Pregnancy with multiple sclerosis

Vukusic, Sandra; Michel, Laure; Leguy, Soizic; Lebrun-Frénay, Christine

doi:10.1016/j.neurol.2020.05.005

Cited by 28 publications

(25 citation statements)

References 86 publications

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“…13 The European Medicines Agency (EMA) reconsidered its prescribing policy in 2019, allowing doctors to consider continuing therapy until conception, during pregnancy and while breastfeeding. 4 For glatiramer acetate, available since 2004, the EMA also amended its labeling in 2016 and removed a warning against its use during pregnancy. 4 Therefore, it was not surprising to find these two DMTs as the most used during pregnancy in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, very few studies have described pregnancy incidence rates among women with MS. 2,3 Pregnancy is known not to worsen MS course (except for the relapse rebound in the post-partum period). [4][5][6][7] Moreover, pregnancy or delivery complications, low birth weight, preterm birth, or malformation were not likely to occur more often in MS than in the general population. 5,8,9 Standard medical practice was to discontinue diseasemodifying therapies (DMTs) before conception to minimize the risk of fetal harm.…”

Section: Introductionmentioning

confidence: 89%

“…Pregnancy is known not to worsen MS course (except for the relapse rebound in the post-partum period). 4–7 Moreover, pregnancy or delivery complications, low birth weight, preterm birth, or malformation were not likely to occur more often in MS than in the general population. 5,8,9…”

Section: Introductionmentioning

confidence: 90%

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Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies

et al. 2021

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Background: Multiple sclerosis (MS) is usually diagnosed between 20-40 years old, when women often plan to have children. Objective: Our objectives were to estimate pregnancy incidence rates in women with multiple sclerosis (MS), and to describe the use of disease-modifying therapies (DMTs) before conception and during pregnancy, and pregnancy outcomes. Methods: This retrospective cohort study included all 15- to 49-year-old women with MS in the French national health insurance database over 2010–2015. A pregnancy was exposed if a DMT reimbursement claim occurred during pregnancy or in the 14 preceding days. We used zero-inflated negative binomial (ZINB) regression models to estimate incidence rates and ordinal and multinomial regression models to estimate DMT exposure and pregnancy outcomes. Results: The pregnancy incidence rate was 4.5 per 100 person-years. The probability of having a DMT-exposed pregnancy increased from 0.22 in 2010 to 0.30 in 2015. The probability of live birth was 0.72 (95% CI = 0.70–0.74) for exposed pregnancies (varied considerably among DMTs), 0.77 (95% CI = 0.76–0.79) without treatment, and 0.81 (95% CI = 0.79–0.83) if treatment was stopped within the previous year. Conclusion: In this population-based study, we showed an increase of exposed pregnancies over time, beta-interferon and glatiramer acetate being the most used DMTs and associated with the highest probabilities of live birth. Interrupted exposed pregnancies may reflect undesired pregnancies or fear of an adverse outcome, while recent DMT stop probably reflects pregnancy planning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

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Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies

et al. 2021

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“…All this evidence underlines how clinicians should discuss the possibility of breastfeeding with the patient, pondering both her wish and her disease activity before and during gestation ( 7 , 66 ).…”

Section: Breastfeedingmentioning

confidence: 99%

“…All these reasons pose an extra challenge in guiding MS women in their fertile age in making choices about pregnancy ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies

2021

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Purpose of this Review: This article is a systematic review on the influence pregnancy has on multiple sclerosis and the resulting impact of disease-modifying therapies.Findings: Multiple sclerosis predominantly affects young women with a clinical onset most often during the child-bearing age. The impact of multiple sclerosis and disease-modifying therapies on fertility, pregnancy, fetal outcome, and breastfeeding is a pivotal topic when it comes to clinical practice. The introduction of disease-modifying therapies has changed not only the natural history of the disease but also the perspective of pregnancy in women with multiple sclerosis. Family planning requires careful consideration, especially because many disease-modifying drugs are contraindicated during pregnancy. In this article, we review current evidence collected from published literature and drug-specific pregnancy registers on the use of disease-modifying therapies. Additionally, we discuss safety profiles for each drug and correlate them to both risk for the exposed fetus and risk for the mothers interrupting treatments when seeking pregnancy.

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Social determinants of health on attitudes toward childbearing among women with multiple sclerosis: A cross‐sectional study

Khoshsirat,

Mokaram,

Mahmoodi

et al. 2024

Brain and Behavior

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BackgroundPregnancy and motherhood are very valuable but challenging for women with multiple sclerosis (MS). Given that there are limited studies in this field, this study aimed to determine the social determinants of health on attitudes toward childbearing among women with MS.MethodsWe conducted a cross‐sectional study on 206 women with MS in Alborz province, Iran, from February to June 2023 using convenience sampling. The data were collected using the questionnaire, and a linear regression analysis was applied.ResultsThe mean age of the participants was 36.80 ± 6.50 years. Participants’ Attitudes toward Fertility and Childbearing (PAFC) had a positive significant association with social support (B = .10, SE = .04, p = .023) and a significant negative association with the total score of depression, anxiety, and stress scale (B = −.13, SE = .06, p = .047) and depression (B = −.40, SE = .18, p = .023). However, the association between anxiety (B = −.25, SE = .20, p = .211), stress (B = −.36, SE = .18, p = .050), MS severity (B = .04, SE = .30, p = .890), and socioeconomic status scale (SES) (B = −.08, SE = .32, p = .806) was nonsignificant with PAFC.ConclusionOur results showed that factors, including social support and mental health especially depression, can affect PAFC in women with MS. Therefore, it is necessary to determine specific strategies for policymakers to help MS patients manage pregnancy and motherhood.

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Pregnancy with multiple sclerosis

Cited by 28 publications

References 86 publications

Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies

Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies

Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies

Social determinants of health on attitudes toward childbearing among women with multiple sclerosis: A cross‐sectional study

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