Clinical and obstetric characteristics in women with multiple sclerosis during pregnancy
Main Article Content
Keywords
Multiple Sclerosis, Pregnancy Complications, Pregnancy Rate, Drug Therapy
Abstract
Background: Multiple sclerosis (MS) is an inflammatory demyelinating disease that affects the central nervous system. It is the second leading cause of disability in young adults, with a higher prevalence in women, and 70% to 75% of these women are of reproductive age.
Objective: To identify the clinical characteristics of pregnant patients with multiple sclerosis.
Material and methods: Retrospective cohort. Medical records from the Neurology Department of the Specialty Hospital, CMNO of the Mexican Social Security Institute were reviewed from January 2001 to December 2022. Women diagnosed with MS who had previously been pregnant were identified.
Results: Twenty-two patients who had been pregnant after their MS diagnosis were recruited. The age at diagnosis was 25.50 ± 6.7 years, and the age at pregnancy was 31.94 ± 5.54 years. No significant changes (p = 0.636) were observed on the Expanded Disability Status Scale (EDSS) during pregnancy. The most used medication was glatiramer acetate. 77.8% of patients did not experience disease relapses during pregnancy.
Conclusions: Pregnant women with multiple sclerosis treated at the National Western Medical Center showed clinical stability according to the EDSS before, during, and after pregnancy (p = 0.636). Most patients did not experience disease relapses during pregnancy, nor did they report complications during the immediate postpartum period.
References
1. McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and Treatment of Multiple Sclerosis: A Review. JAMA. 2021;325(8):765-779. Disponible en: https://doi.org/10.1016/j.neurop.2021.07.001.
2. Zhang WT, Zhang GX, Zhao RZ, et al. Eating habits of patients with multiple sclerosis in three different countries: China, Spain and Cuba. Neurology Perspectives. 2021;1(3): 170-177. Disponible en: https://doi.org/10.1016/j.neurop.2021.07.001.
3. Bonnan M, Debeugny S, Mejdoubi M, et al. Predictive value of conventional MRI parameters in first spinal attacks of neuromyelitis optica spectrum disorder. Mult Scler. 2020;26(4):468-475. doi: 10.1177/1352458519834857.
4. Coyle K. Patricia, MD, FAAN. Multiple Sclerosis in Pregnancy. Continuum (Minneap Minn). 2014;20(1):42-59.
5. Moldenhauer LM, Hull ML, Foyle KL, et. al. Immune-Metabolic Interactions and T Cell Tolerance in Pregnancy. J Immunol. 2022;209(8):1426-1436. doi: 10.4049/jimmunol.2200362.
6. Zenere A, Hellberg S, Papapavlou Lingehed G, et al. Prominent epigenetic and transcriptomic changes in CD4+ and CD8+ T cells during and after pregnancy in women with multiple sclerosis and controls. J Neuroinflammation. 2023;20(1):98. doi: 10.1186/s12974-023-02781-2.
7. Hellwig K, Verdun di Cantogno E, y Sabidó M. A systematic review of relapse rates during pregnancy and postpartum in patients with relapsing multiple sclerosis. Therapeutic advances in neurological disorders. 2021;14:17562864211051012. doi: 10.1177/17562864211051012.
8. Søndergaard HB, Airas L, Christensen JR, et al. Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis. Front Immunol. 2021;11:552101. doi: 10.3389/fimmu.2020.552101.
9. Langer-Gould A, Smith JB, Albers KB, et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology. 2020;94(18):e1939-e1949. Disponible en: https://doi.org/10.1212/ WNL.0000000000009374
10. Hellwig K. Pregnancy in multiple sclerosis. Eur Neurol. 2014;72(1):39-42. doi: 10.1159/000367640.
11. Saito S, Ikeguchi R, Kitagawa K, et al. Clinical Experience with Dimethyl Fumarate and Natalizumab in Pregnant Women with Multiple Sclerosis: A Four-Patient Case Series. Case Rep Neurol Med. 2024;2024:7808140. doi: 10.1155/2024/7808140.
