Pregnancy, DMTs, and MS: A New Study
Many years ago a woman I know who has multiple sclerosis (MS) became pregnant. After her child was born her MS became significantly worse.
There have been many studies on the impact of pregnancy on someone with MS, with most concluding that the number of MS relapses are reduced during pregnancy but tend to increase immediately following birth, particularly in the first three months.
There are other alternative opinions; I found one on the Johns Hopkins Medicine website. It advises that: “Fortunately, pregnancy does not appear to speed up the course or worsen the effects of MS.” I’m not so sure that’s correct.
Factors affecting MS and pregnancy
A recent study looks at what may affect the course of MS for a woman who becomes pregnant. The study, by a group of Austrian researchers, followed 239 women with relapsing-remitting MS (RRMS) through 387 pregnancies. It compared their relapse rates and their Expanded Disability Status Scale (EDSS) scores before, during, and after pregnancy. The study concluded that four factors can affect the risk of a relapse and disability progression after a woman conceives: Her relapse activity before conception, her EDSS score at conception, use of a highly effective disease-modifying therapy (H-DMT) before conception, and length of the DMT washout period. In addition, two factors had an impact on relapses and progression after the birth: Relapse activity before and during the pregnancy and the use of a H-DMT pre-conception. In this case the DMT was Tysabri (natalizumab). Importantly, researchers found that an early restart of the DMT reduced the risk of postpartum relapse.Recommendations
Based upon their research, the Austrian investigators believe that a one-size-fits-all approach isn’t appropriate when dealing with MS and pregnancy. Rather, they recommend: “A personalized approach in planning pregnancy in women with MS while on H-DMT needs to be adopted. It seems reasonable maintaining natalizumab closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during early pregnancy and after delivery.” Currently, there is limited guidance on how long of a washout of a DMT is necessary before conception and how soon after delivery a DMT can be resumed safely. So, a woman’s neurologist, hopefully in consultation with her obstetrician, should be her guide in this situation. I think it also couldn’t hurt to get more than one opinion, but be prepared for them to be different. Let’s also advocate for more studies of the MS-pregnancy equation, to help determine what will create the best outcome for both mother and child. You’re invited to follow my personal blog at www.themswire.com.***
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Greg tully
Great help I feel I have more energy sleep better. My joints are not sore I find overall I feel better also I get asked for my bottle when I have finished my months allowance
Ed Tobias
Greg,
Is your comment intended to respond to my column about pregnancy and MS? I suspect you were responding to a different post.
Ed
Sarah
Why are they not looking into the fact that some MS relapse triggers could be hormonal?
Hence why more women than men get MS?
Zuzana Ifrim
Sarah....this is just what I am saying too!
Shammalammadingdong
Until these studies start to take into account lifestyle factors, especially diet, a large amount of variability will he unaccounted for
ita Sara
I had 5 children born between 1976 and 1985. Had no clue my younger daughter would be dx'd with MS at age 20 and myself in 2005 at age 57. I had no clues til then. I did have ms hugs but neither myself nor my internist new what they were and thought it was a muscle contraction. My daughter had TM and then ON and then I had TM my first symptoms which I knew right away what it was and that lead to my own dx of MS. My lesions then and now were inactive. My daughter as well is doing well and her doc. took her off MS meds. I too have not progressed. So in my case was it the pregnancies? Was it being on HRT (and still am) that was a factor? Or is it that MS has different entities that do not get worse? So much more to learn when it affects people so differently. Was there a final decision on the estriol study as to whether that + Copaxone was helpful in MS?