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Pregnancy and Family Planning Considerations in Multiple Sclerosis

  • Obstetrical and Gynecologic Care of the Patient with Neurologic Disease (DM Panelli, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To summarize data on pregnancy and multiple sclerosis (MS).

Recent Findings

MS is a chronic neurological illness that mostly affects young adults, particularly women. Family planning is an important issue with this population of patients and involves neurologists and gynecologists/obstetricians caring for them. Childbearing does not negatively influence the course of MS, but it is essential that women who want to conceive are aware of the need for disease control before pregnancy. At present, there are several therapeutic options to control MS, and not all of them are safe to be used by pregnant women. Registry databases are available with information on exposure to these MS drugs.

Summary

The “older,” self-injectable drugs to treat MS (interferon beta and glatiramer acetate) can be safely used by women that intend to conceive. The oral drugs, on the other hand, can cross the placental barrier and should be avoided when pregnancy is intended. There is a limited registry database for these oral drugs. Monoclonal antibodies are the most potent treatments for MS control and must be chosen with care for women intending to conceive. Careful planning regarding infusion schemes for different monoclonal antibodies will facilitate disease control and pregnancy in women with MS.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cotsapas C, Mitrovic M, Hafler D. Multiple sclerosis. Handb Clin Neurol. 2018;148:723–30. https://doi.org/10.1016/B978-0-444-64076-5.00046-6.

    Article  PubMed  Google Scholar 

  2. Howard J, Trevick S, Younger DS. Epidemiology of multiple sclerosis. Neurol Clin. 2016;34(4):919–39. https://doi.org/10.1016/j.ncl.2016.06.016.

    Article  PubMed  Google Scholar 

  3. Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, et al. The epidemiology of multiple sclerosis in Europe. Eur J Neurol. 2006;13(7):700–22. https://doi.org/10.1111/j.1468-1331.2006.01342.x.

    Article  CAS  PubMed  Google Scholar 

  4. Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis. N Engl J Med. 2018;378(2):169–80. https://doi.org/10.1056/NEJMra1401483.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lassmann H. Mechanisms of white matter damage in multiple sclerosis. Glia. 2014;62(11):1816–30. https://doi.org/10.1002/glia.22597.

    Article  PubMed  Google Scholar 

  6. Kutzelnigg A, Lassmann H. Pathology of multiple sclerosis and related inflammatory demyelinating diseases. Handb Clin Neurol. 2014;122:15–58. https://doi.org/10.1016/B978-0-444-52001-2.00002-9.

    Article  PubMed  Google Scholar 

  7. van Langelaar J, Rijvers L, Smolders J, van Luijn MM. B and T cells driving multiple sclerosis: identity, mechanisms and potential triggers. Front Immunol. 2020;11:760. https://doi.org/10.3389/fimmu.2020.00760.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fragoso YD, Adoni T, Brooks JBB, Finkelsztejn A, da Gama PD, Grzesiuk AK, et al. Practical evidence-based recommendations for patients with multiple sclerosis who want to have children. Neurol Ther. 2018;7(2):207–32. https://doi.org/10.1007/s40120-018-0110-3.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Portaccio E, Ghezzi A, Hakiki B, Martinelli V, Moiola L, Patti F, et al. Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs. J Neurol Neurosurg Psychiatry. 2014;85:845–50. https://doi.org/10.1136/jnnp-2013-306054.

    Article  PubMed  Google Scholar 

  10. Tincani A, Dall’Ara F, Lazzaroni MG, Reggia R, Andreoli L. Pregnancy in patients with autoimmune disease: a reality in 2016. Autoimmun Rev. 2016;15(10):975–7. https://doi.org/10.1016/j.autrev.2016.07.017.

    Article  CAS  PubMed  Google Scholar 

  11. Voskuhl R, Momtazee C. Pregnancy: effect on multiple sclerosis, treatment considerations, and breastfeeding. Neurotherapeutics. 2017;14(4):974–84. https://doi.org/10.1007/s13311-017-0562-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Langer-Gould AM. Pregnancy and family planning in multiple sclerosis. Continuum (Minneap Minn). 2019;25(3):773–92. https://doi.org/10.1212/CON.0000000000000745.

    Article  Google Scholar 

  13. Krysko KM, Bove R, Dobson R, Jokubaitis V, Hellwig K. Treatment of women with multiple sclerosis planning pregnancy. Curr Treat Options Neurol. 2021;23(4):11. https://doi.org/10.1007/s11940-021-00666-4.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Miller DH, Fazekas F, Montalban X, Reingold SC, Trojano M. Pregnancy, sex and hormonal factors in multiple sclerosis. Mult Scler. 2014;20:527–36. https://doi.org/10.1177/1352458513519840.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Brusaferri F, Candelise L. Steroids for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials. J Neurol. 2000;247(6):435–42. https://doi.org/10.1007/s004150070172.

    Article  CAS  PubMed  Google Scholar 

  16. Langer-Gould A, Smith JB, Albers KB, Xiang AH, Wu J, Kerezsi EH, et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology. 2020;94(18):e1939–49. https://doi.org/10.1212/WNL.0000000000009374.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Portaccio E, Amato MP. Breastfeeding and post-partum relapses in multiple sclerosis patients. Mult Scler. 2019;25(9):1211–6. https://doi.org/10.1177/1352458519830588.

