Multiple Sclerosis in Pregnancy and its Role in Female Fertility: A Systematic Review

Abstract

Multiple sclerosis (MS) is a neurological disease that typically affects young women of reproductive age. There are still many questions and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. For many years, women with MS have been discouraged from getting pregnant for fears that the disease might negatively affect the fetus or increase their obstetric risk or for claims that the disease might decrease fertility. However, fertility does not seem to be impaired to a larger extent in women with MS. Therefore, all healthcare providers involved in the follow-up of multiple sclerosis patients must be prepared to discuss future fertility, pregnancy, and others matters, in addition to providing them with the best possible counseling. This study presents data based on updated evidence and discusses fertility and pregnancy in patients with MS with respect to the impacts of pregnancy on the risk and prognostic factors tied to MS, and the impact of MS on pregnancy outcomes and fertility treatments administered to females with MS. In conclusion, a clear relationship between infertility and MS has not been established. There seems to exist a link between disease aggressiveness and progression with several processes that might impair fertility. However, MS does not stand as a contraindication to assisted reproductive technology. From the several studies analyzed, it is possible to conclude that pregnancy is possible in women with MS. It is important to discuss and plan the ideal moment to start treatment and managing pregnancy and contraception aiming at better results.

Rat Ovarian Function Is Impaired during Experimental Autoimmune Encephalomyelitis

“…Lower anti-Müllerian hormone levels were recorded in women with MS [ 33 ], and this parameter, along with a lower total antral follicle count and ovarian volume, was associated with higher disease activity [ 34 , 35 ]. Nevertheless, a clear connection between infertility and MS is not proven [ 36 ]. In this study, we aimed to elucidate ovarian status during acute EAE, the most exploited animal model of MS.…”

Multiple Sklerose in Schwangerschaft und Stillzeit

“…Für MS-Patient*innen besteht eine Chance von 1-3%, die Krankheit an ihre Kinder zu vererben [4]. Das Risiko ist somit im Vergleich zur Allgemeinbevölkerung zwar um das 20-bis 30-Fache erhöht, bleibt aber dennoch insgesamt niedrig.…”

“…Zu einem späteren Zeitpunkt stellt sich außerdem die Frage, ob und unter welcher DMT gestillt werden kann. Schwangerschaft zur Remission der Erkrankung für bis zu 2 Jahre führen kann [4].…”

“…Der Schwangerschaftsverlauf und das Risiko für verschiedene negative Schwangerschaftsausgänge wie Spontanaborte oder extrauterine Graviditäten wird durch die MS-Erkrankung nicht negativ beeinflusst [4].…”

Disease-Modifying Therapies (DMTs) in Pregnant and Lactating Women with Multiple Sclerosis: Analysis of Real-World Data from EudraVigilance Database

“…Multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, is the most common chronic neurological disease with a risk of permanent motor and sensory disability and cognitive deterioration [1]. The course of this disease is unpredictable and changes from person to person [2].…”