Female Gender and Reproductive Factors Affecting Risk, Relapses and Progression in Multiple Sclerosis

Abstract

Multiple sclerosis (MS), a chronic inflammatory demyelina-ting and degenerative disease of the central nervous system, is a frequent cause of neurological disability in young adults. Female predominance has increased over the last decades. Although female gender carries a higher risk of developing relapsing remitting MS, being female and at child-bearing age also appears to provide some protection against cognitive decline and against progressive onset MS, an adverse predictive factor when considering long-term disability in MS. The risk of MS in women has been associated with an earlier age at menarche. In most studies, parity did not impact MS risk. However, the recently published association of higher parity and offspring number with a reduced risk of a first demyelinating event suggests a potential suppressive effect. Pregnancy in MS patients has been associated with a reduced relapse rate and a reduction of neurological symptoms, especially in the third trimester. Despite the increased relapse risk in the postpartum period, there is no indication of an adverse effect of childbirth on the long-term course of MS. Fertility treatment in MS has been associated with an increased relapse risk in the following 3-month period, especially when the procedure did not result in pregnancy and gonadotrophin-releasing hormone agonists were used. Altogether, there is substantial evidence to support a regulatory role of sex steroid hormones in MS. In the absence of correlations with single hormone blood levels, we can only speculate about the underlying mechanisms. In conclusion, the increased MS risk in women and the changes in relapse and progression risk in association with reproductive events suggest significant and complex interactions between immune, neuroendocrine and reproductive systems in MS.

Gender Disparities in Ocular Inflammatory Disorders*

“…Fertility treatments utilizing gonadotropin releasing hormone (GnRH) agonists may also increase the risk of relapse in MS patients, especially when it does not result in pregnancy 90 Lastly, the presence of two X chromosomes was shown to increase susceptibility to MS in animal models independent of hormone levels. 91 …”

Favorable Outcomes for both Mother and Baby Are Possible in Pregnant Women with Crimean-Congo Hemorrhagic Fever Disease: A Case Series and Literature Review

“…Pregnancy is a state of relative maternal immune suppression to accommodate the semi-allogeneic fetus [5,6,7]. The clinical features of CCHF infection are well known.…”

Pregnancy Data in a Turkish Multiple Sclerosis Population

“…Contrary to former belief, current studies revealed that pregnancy has no negative effect on MS [18]. Although limited data had existed and results were conflicting, no association between parity and conversion to SPMS has been shown [1,19,20,21,22,23]. …”