    Article  PubMed  Google Scholar 

  18. Rosa GR, O’Brien AT, Nogueira EAG, Carvalho VM, Paz SC, Fragoso YD. There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis. Arq Neuropsiquiatr. 2018;76(6):361–6. https://doi.org/10.1590/0004-282X20180041.

    Article  PubMed  Google Scholar 

  19. Boz C, Terzi M, Zengin Karahan S, Sen S, Sarac Y, Emrah MM. Safety of IV pulse methylprednisolone therapy during breastfeeding in patients with multiple sclerosis. Mult Scler. 2018;24(9):1205–11. https://doi.org/10.1177/1352458517717806.

    Article  CAS  PubMed  Google Scholar 

  20. • Varytė G, Arlauskienė A, Ramašauskaitė D. Pregnancy and multiple sclerosis: an update. Curr Opin Obstet Gynecol. 2021;33(5):378–83. https://doi.org/10.1097/GCO.0000000000000731. This is a review on pregnancy and MS.

  21. •• Simone IL, Tortorella C, Ghirelli A. Influence of pregnancy in multiple sclerosis and impact of disease-modifying therapies. Front Neurol. 2021;12:697974. https://doi.org/10.3389/fneur.2021.697974. This paper provides a comprehensive review on the complexity of MS, pregnancy, and drugs.

  22. Dobson R, Hellwig K. Use of disease-modifying drugs during pregnancy and breastfeeding. Curr Opin Neurol. 2021;34(3):303–11. https://doi.org/10.1097/WCO.0000000000000922.

    Article  PubMed  Google Scholar 

  23. Freedman MS, Devonshire V, Duquette P, Giacomini PS, Giuliani F, Levin MC, Canadian MS Working Group, et al. Treatment optimization in multiple sclerosis: Canadian MS working group recommendations. Can J Neurol Sci. 2020;47(4):437–55. https://doi.org/10.1017/cjn.2020.66.

    Article  PubMed  Google Scholar 

  24. Pastò L, Portaccio E, Ghezzi A, Hakiki B, Giannini M, Razzolini L, MS Study Group of the Italian Neurological Society, et al. Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol. 2012;12:165. https://doi.org/10.1186/1471-2377-12-165.

    Article  PubMed  PubMed Central  Google Scholar 

  25. • Lourenço GA, Nogueira LAC, Rocco R, Fragoso YD, Alves-Leon SV. Multiple sclerosis does not affect the muscular strength of the pelvic floor during pregnancy a case control study. Mult Scler Relat Disord. 2021;49:102746. https://doi.org/10.1016/j.msard.2021.102746. Findings from this study show that women with MS maintain their strength in the pelvic floor throughout gestation.

  26. Soler B, Ciampi E, Uribe-San-Martín R, Keller K, Astudillo M, Charaf V, Reyes A, et al. Pregnancy outcomes in women with multiple sclerosis. Mult Scler Relat Disord. 2021;48: 102682. https://doi.org/10.1016/j.msard.2020.102682.

    Article  PubMed  Google Scholar 

  27. Bonavita S, Lavorgna L, Worton H, Russell S, Jack D. Family planning decision making in people with multiple sclerosis. Front Neurol. 2021;12: 620772. https://doi.org/10.3389/fneur.2021.620772.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Carlino M, Lanzillo R, Chiodi A, Vitelli R, Lavorgna L, Brescia Morra V, et al. Multiple sclerosis and maternity: a psychological explorative qualitative research. Qual Rep. 2020;25:1279–92.

    Google Scholar 

  29. Amato MP, Portaccio E. Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs. CNS Drugs. 2015;29(3):207–20. https://doi.org/10.1007/s40263-015-0238-y.

    Article  CAS  PubMed  Google Scholar 

  30. Pozzilli C, Pugliatti M, Paradig MSG. An overview of pregnancy-related issues in patients with multiple sclerosis. Eur J Neurol. 2015;22(Suppl. 2):34–9. https://doi.org/10.1111/ene.12797.

    Article  PubMed  Google Scholar 

  31. Achiron A, Ben-David A, Gurevich M, Magalashvili D, Menascu S, Dolev M, Israeli Multiple Sclerosis Pregnancy Study Group (IMSPSG), et al. Parity and disability progression in relapsing-remitting multiple sclerosis. J Neurol. 2020;267(12):3753–62. https://doi.org/10.1007/s00415-020-10093-1.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Post Graduate Program of Health and Environment, Universidade Metropolitana de Santos, Avenida Conselheiro Nebias 536, Santos, SP CEP, 11045-002, Brazil

    Yara Dadalti Fragoso, Luciana Prats Branco & Vitor Martinez de Carvalho

Authors
  1. Yara Dadalti Fragoso
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  2. Luciana Prats Branco
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  3. Vitor Martinez de Carvalho
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Contributions

Yara Dadalti Fragoso designed the study, reviewed the literature, and wrote the original draft and the final paper. Luciana Prats Branco reviewed the literature, read and approved the final version of the paper. Vitor Martinez de Carvalho reviewed the literature, read and approved the final version of the paper.

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Correspondence to Yara Dadalti Fragoso.

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Fragoso, Y.D., Branco, L.P. & de Carvalho, V.M. Pregnancy and Family Planning Considerations in Multiple Sclerosis. Curr Obstet Gynecol Rep 11, 90–94 (2022). https://doi.org/10.1007/s13669-022-00329-4

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