Skip to main content
SpringerLink
Log in
Book cover

Health Issues in Women with Multiple Sclerosis pp 19–34Cite as

Pregnancy Considerations and Pregnancy Outcomes in Women with MS

  • Chapter
  • First Online:

  • 601 Accesses

Abstract

Women at childbearing age more often present with relapsing–remitting MS. This phenotype is associated with longer times to disability landmarks compared to primary progressive MS. When planning a family, women with MS need information about conception, pregnancy, postpartum, breastfeeding, and long-term outcomes.

Although the reduced relapse risk during pregnancy is followed by a threefold increase in the 3-month postpartum period, the majority of women do not suffer such relapses. Exclusive breastfeeding has been associated with a reduction of disease activity. Increased social support during the postpartum period may help mothers with MS by minimizing the impact of MS-related symptoms.

The disease itself is not associated with an increased risk to the fetus. There is some evidence to suggest that childbirth could lessen the risk of developing MS and ameliorate the course of MS in terms of relapse rates and progression to irreversible disability. As it is virtually impossible to fully control for the heterogeneity of disease activity in MS, reverse causality cannot be ruled out.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Alonso A, Hernan MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology. 2008;71(2):129–35. Epub 2008/07/09.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Prunty M, Sharpe L, Butow P, Fulcher G. The motherhood choice: themes arising in the decision-making process for women with multiple sclerosis. Mult Scler. 2008;14(5):701–4. Epub 2008/06/21.

    Article  CAS  PubMed  Google Scholar 

  3. Daumer M, Weinshenker BG, Voskuhl R. Pregnancy: a “modifiable” risk factor in MS? Neurology. 2012;78(12):846–8. Epub 2012/03/10.

    Article  PubMed  Google Scholar 

  4. Hutchinson M. One can prevent post-partum MS relapses by exclusive breast feeding: commentary. Mult Scler. 2013;19(12):1569–70. Epub 2013/10/18.

    Article  PubMed  Google Scholar 

  5. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339(5):285–91. Epub 1998/07/31.

    Article  CAS  PubMed  Google Scholar 

  6. Brownlee WJ, Swanton JK, Altmann DR, Ciccarelli O, Miller DH. Earlier and more frequent diagnosis of multiple sclerosis using the McDonald criteria. J Neurol Neurosurg Psychiatry. 2015;86(5):584–5. Epub 2014/11/22.

    Article  PubMed  Google Scholar 

  7. Edan G, Kappos L, Montalban X, Polman CH, Freedman MS, Hartung HP, et al. Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT. J Neurol Neurosurg Psychiatry. 2014;85(11):1183–9. Epub 2013/11/13.

    Article  PubMed  Google Scholar 

  8. Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L. Axonal transection in the lesions of multiple sclerosis. N Engl J Med. 1998;338(5):278–85. Epub 1998/01/29.

    Article  CAS  PubMed  Google Scholar 

  9. Rutschmann OT, McCrory DC, Matchar DB. Immunization Panel of the Multiple Sclerosis Council for Clinical Practice G. Immunization and MS: a summary of published evidence and recommendations. Neurology. 2002;59(12):1837–43. Epub 2002/12/25.

    Article  PubMed  Google Scholar 

  10. Mohr DC, Hart SL, Julian L, Cox D, Pelletier D. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ. 2004;328(7442):731. Epub 2004/03/23.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tremlett H, Zhao Y, Joseph J, Devonshire V. Relapses in multiple sclerosis are age- and time-dependent. J Neurol Neurosurg Psychiatry. 2008;79(12):1368–74. Epub 2008/06/07.

    Article  CAS  PubMed  Google Scholar 

  12. Kalincik T, Vivek V, Jokubaitis V, Lechner-Scott J, Trojano M, Izquierdo G, et al. Sex as a determinant of relapse incidence and progressive course of multiple sclerosis. Brain. 2013;136(Pt 12):3609–17. Epub 2013/10/22.

