Women with MS at higher risk of having premature, smaller babies

Women with multiple sclerosis (MS) may have a higher risk of giving birth to premature or smaller babies, but it’s unclear if using MS medications during pregnancy has an effect on the baby’s health, according to a systematic review.

The long-term health outcomes of children whose mothers have MS have “received minor attention,” said researchers, who called for more studies.

“In this systematic review, we have highlighted the research gaps on the impact of maternal MS on offspring health,” the researchers wrote. “Future studies on long-term health consequences in the offspring of mothers with MS are important.” The review, “Maternal Multiple Sclerosis and Health Outcomes Among the Children: A Systematic Review,” was published in Clinical Epidemiology.

MS is a neurological condition marked by the immune system attacking parts of the brain and spinal cord. Symptoms vary depending on which parts are most affected, but often include problems with vision and movement, as well as numbness or tingling sensations.

The disease is about three times more common in women than men and many women are of childbearing age when they receive a diagnosis. Pregnancy can influence the course of MS, with data indicating it could be protective in the long term.

What’s less known is if and how the disease and the use of disease-modifying therapies (DMTs) during pregnancy can affect a child’s health, both at birth and over time, leading researchers in Denmark to search three large medical databases. Using the online software tool Covidence, 22 studies reporting on child outcomes were sorted into three groups.

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Ten studies looked at women with MS and how the disease affected their child’s health at birth or in the first month after birth. Nine studies included women with MS who took DMTs while pregnant and examined how this affected their child’s health at and after birth. Four studies looked at the long-term health outcomes of children whose mothers had MS. One study fit into more than one group.

In the first group, two studies showed women with MS had a higher risk of giving birth prematurely. Three studies also showed women with MS were up to 2.7 times more likely to give birth to babies who were small for their gestational age or had low birth weight.

There wasn’t enough evidence to say whether having MS during pregnancy more often resulted in a stillbirth or in a low Apgar score, a measure of how well a baby is doing outside the womb.

There also wasn’t enough evidence to know whether taking DMTs during pregnancy affected a baby’s health. No study showed an increased risk for preterm birth, congenital (birth) defects, or other adverse short-term birth outcomes in women who took MS medications during pregnancy.

“It is challenging to advise patients about the safety of medications with regard to exposed offspring when most studies on adverse consequences in the offspring only look at outcomes within the first year of life,” the researchers wrote.

The few studies on long-term health outcomes for children whose mothers had MS focused on topics such as mental health and education, but had mixed results. While some found no associations, others found nonsignificant trends toward an increased risk of cerebral palsy or of mental health conditions such as mood and anxiety disorders.

“There is still a large gap in the literature with regard to studies on long-term somatic health outcomes among children of women with MS,” the researchers wrote. “Future studies on long-term health consequences in the offspring of mothers with MS are important for these patients.”