Abstract:Objective: The objective of this study was to evaluate exposure to disease-modifying therapies (DMTs) during pregnancy in 335 pregnancies of multiple sclerosis (MS) patients and to further determine whether exclusive breastfeeding of MS mothers has any relevant influence on postpartum relapse rate. Background: Only limited data are available on whether DMT exposure during pregnancy affects relapse rate during pregnancy or after birth. Currently, findings on beneficial effect of exclusive breastfeeding on MS disease course are controversially discussed. Methods: We enrolled pregnant women with MS who contacted us directly or via their treating physicians to be included in our nationwide MS and pregnancy database. Results: We identified 78 pregnancies under interferon-beta (IFNβ) preparations, 41 under glatiramer acetate (GLAT), and 216 pregnancies without DMT exposure during pregnancy. As expected, annualized relapse rate (ARR) decreased continuously during pregnancy in nonexposed mothers (p < 0.001) to then increase after birth. In IFNβ-or GLAT-exposed women this typical pattern was not as obvious. Congenital anomalies were within normal ranges in exposed pregnancies. In total, 170 women were identified who exclusively breastfed (EBF). Significantly reduced postpartum relapse rate during the first 3 months after birth were registered in the EBF group as compared with nonexclusively breastfeeding (NEBF) or nonbreastfeeding women (NBF) women with MS (p < 0.0001). Relapse rate (RR) in the year before pregnancy had been similar throughout all groups. We did not observe any significant differences in RR of NEBF and NBF women. Conclusion: Exclusive breastfeeding showed some beneficial effects on postpartum relapse rate in our cohort. Our data support that IFNβ and GLAT do not seem to represent a major teratogenic risk in pregnancy.

IMPORTANCE Women with multiple sclerosis (MS) experience an elevated risk of relapse after giving birth. The effect of exclusive breastfeeding on postpartum risk of MS relapse is unclear. OBJECTIVES To determine the effect of exclusive breastfeeding on postpartum risk of MS relapse and to investigate the effect of introducing supplemental feedings on that risk.

Interferon-beta exposure during early pregnancy does not influence the mean birth weight, risk of preterm birth, or other adverse pregnancy outcomes. Our study provides further reassurance that interferon-beta treatment can be safely continued up until women become pregnant.

Our data provide further evidence that glatiramer acetate exposure during the first trimester of pregnancy appears safe and without teratogenic effect. These findings provide important additive knowledge to better counsel women with multiple sclerosis in planning a pregnancy.

To describe a patient with paraneoplastic cerebellar syndrome and the uncommon association of isolated ZIC4 antibodies and ovarian cancer. Design: Case report and review of the literature. Setting: Hospitalized care, follow-up in private practice. Patient: A 60-year-old woman with severe paraneoplastic cerebellar syndrome and an underlying ovarian adenocarcinoma.

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Zusammenfassung Die Multiple Sklerose (MS) ist eine der h?ufigsten neurologischen Erkrankungen des jungen Erwachsenenalters, eines Lebensabschnitts, in dem die Familienplanung h?ufig eine wichtige Rolle spielt. Obwohl die Fertilit?t an sich bei MS-Kranken nicht eingeschr?nkt ist, kann die Diagnose mit einem unerf?llten Kinderwunsch, der eine hormonelle Stimulationsbehandlung notwendig macht, zuf?llig zusammenkommen. Seit Kurzem wei? man, dass durch hormonelle Stimulationstherapien Sch?be ausgel?st werden k?nnen. Wir beschreiben in diesem Fallbericht eine erfolgreiche Hormonstimulation mit konsekutiver Schwangerschaft unter Beibehaltung der Interferon-?-1b-Medikation. Auch in der Stillzeit wurde Betaferon? nicht abgesetzt. Bislang erlitt die Patientin post partum keinen Schub.

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