    Article  PubMed  Google Scholar 

  13. Miller DH, Leary SM. Primary-progressive multiple sclerosis. Lancet Neurol. 2007;6(10):903–12. Epub 2007/09/22.

    Article  PubMed  Google Scholar 

  14. Leray E, Yaouanq J, Le Page E, Coustans M, Laplaud D, Oger J, et al. Evidence for a two-stage disability progression in multiple sclerosis. Brain. 2010;133(Pt 7):1900–13. Epub 2010/04/29.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tedeholm H, Skoog B, Lisovskaja V, Runmarker B, Nerman O, Andersen O. The outcome spectrum of multiple sclerosis: disability, mortality, and a cluster of predictors from onset. J Neurol. 2015;262(5):1148–63. Epub 2015/02/26.

    Article  PubMed  Google Scholar 

  16. Disanto G, Pakpoor J, Morahan JM, Hall C, Meier UC, Giovannoni G, et al. Epstein-Barr virus, latitude and multiple sclerosis. Mult Scler. 2013;19(3):362–5. Epub 2012/07/07.

    Article  PubMed  Google Scholar 

  17. Ponsonby AL, Lucas RM, van der Mei IA, Dear K, Valery PC, Pender MP, et al. Offspring number, pregnancy, and risk of a first clinical demyelinating event: the AusImmune Study. Neurology. 2012;78(12):867–74. Epub 2012/03/10.

    Article  PubMed  Google Scholar 

  18. Cossburn M, Ingram G, Hirst C, Ben-Shlomo Y, Pickersgill TP, Robertson NP. Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis. Mult Scler. 2012;18(1):45–54. Epub 2011/08/26.

    Article  CAS  PubMed  Google Scholar 

  19. Tremlett H, Zhao Y, Rieckmann P, Hutchinson M. New perspectives in the natural history of multiple sclerosis. Neurology. 2010;74(24):2004–15. Epub 2010/06/16.

    Article  PubMed  Google Scholar 

  20. Confavreux C, Vukusic S, Adeleine P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain. 2003;126(Pt 4):770–82. Epub 2003/03/05.

    Article  PubMed  Google Scholar 

  21. Scalfari A, Neuhaus A, Daumer M, Ebers GC, Muraro PA. Age and disability accumulation in multiple sclerosis. Neurology. 2011;77(13):1246–52. Epub 2011/09/16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, et al. Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. Arch Neurol. 2006;63(12):1686–91. Epub 2006/12/19.

    Article  PubMed  Google Scholar 

  23. Lebrun C, Bensa C, Debouverie M, De Seze J, Wiertlievski S, Brochet B, et al. Unexpected multiple sclerosis: follow-up of 30 patients with magnetic resonance imaging and clinical conversion profile. J Neurol Neurosurg Psychiatry. 2008;79(2):195–8. Epub 2008/01/19.

    Article  CAS  PubMed  Google Scholar 

  24. Henry JD, Rendell PG. A review of the impact of pregnancy on memory function. J Clin Exp Neuropsychol. 2007;29(8):793–803. Epub 2007/11/22.

    Article  PubMed  Google Scholar 

  25. Bove RM, Healy B, Augustine A, Musallam A, Gholipour T, Chitnis T. Effect of gender on late-onset multiple sclerosis. Mult Scler. 2012;18(10):1472–9.

    Article  PubMed  Google Scholar 

  26. Koch M, Kingwell E, Rieckmann P, Tremlett H, Neurologists UMC. The natural history of secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2010;81(9):1039–43. Epub 2010/07/20.

    Article  PubMed  Google Scholar 

  27. Tremlett H, Paty D, Devonshire V. Disability progression in multiple sclerosis is slower than previously reported. Neurology. 2006;66(2):172–7. Epub 2006/01/26.

    Article  PubMed  Google Scholar 

  28. Stellmann JP, Neuhaus A, Lederer C, Daumer M, Heesen C. Validating predictors of disease progression in a large cohort of primary-progressive multiple sclerosis based on a systematic literature review. PLoS One. 2014;9(3), e92761. Epub 2014/03/22.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry. 2016;87(3):324–31.

    Article  PubMed  Google Scholar 

  30. Fazekas F, Enzinger C, Wallner-Blazek M, Ropele S, Pluta-Fuerst A, Fuchs S. Gender differences in MRI studies on multiple sclerosis. J Neurol Sci. 2009;286(1–2):28–30. Epub 2009/08/28.

