Multiple sclerosis and vitamin D during pregnancy and lactation

Jalkanen, A.; Kauko, Tommi; Turpeinen, Ursula; Hämäläinen, Esa; Airas, Laura

doi:10.1111/ane.12306

Cited by 22 publications

(14 citation statements)

References 13 publications

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“…2015 113 was a Mendelian randomization analysis showing that genetically low 25(OH)D levels were associated with increased risk of MS. Jalkanen et al. 2015 114 found a high level of vitamin D deficiency during pregnancy in MS patients.…”

Section: Multiple Sclerosis (Ms) Type 1 Diabetes Rheumatoid Arthritismentioning

confidence: 99%

The risks and benefits of sun exposure 2016

Hoel

Berwick

Gruijl

et al. 2016

Dermato-Endocrinology

113

102

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Public health authorities in the United States are recommending that men, women and children reduce their exposure to sunlight, based on concerns that this exposure will promote skin cancer. On the other hand, data show that increasing numbers of Americans suffer from vitamin D deficiencies and serious health problems caused by insufficient sun exposure. The body of science concerning the benefits of moderate sun exposure is growing rapidly, and is causing a different perception of sun/UV as it relates to human health. Melanoma and its relationship to sun exposure and sunburn is not adequately addressed in most of the scientific literature. Reports of favorable health outcomes related to adequate serum 25(OH)D concentration or vitamin D supplementation have been inappropriately merged, so that benefits of sun exposure other than production of vitamin D are not adequately described. This review of recent studies and their analyses consider the risks and benefits of sun exposure which indicate that insufficient sun exposure is an emerging public health problem. This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D.

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Section: Multiple Sclerosis (Ms) Type 1 Diabetes Rheumatoid Arthritismentioning

confidence: 99%

The risks and benefits of sun exposure 2016

Hoel

Berwick

Gruijl

et al. 2016

Dermato-Endocrinology

113

102

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“…Vitamin D deficiency increases risk for MS, and MS women were shown to have lower vitamin D concentrations during pregnancy and postpartum compared with controls [Jalkanen et al 2015]. Vitamin D deficiency should be evaluated and treated prior to pregnancy.…”

Section: Basic Counselingmentioning

confidence: 99%

Management of women with multiple sclerosis through pregnancy and after childbirth

Coyle

2016

Ther Adv Neurol Disord

121

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Multiple sclerosis (MS) is a major acquired neurologic disease of young adults. The prototypic patient is a young woman of reproductive age. Gender preference is becoming more pronounced, since MS is increasing specifically among women. Any healthcare provider who deals with MS must be prepared to discuss pregnancy issues, and provide appropriate counseling. This is now complicated by the availability of multiple treatment options. There is growing literature on which to base recommendations, particularly regarding washout periods. After a brief background introduction, this review will discuss state-of-the-art family planning counseling in the treatment era, divided into prepregnancy, pregnancy, and postpartum MS issues.

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“…The role of maternal vitamin D deficiency during pregnancy has been well-established. The association of maternal 25(OH) vitamin D levels <12 ng/ mL during early pregnancy result in nearly twofold higher risk of MS in the offspring, compared with women who did not have deficient vitamin D levels 22,33,34 . Therefore, women with MS are advised to take vitamin D at the average dosage of 1,000-2,000 units/day prior to conception and to ensure levels are between 30 and 40 ng/mL 35 .…”

Section: Preconception Period In Women With Msmentioning

confidence: 99%

“…Recommendations: The following approaches can be considered: the most conservative approach is to discontinue natalizumab before conception and maintain effective contraception for 2-3 additional months after discontinuation of the drug. However since most woman treated with natalizumab are likely to have high disease activity and considering the potential risk of severe relapses or even rebound disease activity after withdrawal, it seems reasonable to continue natalizumab throughout the pregnancy (active approach) with extended infusion intervals of 6-8 weeks and discontinue the drug in the last trimester (week [32][33][34]. The newborn should be screened for potential hematological abnormalities.…”

Section: Journal Of Drug Assessmentmentioning

confidence: 99%

Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations

Canibaño

Deleu

Mesraoua

et al. 2020

Journal of Drug Assessment

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Objective: To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them. Research design and methods: A systematic review was performed based on a comprehensive literature search. Results: MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not per se high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNb) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNb are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn. Conclusions: This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.

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Multiple sclerosis and vitamin D during pregnancy and lactation

Abstract: Vitamin D deficiency during the pregnancy and lactation seems to be common in mothers with MS and needs to be treated adequately.

Cited by 22 publications

References 13 publications

The risks and benefits of sun exposure 2016

The risks and benefits of sun exposure 2016

Management of women with multiple sclerosis through pregnancy and after childbirth

Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations

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