Multiple sclerosis and pregnancy from a gynecologist‘s perspective – as sisted reproduction options


Authors: P. Hanulíková 1,2;  T. Mardešić 3
Authors‘ workplace: Ústav pro péči o matku a dítě, Praha 1;  LF v Plzni, UK 2;  Sanatorium Pronatal, Praha 3
Published in: Cesk Slov Neurol N 2019; 82(2): 0
Category: Review Article
doi: 10.14735/amcsnn2019155

Overview

The incidence of MS is increasing, especial­ly in young women (20– 40 years). As incidence increases, experience in the management of pregnancies in these patients also accumulates. Dur­­ing pregnancy, the risk of relapse declines continuously especial­ly in the third trimester. After childbirth, disease activity after temporary increase (3 months) returns to pre-pregnancy levels at about 6 months. Use of dis­ease-modify­­ing ther­apy (DMT) in women with MS leads to clinical dis­ease stabilization, mak­­ing it ideal conditions for plan­ned conception. MS patients may use the majority of contraceptive methods while be­­ing under DMT. The course of MS is not influenced by pregnancy, and the care of pregnant women and neonatal outcomes are similar to that of women without MS. Due to the frequency of fertility disorders in the population, this is­sue also af­fects patients with MS, where dur­­ing the period of stabilization of the dis­ease the methods of as­sisted reproduction can be used.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