12. Varytė G, Arlauskienė A, Ramašauskaitė D. Pregnancy and multiple sclerosis: an update. Curr Opin Obstet Gynecol. 2021;33(5):378-383. doi: 10.1097/GCO.0000000000000731.
13. Alroughani R, Inshasi J, Al-Asmi A, et al. Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. Neurol Ther. 2020;9(2):265-280. doi: 10.1007/s40120-020-00201-8.
14. Demortiere S, Maarouf A, Rico A, et al. Disease Evolution in Women With Highly Active MS Who Suspended Natalizumab During Pregnancy vs Rituximab/Ocrelizumab Before Conception. Neurol Neuroimmunol Neuroinflamm. 2023;10(5):e200161. doi: 10.1212/NXI.0000000000200161.
15. Moradinazar M, Najafi F, Nazar ZM, et al. Lifetime Prevalence of Abortion and Risk Factors in Women: Evidence from a Cohort Study. J Pregnancy. 2020;27(2020):4871494. doi: 10.1155/2020/4871494.
16. Lamaita R, Melo C, Laranjeira C, et al. Multiple Sclerosis in Pregnancy and its Role in Female Fertility: A Systematic Review. JBRA Assist Reprod. 2021;25(3):493-499. doi: 10.5935/1518-0557.20210022.
17. Moberg JY, Laursen B, Thygesen LC, et al. Reproductive history of the Danish multiple sclerosis population: A register-based study. Mult Scler. 2020;26(8):902-911. doi: 10.1177/1352458519851245.
18. Houtchens MK, Edwards NC, Hayward B, et al. Live birth rates, infertility diagnosis, and infertility treatment in women with and without multiple sclerosis: Data from an administrative claims database. Mult Scler Relat Disord. 2020;46:102541. doi: 10.1016/j.msard.2020.102541.
19. Hellwig K, Geissbuehler Y, Sabidó M, et al. European Interferon-beta Pregnancy Study Group. Pregnancy outcomes in interferon-beta-exposed patients with multiple sclerosis: results from the European Interferon-beta Pregnancy Registry. J Neurol. 2020;267(6):1715-1723. doi: 10.1007/s00415-020-09762-y.
20. Cuello JP, Martínez-Ginés ML, Tejeda-Velarde A, et al. Cytokine profile during pregnancy predicts relapses during pregnancy and postpartum in multiple sclerosis. J Neurol Sci. 2020;414:116811. doi: 10.1016/j.jns.2020.116811
21. Koetzier SC, Neuteboom RF, Wierenga-Wolf AF, et al. Effector T Helper Cells Are Selectively Controlled During Pregnancy and Related to a Postpartum Relapse in Multiple Sclerosis. Front Immunol. 2021;12:642038. doi: 10.3389/fimmu.2021.642038.
22. Deems NP, Leuner B. Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease. Front Neuroendocrinol. 2020;57:100820. doi: 10.1016/j.yfrne.2020.100820.
23. Lopez-Leon S, Geissbühler Y, Sabidó M, et al. A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project. J Neurol. 2020;267(9):2721-2731. doi: 10.1007/s00415-020-09913-1.
24. Mikkelsen AP, Egerup P, Kolte AM, et al. Pregnancy loss and risk of multiple sclerosis and autoimmune neurological disorder: A nationwide cohort study. PLoS One. 2022;17(3):e0266203. doi: 10.1371/journal.pone.0266203.
25. Langer-Gould A, Smith JB, Albers KB, et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology. 2020;94(18):e1939-e1949. doi: 10.1212/WNL.0000000000009374.
26. Dobson R, Mowry EM. Breastfeeding may reduce postpartum relapse in some women with multiple sclerosis. Neurology. 2020;94(18):769-770. doi: 10.1212/WNL.0000000000009369.
27. Ghiasian M, Nouri M, Moghadasi AN, et al. Effect of pregnancy and exclusive breastfeeding on multiple sclerosis relapse rate and degree of disability within two years after delivery. Clin Neurol Neurosurg. 2020;194:105829. doi: 10.1016/j.clineuro.2020.105829.
28. Celius EG. Breastfeeding and treatment of multiple sclerosis. Mult Scler. 2021;27(5):801-802. doi: 10.1177/1352458520931786
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