Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland

Abstract

The majority of individuals obtaining the diagnosis of multiple sclerosis are women of childbearing age. They are naturally concerned as to how multiple sclerosis affects the course of pregnancy and the developing foetus. The objective of this study was to prospectively evaluate the incidence of pregnancy complications and delivery risks, and to follow the natural course of multiple sclerosis during and after pregnancy in a cohort of Finnish patients with multiple sclerosis. Sixty-one patients with multiple sclerosis who became pregnant during the years 2003-2005 were prospectively followed-up from early pregnancy until 6 months postpartum. Multiple sclerosis relapses, Expanded Disability Status Scale rates and obstetric details were recorded. The results were compared with the statistics obtained from Finnish Medical Birth Register from the year 2004. We found that patients with multiple sclerosis were no more likely to experience pregnancy complications than Finnish pregnant women generally, but they had a greater likelihood for a need of artificial insemination (4.9% vs. 0.9%; p = 0.0009). Subjects with multiple sclerosis were more likely to undergo assisted vaginal delivery than the at-large cohort (16.4% vs. 6.5%; p = 0.0017). We conclude that pregnancy does not seem to pose a woman with multiple sclerosis to a greater risk for pregnancy complications when compared with women in general. The potential need for instrumental delivery should, however, be taken into account when planning the delivery of a mother with multiple sclerosis.

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

“…1 Recent studies have shown that pregnant MS patients have the same risk of pregnancy complications as the general population. 2 The influence of pregnancy on the course of disease in MS has also been studied over the years.According to the Pregnancy in Multiple Sclerosis (PRIMS) trial, the mean ± SD number of relapses was 0.7 ± 0.9 per woman per year in the year before pregnancy; it was 0.5 ± 1.3 during the first trimester of pregnancy, 0.6 ± 1.6 during the second trimester, and 0.2 ± 1.0 during the third trimester. It increased to 1.2 ± 2.0 during the first 3 months postpartum and then returned to the pre-pregnancy rate.…”

“…1 Recent studies have shown that pregnant MS patients have the same risk of pregnancy complications as the general population. 2 The influence of pregnancy on the course of disease in MS has also been studied over the years.…”

Pregnancy and multiple sclerosis

“…In some cases, clinical MS disease activity has also been described shortly before the delivery. 21 In conclusion, during the six-month postpartum period, 21 of 28 (75%) patients demonstrated MS disease activity either by a clinical MS relapse or by a T2 activity on the MRI scans.…”

“…21 The mother's functional status should of course always be taken into account: a mother with significant functional disability will be more likely to encounter problems associated with fatigue and exhaustion during the second stage of delivery.…”

The Features of Reproductive Health of Women With Multiple Sclerosis

“…Данные о фертильности женщин, страдающих РС, носят противоречивый характер: по данным K. Hellwig et al (2008), фертильность у женщин с РС не нарушена [7], в то время как по результатам исследования A. Jalkanen et al (2010) установлена более высокая потребность во вспомогательных ре-продуктивных технологиях (ВРТ) у пациенток с РС, по сравнению с населением в целом [8].…”