History of multiple sclerosis in 2 successive pregnancies

Benoit, A; Durand‐Dubief, Françoise; Amato, Maria Pia; Portaccio, Emilio; Casey, Romain; Roggerone, S.; Androdias, Géraldine; Gignoux, Laurence; Ionescu, Iuliana; Marrosu, M.G.; Cocco, Eleonora; Ghezzi, Angelo; Annovazzi, Pietro; Trojano, María; Simone, Marta; Marignier, Romain; Confavreux, Christian; Vukusic, Sandra

doi:10.1212/wnl.0000000000003036

Cited by 17 publications

(21 citation statements)

References 31 publications

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“…The effect of breastfeeding on postpartum relapse risk has been controversial, with some studies supporting a protective effect, 192,200,201,203,204 while others have not. 5,119,199,205–212 There is no evidence to suggest a harmful effect of breastfeeding on MS relapse risk, which is important given the many benefits of breastfeeding to the infant and mother. 170 A recent systematic review and meta-analysis included 24 studies evaluating the association between breastfeeding and postpartum MS relapses, of which 16 had data available to pool.…”

Section: Breastfeeding and Postpartum Relapsesmentioning

confidence: 99%

Sex effects across the lifespan in women with multiple sclerosis

Krysko

Graves

Dobson

et al. 2020

Ther Adv Neurol Disord

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Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.

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Section: Breastfeeding and Postpartum Relapsesmentioning

confidence: 99%

Sex effects across the lifespan in women with multiple sclerosis

Krysko

Graves

Dobson

et al. 2020

Ther Adv Neurol Disord

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“…Recently, a study comparing disease activity between the first and second pregnancies in a group of women with MS revealed similar disease activity. The above study indicated that the risk of relapses after the second pregnancy does not correlate with the outcome of the previous pregnancy .…”

Section: Discussionmentioning

confidence: 74%

Pregnancy planning and outcomes in patients with multiple sclerosis after mitoxantrone therapy: a monocentre assessment

Frau

Coghe

Casanova

et al. 2018

Euro J of Neurology

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“…This could be due to the fact that, if MS women were generally advised to consider pregnancy in a quiet period of the disease, women who experienced a relapse during a first pregnancy or after delivery may fear a similar outcome and be discouraged from considering a second pregnancy. In line with this, it is likely that women with MS with multiple pregnancies are also those with milder MS [31]; assuming that higher disease activity is related to worse long-term disability, they could have better long-term clinical outcomes. Furthermore, it should be highlighted that pregnancy is a well-circumscribed biological event in a long history of disease and that our patients had heterogeneous MS characteristics and DMT exposures before and after pregnancy, which complicates our evaluation of outcomes.…”

Section: Discussionmentioning

confidence: 90%

Effects of Pregnancy and Breastfeeding on Clinical Outcomes and MRI Measurements of Women with Multiple Sclerosis: An Exploratory Real-World Cohort Study

et al. 2021

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Introduction Pregnancy represents an important event for women with multiple sclerosis (MS) and is often accompanied by post-partum disease reactivation. To date, the influence of this reproductive phase on long-term MS outcomes is still largely unexplored. The objective of the study was characterise a large real-world cohort of women with MS to evaluate the effects of pregnancy and breastfeeding on short- and long-term clinical and magnetic resonance imaging (MRI) outcomes while exploring the relationships with MRI measurements of brain atrophy. Methods MS patients with and without pregnancy were recruited. Clinical relapses and MRI activity of the year before conception versus the year after delivery were evaluated. Regression models were performed to investigate the relationships between long-term MS outcomes (EDSS score and MRI brain measurements obtained by SIENAX software) and pregnancy and breastfeeding duration. Results Two hundred ten women with MS were enrolled; of them, 129 (61.4%) had at least one pregnancy. Of all pregnancies ( n = 212), those that occurred after MS onset (90 [42.4%]) were examined to evaluate the short-term outcomes. A higher annualised relapse rate in the post-partum year versus the pre-conception year (0.54 ± 0.84 vs. 0.45 ± 0.71; p = 0.04) was observed. A regression analysis showed that clinical activity after delivery was associated with clinical activity of the year before conception ( p = 0.001) as well as duration of breastfeeding ( p = 0.022). Similarly, post-partum MRI activity was associated with pre-conception MRI activity ( p = 0.026) and shorter breastfeeding duration ( p = 0.013). Regarding long-term outcomes, having had at least one pregnancy during MS was associated with a lower EDSS score ( p = 0.021), while no relationships were reported with MRI measurements. Conversely, a breastfeeding duration > 6 months was associated with lower white matter volume ( p = 0.008). Conclusions Our study underlines the importance of considering the effects of pregnancy and breastfeeding on short- and long-term MS outcomes. In the current therapeutic landscape, pregnancy planning and treatment optimisation in the post-partum period, in particular for women who choose to breastfeed, are fundamental for the management of these biological phases so central in a woman’s life.

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History of multiple sclerosis in 2 successive pregnancies

Cited by 17 publications

References 31 publications

Sex effects across the lifespan in women with multiple sclerosis

Sex effects across the lifespan in women with multiple sclerosis

Pregnancy planning and outcomes in patients with multiple sclerosis after mitoxantrone therapy: a monocentre assessment

Effects of Pregnancy and Breastfeeding on Clinical Outcomes and MRI Measurements of Women with Multiple Sclerosis: An Exploratory Real-World Cohort Study

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