Pregnancy-Associated Issues in Multiple Sclerosis Patients Highlighted in New Review

A study recently published in the European Journal of Neurology reviewed some of the issues associated with pregnancy in multiple sclerosis (MS) patients. The study is entitled “An overview of pregnancy-related issues in patients with multiple sclerosis” and was developed by researchers at Sapienza University of Rome and University of Ferrara in Italy.

MS is a chronic, progressive neurodegenerative disorder that results from an attack on the central nervous system (brain, spinal cord and optical nerves) by the body’s own immune system, resulting in motor function impairment, irreversible neurological disability and paralysis.

Pregnancy is usually not considered a high risk condition in women with MS, although it poses some therapeutic challenges. According to the authors, the timing of treatment is the primary topic debated within the subject of pregnancy in MS patients.

Studies have shown that the disease relapse rate in pregnant patients is reduced, especially in the third trimester; however, the relapse rate often increases considerably in the first few months after the baby’s birth, usually returning to the rate reported in the pre-pregnancy year.

The protective effect that pregnancy seems to have in MS patients in terms of relapse rate and disease activity is not completely understood. The most accepted hypothesis is that, during pregnancy, estrogen and other sex hormones promote immunological changes that lead to a predominant anti-inflammatory state, whereas a pro-inflammatory state is then triggered in the postpartum period.

The overall effect of pregnancy on women with MS is still not clear. Long-term studies up to 10 years have suggested that pregnancy appears to have no impact on long-term disease course or disability progression, nor on the pregnancy course or fetal outcomes. Other studies have, however, indicated that pregnancy seems to have a benign impact on MS.

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Disease-modifying therapies (DMTs) taken by MS patients can have potential adverse effects on pregnancy outcomes and fertility, although these effects can vary depending on each therapy. In general, patients are advised to discontinue DMTs prior to conception. However, some clinicians support the continuous use of therapies like interferon-beta and glatiramer acetate during pregnancy in order to reduce the relapse risk in patients with severe or highly active disease. After delivery, the re-initiation of DMT therapy is also controversial. Evidence suggests that DMTs use during breastfeeding should be avoided, while other studies suggest that due to the increased relapse risk in the immediate postpartum period, DMT therapy should be immediately re-initiated.

The authors emphasize that the apparent lack of a negative impact on long-term MS disease course and disability, as well as on pregnancy course and fetal outcomes, is a relevant fact that should be clearly communicated to women with MS. Concerning the use of DMTs, the authors believe that the clinical decision should be discussed between the patient and the physician, and tailored to each individual case.