pregnancy – multiple sclerosis – childbirth – assisted reproduction


Sources

1. Meluzínová E. Těhotenství a roztroušená skleróza. Neurol praxi 2010; 11(5): 297– 299.
2. Sadovnick AD, Eisen K, Hashimoto SA et al. Pregnancy and multiple sclerosis. A prospective study. Arch Neurol 1994; 51(11): 1120– 1124. 
3. Rudick RA. Pregnancy and multiple sclerosis. Arch Neurol 1995; 52(9): 849– 850. 
4. Sweeney WJ. Pregnancy and multiple sclerosis. Am J Obstet Gynecol 1953; 66(1): 124– 130.
5. Vukusic S, Confarveux C. Pregnancy in multiple sclerosis: the children of PRIMS. Clin Neurol Neurosurg 2006; 108(3): 226– 270. doi: 10.1016/ j.clineuro.2005.11.016.
6. Patas K, Engler JB, Friese MA et al. Pregnancy and multiple sclerosis: feto-maternal im­mune cross talk and its implications for dis­ease activity. J Reprod Im­munol 2013; 97(1): 140– 146. doi: 10.1016/ j.jri.2012.10.005.
7. Piccin­ni MP. Role of T-cell cytokines in decidua and in cumulus oophorus dur­­ing pregnancy. Gynecol Obstet Invest 2007; 64(3): 144– 148. doi: 10.1159/ 000101738.
8. Vukusic S, Hutchinson M, Hours M et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 2004;127(Pt 6): 1353– 1360. doi: 10.1093/ brain/ awh152.
9. Coyle PK. Management of women with multiple sclerosis through pregnancy and after childbirth. Ther Adv Neurol Disord 2016; 9(3): 198– 210. doi: 10.1177/ 1756285616631897.
10. Finkelsztejn A, Brooks JB, Paschoal FM et al. What can we real­ly tell women with multiple sclerosis regard­­ing pregnancy? A systematic review and meta-analysis of the literature. BJOG 2011; 118(7): 790– 797. doi: 10.1111/ j.1471-0528.2011.02931.x.
11. Alwan S, Yee IM, Dybalski M et al. Reproductive decision mak­­ing after the dia­gnosis of multiple sclerosis (MS). Mult Scler 2013; 19(3): 351– 358. doi: 10.1177/ 1352458512452920.
12. Zuvich RL, McCauley JL, Pericak-Vance MA et al. Genetics and pathogenesis of multiple sclerosis. Sem Im­munol 2009; 21(6): 328– 333. doi: 10.1016/ j.smim.2009.08.003.
13. Ristori G, Can­noni S, Stazi MA et al. Multiple sclerosis in twins from continental Italy and Sardinia: a nationwide study. Ann Neurol 2006; 59(1): 27– 34. doi: 10.1002/ ana.20683.
14. Sadovnick AD, Macleod PM. The familial nature of multiple sclerosis: empiric recur­rence risks for first, second-, and third-degree relatives of patients. Neurology 1981; 31(8): 1039– 1041.
15. Curtis KM, Tepper NK, Jatlaoui TC et al. U.S. medical eligibility criteria for contraceptive use. MMWR Recomm Rep 2016; 65(3): 1– 103. doi: 10.15585/ m­mwr.r­r6503a1.
16. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization 2015.
17. Houtchens MK, Zapata LB, Curtis KM et al. Contraception for women with multiple sclerosis: Guidance for healthcare providers. Mult Scler 2017; 23(6): 757– 764. doi: 10.1177/ 1352458517701314.
18. Bove R, Alwan S, Friedman JM et al. Management of multiple sclerosis dur­­ing pregnancy and the reproductive years. A systematic review. Obstet Gynecol 2014; 124(6): 1157– 1168. doi: 10.1097/ AOG.0000000000000541.
19. Jalkanen A, Kauko T, Turpeinen U et al. Multiple sclerosis and vitamin D dur­­ing pregnancy and lactation. Acta Neurol Scand 2015; 131(1): 64– 67. doi: 10.1111/ ane.12306.
20. ACOG Com­mittee on Obstetric Practise. ACOG Com­mittee opinion no. 495: vitamin D: screen­­ing and supplementation dur­­ing pregnancy. Obstet Gynecol 2011; 118(1): 197– 198. doi: 10.1097/ AOG.0b013e318227f06b.
21. Meggiolaro A, Migliara G, La Tor­re G. As­sociation between Human Papil­loma Virus (HPV) vaccination and risk of multiple sclerosis: a systematic review. Hum Vaccin Im­munother 2018; 14(5): 1266– 1274. doi: 10.1080/ 21645515.2017.
22. Rolfes L, Lokhorst B, Samijn J et al. Cervical dysplasia as­sociated with the use of natalizumab. Neth J Med 2013; 71(9): 494– 495.
23. Unzeitig V, Měchurová A, Ľubušký M et al. Zásady dispenzární péče ve fyziologickém těhotenství –  doporučený postup. Čes Gynekol 2015; 80(6): 456– 458.
24. Kagan KO, Wright D, Valencia C et al. Screen­­ing for trisomies 21, 18 and 13 by maternal age, fetal nuchal translucency, fetal heart rate, free beta-hCG and pregnancy--as­sociated plasma protein-A. Hum Reprod 2008; 23(9): 1968– 1975. doi: 10.1093/ humrep/ den224.
25. Springer D, Jiskra J, Limanova Z et al. Thyroid in pregnancy: from physiology to screening. Crit Rev Clin Lab Sci 2017; 54(2): 102– 116. doi: 10.1080/ 10408363.2016.1269309.
26. Sloka JS, Phil­lips PW, Stefanel­li M et al. Co-occur­rence of autoim­mune thyroid dis­ease in a multiple sclerosis cohort. J Autoim­mune Dis 2005; 2: 9. doi: 10.1186/ 1740-2557-2-9.
27. Límanová Z. Optimální léčba onemocnění štítné žlázy v graviditě. Farmakoter Revue 2017; 2: 231– 235.
28. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid As­sociation for the dia­gnosis and management of thyroid dis­ease dur­­ing pregnancy and postpartum. Thyroid 2011; 21(10): 1081– 1125. doi: 10.1089/ thy.2011.0087.
29. Horáček J, Jiskra J, Límanová Z et al. Doporučení pro dia­gnostiku a léčbu onemocnění štítné žlázy v těhotenství a pro ženy s poruchou fertility. Vnitr Lek 2013; 59(10): 909– 931.
30. Ľubušký M, Krofta L, Vlk R. Pravidelná ultrazvu­ková vyšetření v průběhu prenatální péče –  doporučený postup. Čes Gynek 2013; 78(2): 134– 135.
31. Kel­ly VM, Nelson LM, Chakravarty EF. Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology 2009; 73(22): 1831– 1836. doi: 10.1212/  WNL.0b013e3181c3f27d.
32. Lu E, Zhu F, van der Kop M et al. Labor induction and augmentation in women with multiple sclerosis. Mult Scler 2013; 19(9): 1182– 1189. doi: 10.1177/ 1352458512474090.
 33. Lu E, Zhao Y, Zhu F et al. Birth hospitalization in mothers with multiple sclerosis and their newborns. Neurology 2013; 80(5): 447– 452. doi: 10.1212/ WNL.0b013e31827f0efc.
34. Dahl J, Myhr KM, Daltveit AK et al. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology 2005; 65(12): 1961– 1963. doi: 10.1212/ 01.wnl.0000188898.02018.95.
35. Dahl J, Myhr KM, Daltveit AK et al. Plan­ned vaginal births in women with multiple sclerosis: delivery and birth outcome. Acta Neurol Scand Suppl 2006; 183: 51– 54. doi: 10.1111/ j.1600-0404.2006.00616.x.
36. Chen YH, Lin HL, Lin HC. Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study. Mult Scler 2009; 15(5): 606– 612. doi: 10.1177/ 1352458508101937.
37. van der Kop ML, Pearce MS, Dahlgren L et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol 2011; 70(1): 41– 50. doi: 10.1002/ ana.22483.
38. Dalmas AF, Texier C, Ducloy-Bouthors AS et al. Obstetrical analgesia and anaesthesia in multiple sclerosis. Ann Fr Anesth Reanim 2003; 22(10): 861– 864.
39. Bader AM, Hunt CO, Datta S et al. Anesthesia for the obstetric patient with multiple sclerosis. J Clin Anesth 1988; 1(1): 21– 24.
40. Caval­la P, Rovei V, Masera S et al. Fertility in patiens with multiple sclerosis: cur­rent knowledge and future perspectives. Neurol Sci 2006; 27(4): 231– 239. doi: 10.1007/ s10072-006-0676-x.
41. Laplaud DA, Lefrere F, Leray E et al. Increased risk of relapse in multiple sclerosis patients after ovarian stimulation for IVF. Gynecol Obstet Fertil 2007; 35(10): 1047– 1050. doi: 10.1016/ j.gyobfe.2007.07.033.
42. Hel­lwig K, Schimrigk S, Beste C et al. Increase in relace rate dur­­ing as­sisted reproduction technice in patiens with multiple sclerosis. Eur Neurol 2009; 61(2): 65– 68. doi: 10.1159/ 000177937.
43. Cor­reale J, Farez MF, Ysr­raelit MC. Increase in multiple sclerosis activity after as­sisted reproduction technology. Ann Neurol 2012; 72(5): 682– 694. doi: 10.1002/ ana.23745.
44. Michel L, Foucher Y, Vukusic S et al.: Increased risk of multiple sclerosis relapse after IVF. J Neurol Neurosurg Psychiatry 2012; 83(8): 796– 802. doi: 10.1136/ jn­np-2012-302235.

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Paediatric neurology Neurosurgery Neurology

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