    Article  PubMed  Google Scholar 

  31. Schoonheim MM, Popescu V, Rueda Lopes FC, Wiebenga OT, Vrenken H, Douw L, et al. Subcortical atrophy and cognition: sex effects in multiple sclerosis. Neurology. 2012;79(17):1754–61.

    Article  PubMed  Google Scholar 

  32. Magyari M, Koch-Henriksen N, Pfleger CC, Sorensen PS. Reproduction and the risk of multiple sclerosis. Mult Scler. 2013;19(12):1604–9. Epub 2013/03/20.

    Article  PubMed  Google Scholar 

  33. Hedstrom AK, Hillert J, Olsson T, Alfredsson L. Reverse causality behind the association between reproductive history and MS. Mult Scler. 2014;20(4):406–11. Epub 2013/07/28.

    Article  CAS  PubMed  Google Scholar 

  34. Runmarker B, Andersen O. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain. 1995;118(Pt 1):253–61. Epub 1995/02/01.

    Article  PubMed  Google Scholar 

  35. Hernan MA, Hohol MJ, Olek MJ, Spiegelman D, Ascherio A. Oral contraceptives and the incidence of multiple sclerosis. Neurology. 2000;55(6):848–54. Epub 2000/09/20.

    Article  CAS  PubMed  Google Scholar 

  36. Alonso A, Jick SS, Olek MJ, Ascherio A, Jick H, Hernan MA. Recent use of oral contraceptives and the risk of multiple sclerosis. Arch Neurol. 2005;62(9):1362–5. Epub 2005/09/15.

    Article  PubMed  Google Scholar 

  37. Holmqvist P, Hammar M, Landtblom AM, Brynhildsen J. Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis. Fertil Steril. 2010;94(7):2835–7. Epub 2010/09/03.

    Article  PubMed  Google Scholar 

  38. Lebrun C, Le Page E, Kantarci O, Siva A, Pelletier D, Okuda D. Impact of pregnancy on conversion to clinically isolated syndrome in a radiologically isolated syndrome cohort. Mult Scler. 2012;18(9):1297–302.

    Article  CAS  PubMed  Google Scholar 

  39. Poser S, Poser W. Multiple sclerosis and gestation. Neurology. 1983;33(11):1422–7. Epub 1983/11/01.

    Article  CAS  PubMed  Google Scholar 

  40. Smeltzer SC. Reproductive decision making in women with multiple sclerosis. J Neurosci Nurs. 2002;34(3):145–57. Epub 2002/06/26.

    Article  PubMed  Google Scholar 

  41. Bove R, Alwan S, Friedman JM, Hellwig K, Houtchens M, Koren G, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol. 2014;124(6):1157–68. Epub 2014/11/22.

    Article  CAS  PubMed  Google Scholar 

  42. Masera S, Cavalla P, Prosperini L, Mattioda A, Mancinelli C, Superti G, et al. Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis. Mult Scler. 2015;21(10):1291–7.

    Article  CAS  PubMed  Google Scholar 

  43. Ramagopalan S, Yee I, Byrnes J, Guimond C, Ebers G, Sadovnick D. Term pregnancies and the clinical characteristics of multiple sclerosis: a population based study. J Neurol Neurosurg Psychiatry. 2012;83(8):793–5.

    Article  PubMed  Google Scholar 

  44. D’Hooghe MB, Nagels G, Uitdehaag BM. Long-term effects of childbirth in MS. J Neurol Neurosurg Psychiatry. 2010;81(1):38–41. Epub 2009/11/27.

    Article  PubMed  Google Scholar 

  45. Weinshenker BG, Hader W, Carriere W, Baskerville J, Ebers GC. The influence of pregnancy on disability from multiple sclerosis: a population-based study in Middlesex County, Ontario. Neurology. 1989;39(11):1438–40. Epub 1989/11/01.

    Article  CAS  PubMed  Google Scholar 

  46. Alwan S, Yee IM, Dybalski M, Guimond C, Dwosh E, Greenwood TM, et al. Reproductive decision making after the diagnosis of multiple sclerosis (MS). Mult Scler. 2013;19(3):351–8. Epub 2012/07/05.

