increase in significant fetal malformations or major growth abnormalities. It has been known for some time that ms disease activity markedly reduces during the last. Multiple sclerosis and pregnancy postgraduate medical. Labor and delivery are usually the same as in other women and no special management is needed. More than half of patients with ms develop the disease in their fertile. National institutes of health, national library of medicine, management of multiple sclerosis during pregnancy and the reproductive years. It is therefore important that family planning and pregnancy is proactively discussed, particularly when. To examine the evidence guiding management of multiple sclerosis ms in reproductiveaged women. Q what are the considerations and recommendations for pregnancy and breastfeeding in women with multiple sclerosis.
However, ms may cause symptoms that make sex challenging. The disease can therefore present at a time when many have, or are considering, starting a family. If a woman becomes pregnant while using gilenya, the medicine must be stopped and the pregnancy will have to be closely monitored. Moreover, pregnancy decreases the number of relapses, but flares increase in the first. This is a key topic in ms because the typical patient is a young woman of childbearing age. Family matters groupa community for everyone, including partners, parents, kids, brothers, sisters, grandparents and more the whole family, in whatever way you define it affected by multiple sclerosis. Symptoms during pregnancy may stay the same or get better. Women with ms usually need no special gynecologic care during pregnancy. The reasons for the increased postpartum activity are not entirely clear, but factors such as the abrupt decrease in oestrogen levels immediately after the delivery and the loss of the immunosuppressive state of pregnancy are likely of importance. Ms during pregnancy may result in a baby of smaller size or necessitate a csection. This process results in the demyelination of white matter in the brain and spinal cord. Guidelines recommend early use of diseasemodifying therapies dmts, which are contraindicated or recommended with considerable caution, during pregnancybreastfeeding. Pregnancy and multiple sclerosis jama neurology jama. Multiple sclerosis can be divided into four clinical subtypes.
Key content multiple sclerosis ms is a chronic neurological disease. Pregnancy is a major concern for many patients with multiple sclerosis ms bove et al. Multiple sclerosis and pregnancy kanagaraj 2019 the. Why should someone with multiple sclerosis ms enjoy. Multiple sclerosis or ms is a cns disease in which the immune system attacks the myelin sheath. Ms has a higher prevalence among women and people in temperate regions such as europe and north america. Women with ms have a normal fertility rate and no increase in fetal abnormalities or spontaneous miscarriage.