Parity Associated with Long-Term Disease Progression in Women with Multiple Sclerosis

Teter, Barbara; Kavak, Katelyn; Kolb, Channa

doi:10.4172/jmso.1000101

Cited by 6 publications

(11 citation statements)

References 39 publications

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“…here is general agreement that pregnancy does not influence disability or progression in women with multiple sclerosis (MS) [1][2][3][4] and some evidence that it confers a favorable long-term prognosis. 5 Despite the fact that pregnancy is no longer discouraged, none of the current disease-modifying therapies (DMTs) is approved for use during pregnancy. Thus, treatment is typically discontinued on confirmation of an unintended pregnancy or when a woman is trying to conceive.…”

mentioning

confidence: 99%

Pregnancy Outcomes from the Branded Glatiramer Acetate Pregnancy Database

Sandberg‐Wollheim¹,

Neudorfer²,

Grinspan³

et al. 2018

International Journal of MS Care

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mentioning

confidence: 99%

Pregnancy Outcomes from the Branded Glatiramer Acetate Pregnancy Database

Sandberg‐Wollheim¹,

Neudorfer²,

Grinspan³

et al. 2018

International Journal of MS Care

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“…Our data hamper us in confirming previous evidence that number of pregnancies may convey a favorable disability prognosis in MS [ 14 , 15 , 16 ]. Previous studies have been conducted to investigate the role of pregnancy on disability progression, supporting that parous wwMS had a lower risk than nulliparous wwMS in reaching EDSS 4.0 and 6.0 [ 10 , 12 , 17 ]. To our knowledge, this is the first study conducted to evaluate whether, within “parous” wwMS, the number of pregnancies (“offspring number”) could be associated with the long-term disability status.…”

Section: Discussionmentioning

confidence: 99%

“…A significant reduction of relapses during pregnancy (70% in the last trimester) was observed, with a sharp rebound to 70% above pre-pregnancy relapse rates during the first three months postpartum [ 3 , 4 ]. Recently, Teter et al [ 12 ] showed that during a mean follow-up period of 5.6 years after delivery, the parous wwMS take a longer time to reach a disability milestone (the use of a cane, EDSS of 6.0). However, other studies showed no effect of parity on disability, even if the follow-up periods tended to be inconsistent or too short (3–12 months postpartum) [ 10 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the last few decades, much effort was made in determining whether pregnancy has long-term effects on the disease course, above all on the disability’s accrual [ 9 , 10 , 11 , 12 ]. Yet, the results are still controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, the results are still controversial. The same is about any difference in terms of the number of pregnancies and the risk of long-term disability [ 12 , 13 ]. Because MS strikes young women during their childbearing age, many women with MS (wwMS) are concerned about the consequences of the childbirth and whether their maternal experience could be even repeated in more than one pregnancy [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Offspring Number Does Not Influence Reaching the Disability’s Milestones in Multiple Sclerosis: A Seven-Year Follow-Up Study

D’Amico

Leone

Patti

2016

IJMS

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Objectives: data on pregnancy long-term effects on multiple sclerosis (MS) course are still controversial; whether experiencing more than one pregnancy exposes one to risk of the disability‘s accrual is still unknown. We investigated differences existing in terms of disability progression among women with MS (wwMS) who had one or more children after their MS onset. Methods: Monoparous and multiparous wwMS were enrolled from the Catania MS Center, Italy, in a monocenter retrospective study. A Cox proportional hazards model was used to examine the effect of the number of parities on time from MS disease onset to EDSS 4.0 and 6.0. The study protocol was approved by the local Ethical Committee. Results: during the seven years of observation, 32.1% and 23.2% of the monoparous group reached expanded disability disease status (EDSS) 4.0 and 6.0 respectively, compared to 13.3% and 3.3% of the multiparous group (p = 0.057 and p = 0.017; respectively). The Kaplan–Meier curve analysis showed no statistically-significant differences between the two groups in reaching the two milestones. The multiparous group showed a longer time to reach the EDSS 4.0 (3.5 vs. 2.6 years, log-rank 0.57, p = 0.45). The Cox regression analysis showed that the EDSS at the time of first pregnancy (Exp(B) 9.4, CI 4.5–19.7, p < 0.001) and the time from MS onset to first pregnancy (Exp(B) 0.96, CI = 0.93–0.98, p < 0.05) were significant predictors of reaching the EDSS 4.0, whereas a model including only the EDSS one year after the first pregnancy significantly predicted (Exp(B) value of 6.4, CI 2.6–15.4, p < 0.001) the reaching of EDSS 6.0. Conclusions: Our results suggest that experiencing more than one pregnancy could not convey a different clinical outcome in wwMS. Further research is needed to confirm our results.

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Pharmacotherapeutic considerations in women with multiple sclerosis

Andersen

Magyari

2020

Expert Opinion on Pharmacotherapy

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Introduction: Multiple sclerosis (MS) is a chronically progressive disease of the central nervous system. The relapsing form of the disease predominantly affects women with onset between the ages 20 to 40 years. Therefore, timing, choice, and treatment options should take pregnancy planning into consideration to accommodate both the needs and safety of the mother and health of the fetus. Areas covered: In this review, the authors discuss and summarize the recent evidence of different pharmacotherapeutic possibilities in the treatment of women with MS. Expert opinion: There is evidence that disease modifying therapy reduces the risk of relapses and diminishes disability progression in people with relapsing MS. The disease is often diagnosed in the childbearing years, and thus pregnancy planning can possibly be a part of the pharmacotherapeutic considerations. The management of women planning pregnancy requires a balancing of risks. The clinician must consider the risks related to treatment discontinuation versus the risk of exposing the developing fetus to drugs that are potential fetotoxic. Randomized controlled trials of medication safety-if used during pregnancy, are prohibited for ethical reasons; hence, the evidence is continuously gathered from observational data, post-authorization studies and pregnancy registries.

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Parity Associated with Long-Term Disease Progression in Women with Multiple Sclerosis

Abstract: Background: Pregnancy in multiple sclerosis (MS) is marked by a decrease in relapse activity with a corresponding rebound in the first months postpartum. Because MS typically occurs during childbearing years, it is important to determine the long term effect of pregnancy.

Cited by 6 publications

References 39 publications

Pregnancy Outcomes from the Branded Glatiramer Acetate Pregnancy Database

Pregnancy Outcomes from the Branded Glatiramer Acetate Pregnancy Database

Offspring Number Does Not Influence Reaching the Disability’s Milestones in Multiple Sclerosis: A Seven-Year Follow-Up Study

Pharmacotherapeutic considerations in women with multiple sclerosis

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