    Article  CAS  PubMed  Google Scholar 

  47. Luchetti S, van Eden CG, Schuurman K, van Strien ME, Swaab DF, Huitinga I. Gender differences in multiple sclerosis: induction of estrogen signaling in male and progesterone signaling in female lesions. J Neuropathol Exp Neurol. 2014;73(2):123–35. Epub 2014/01/16.

    Article  CAS  PubMed  Google Scholar 

  48. Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology. 2005;65(12):1961–3. Epub 2005/12/29.

    Article  CAS  PubMed  Google Scholar 

  49. Dahl J, Myhr KM, Daltveit AK, Gilhus NE. Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis. J Neurol. 2008;255(5):623–7. Epub 2008/02/20.

    Article  PubMed  Google Scholar 

  50. Jalkanen A, Alanen A, Airas L, Finnish Multiple S, Pregnancy Study G. Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler. 2010;16(8):950–5. Epub 2010/06/15.

    Article  CAS  PubMed  Google Scholar 

  51. Mueller BA, Zhang J, Critchlow CW. Birth outcomes and need for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol. 2002;186(3):446–52. Epub 2002/03/21.

    Article  PubMed  Google Scholar 

  52. Kelly VM, Nelson LM, Chakravarty EF. Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology. 2009;73(22):1831–6. Epub 2009/11/20.

    Article  PubMed  Google Scholar 

  53. Chen YH, Lin HL, Lin HC. Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study. Mult Scler. 2009;15(5):606–12. Epub 2009/03/26.

    Article  CAS  PubMed  Google Scholar 

  54. van der Kop ML, Pearce MS, Dahlgren L, Synnes A, Sadovnick D, Sayao AL, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011;70(1):41–50. Epub 2011/06/29.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Neuteboom RF, Janssens AC, Siepman TA, Hoppenbrouwers IA, Ketelslegers IA, Jafari N, et al. Pregnancy in multiple sclerosis: clinical and self-report scales. J Neurol. 2012;259(2):311–7. Epub 2011/08/04.

    Article  CAS  PubMed  Google Scholar 

  56. Vukusic S, Hutchinson M, Hours M, Moreau T, Cortinovis-Tourniaire P, Adeleine P, et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain. 2004;127(Pt 6):1353–60. Epub 2004/05/08.

    Article  PubMed  Google Scholar 

  57. Paavilainen T, Kurki T, Parkkola R, Farkkila M, Salonen O, Dastidar P, et al. Magnetic resonance imaging of the brain used to detect early post-partum activation of multiple sclerosis. Eur J Neurol. 2007;14(11):1216–21. Epub 2007/08/31.

    Article  CAS  PubMed  Google Scholar 

  58. Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the ‘treatment era’. Nat Rev Neurol. 2015;11(5):280–9. Epub 2015/04/22.

    Article  PubMed  Google Scholar 

  59. Langer-Gould A, Huang SM, Gupta R, Leimpeter AD, Greenwood E, Albers KB, et al. Exclusive breastfeeding and the risk of postpartum relapses in women with multiple sclerosis. Arch Neurol. 2009;66(8):958–63. Epub 2009/06/10.

    Article  PubMed  Google Scholar 

  60. Hellwig K, Haghikia A, Rockhoff M, Gold R. Multiple sclerosis and pregnancy: experience from a nationwide database in Germany. Ther Adv Neurol Disord. 2012;5(5):247–53. Epub 2012/09/14.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pakpoor J, Disanto G, Lacey MV, Hellwig K, Giovannoni G, Ramagopalan SV. Breastfeeding and multiple sclerosis relapses: a meta-analysis. J Neurol. 2012;259(10):2246–8. Epub 2012/05/24.

    Article  PubMed  Google Scholar 

  62. Gulick EE, Kim S. Postpartum emotional distress in mothers with multiple sclerosis. J Obstet Gynecol Neonatal Nurs. 2004;33(6):729–38. Epub 2004/11/25.

