Multiple sclerosis gender issues: clinical practices of women neurologists

Abstract

Substantially more women than men develop multiple sclerosis (MS), but information about the effects of MS and gender-specific issues such as pregnancy, breastfeeding, menstruation and hormone use is lacking. A survey study of neurologists' practice patterns was undertaken to elicit information about gender-specific topics and the use of disease-modifying MS therapies (DMT) including the interferons and glatiramer acetate (GA). A total of 147 surveys were returned. Half of respondents require patients to discontinue DMT during pregnancy, while 35% encourage discontinuation. Among those who allow patients to continue therapy, half consider GA to be safer during pregnancy than the interferons. Nearly 86% of respondents do not use DMT in patients who are breastfeeding. Among the 11% who actually prescribe during breastfeeding, most recommend GA. Neurologists generally leave the decision to breastfeed up to patients, and most refer patients to obstetrician/gynaecologists for counselling about contraception or hormone replacement therapy. The survey results described here provide insight into how neurologists manage reproductive health issues among women with MS.

Immunomodulation and postpartum relapses in patients with multiple sclerosis

“…Moreover DMT (INF-and even more so glatiramer acetate) have a delayed onset of efficacy beyond the peak of the postpartal exacerbations [Comi et al 2001;Li and Patty, 1999]. DMT is not recommended after birth in breastfeeding mothers, since there are no reliable data on its transfer into the milk and its effects on babies [Hoffmann, 2006;Coyle, 2004]. IVIG application is considered an alternative, but not approved for the treatment of MS patients, at least in Germany [Haas and Hommes, 2007;Hoffmann et al 2006].…”

“…Prophylactic application of intravenous steroids showed some effect in a small cohort [de Seze et al 2004], but this may interact with wound healing after delivery. A contraindication exists for the current available disease-modifying therapies (DMTs; i.e., interferon (IFN) beta or glatiramer acetate) during pregnancy and breast-feeding [Hoffmann et al 2006;Coyle et al 2004]. Moreover when women do not breastfeed, the efficacy of DMT on postpartal relapse prevention is not proven to date [Vukusic et al 2004].…”

Multiple sclerosis and pregnancy: experience from a nationwide database in Germany

“…There is no strong evidence suggesting the optimal time point to ablactate and to reintroduce DMT. Breastfeeding mothers are recommended not to start DMT after birth, as there are no reliable data available on drug transfer into milk and their effects on newborns [Coyle et al 2004]. If women choose not to breastfeed, we recommend to start DMT as soon as possible after birth as there is sufficient evidence for INFβ and GLAT have a delayed onset of efficacy [Comi et al 2001;Li and Paty, 1999].…”

Gyermekvállalás és szüléskimenetel sclerosis multiplexben a nemzetközi irodalom tükrében

“…Bátorítani kell az SM-ben szenvedő nőt a szoptatásra, elsősorban az újszülött szá-mára nélkülözhetetlen tápanyagok és ellenanyagok miatt. Több központ bevonásával készült tanulmányban post partum intravénás immunglobulin adagolását köve-tően 163, SM-ben szenvedő nőben az anyatejes táplálás felmérésekor a nők 85%-a 3 hónapig vagy tovább szoptatott [58].…”