    Article  PubMed  Google Scholar 

  63. Gulick EE. Postpartum functioning in mothers with multiple sclerosis. West J Nurs Res. 2007;29(5):589–602; discussion 3–12. Epub 2007/06/06.

    Article  PubMed  Google Scholar 

  64. Gjerdingen DK, Chaloner K. Mothers’ experience with household roles and social support during the first postpartum year. Women Health. 1994;21(4):57–74. Epub 1994/01/01.

    Article  CAS  PubMed  Google Scholar 

  65. Karp I, Manganas A, Sylvestre MP, Ho A, Roger E, Duquette P. Does pregnancy alter the long-term course of multiple sclerosis? Ann Epidemiol. 2014;24(7):504–8 e2. Epub 2014/06/18.

    Article  PubMed  Google Scholar 

  66. Thompson DS, Nelson LM, Burns A, Burks JS, Franklin GM. The effects of pregnancy in multiple sclerosis: a retrospective study. Neurology. 1986;36(8):1097–9. Epub 1986/08/01.

    Article  CAS  PubMed  Google Scholar 

  67. Koch M, Uyttenboogaart M, Heersema D, Steen C, De Keyser J. Parity and secondary progression in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80(6):676–8. Epub 2009/05/19.

    Article  CAS  PubMed  Google Scholar 

  68. Verdru P, Theys P, D’Hooghe MB, Carton H. Pregnancy and multiple sclerosis: the influence on long term disability. Clin Neurol Neurosurg. 1994;96(1):38–41. Epub 1994/02/01.

    Article  CAS  PubMed  Google Scholar 

  69. D’Hooghe MB, Haentjens P, Nagels G, D’Hooghe T, De Keyser J. Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis. J Neurol. 2012;259(5):855–61.

    Article  PubMed  Google Scholar 

  70. Gilli F, Lindberg RL, Valentino P, Marnetto F, Malucchi S, Sala A, et al. Learning from nature: pregnancy changes the expression of inflammation-related genes in patients with multiple sclerosis. PLoS One. 2010;5(1), e8962. Epub 2010/02/04.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Gilli F, Navone ND, Perga S, Marnetto F, Caldano M, Capobianco M, et al. Loss of braking signals during inflammation: a factor affecting the development and disease course of multiple sclerosis. Arch Neurol. 2011;68(7):879–88. Epub 2011/03/16.

    Article  PubMed  Google Scholar 

  72. Patas K, Engler JB, Friese MA, Gold SM. Pregnancy and multiple sclerosis: feto-maternal immune cross talk and its implications for disease activity. J Reprod Immunol. 2013;97(1):140–6. Epub 2013/02/26.

    Article  CAS  PubMed  Google Scholar 

  73. Kinsley CH, Lambert KG. Reproduction-induced neuroplasticity: natural behavioural and neuronal alterations associated with the production and care of offspring. J Neuroendocrinol. 2008;20(4):515–25. Epub 2008/02/13.

    Article  CAS  PubMed  Google Scholar 

  74. Kim P, Leckman JF, Mayes LC, Feldman R, Wang X, Swain JE. The plasticity of human maternal brain: longitudinal changes in brain anatomy during the early postpartum period. Behav Neurosci. 2010;124(5):695–700. Epub 2010/10/14.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurology, National MS Center Melsbroek, Vanheylenstraat 16, Melsbroek, 1820, Belgium

    Marie B. D’hooghe, Tatjana Reynders & Jacques De Keyser

Authors
  1. Marie B. D’hooghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatjana Reynders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacques De Keyser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie B. D’hooghe .

Editor information

Editors and Affiliations

  1. Partners MS Center, Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts, USA

    Maria K. Houtchens

  2. MS Clinic UBC Medical Genetics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

    A. Dessa Sadovnick

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag Wien

About this chapter

Cite this chapter

D’hooghe, M.B., Reynders, T., De Keyser, J. (2017). Pregnancy Considerations and Pregnancy Outcomes in Women with MS. In: Houtchens, M., Sadovnick, A. (eds) Health Issues in Women with Multiple Sclerosis. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4858-7_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-4858-7_3

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4856-3

  • Online ISBN: 978-3-7091-4858-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation