Pregnancy in Multiple Sclerosis

Hellwig, Kerstin

doi:10.1159/000367640

Cited by 57 publications

(68 citation statements)

References 7 publications

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“…A recent study also reported that parity was not independently associated with secondary progression in 277 pregnant MS women with a median disease duration of 17 years [4]. In summary, present data have supported that pregnancy is generally safe for MS patients [5,6,7]. …”

Section: Introductionsupporting

confidence: 78%

Pregnancy Data in a Turkish Multiple Sclerosis Population

et al. 2015

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Background: To conduct the first retrospective clinical study investigating pregnancy in Turkish multiple sclerosis (MS) patients. Summary: We evaluated 558 pregnancies in 199 MS patients and results were compared with general Turkish population's data. The fertility rate in the MS group was found to be lower than that in the general population, even before MS diagnosis was established. Our study suggests that the higher number of pregnancies may have a favorable effect on transition from relapsing-remitting MS to secondary progressive MS, although no effect has been shown regarding the possibility to reach EDSS 6.0 as a milestone. Key Messages: Our data support the conclusion that MS does not have a negative effect on the MS course and disability.

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Section: Introductionsupporting

confidence: 78%

Pregnancy Data in a Turkish Multiple Sclerosis Population

et al. 2015

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“…A U.S. study of women with spinal cord injury found no significant differences between pre- and post-injury pregnancies with regard to the proportions of miscarriages [5]. Similarly, data from Germany indicated that women with multiple sclerosis were not at increased risk of miscarriage [33]. Our multivariable regression analysis did suggest that disability was not as strong a predictor of miscarriage as maternal age, marital status, or health status.…”

Section: Discussionmentioning

confidence: 53%

Live birth, miscarriage, and abortion among U.S. women with and without disabilities

Horner‐Johnson

Kulkarni-Rajasekhara

Darney

et al. 2017

Disability and Health Journal

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Background Prior studies have found that women with disabilities who give birth are more likely to have preterm deliveries and low birthweight infants. However, it is not known what proportion of pregnant women with disabilities experience live birth, versus miscarriage or abortion. Objective To compare proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample. Methods We analyzed pooled Medical Expenditure Panel Survey (MEPS) data from Panels 1–11 (covering years 1996–2007), which included a Pregnancy Detail module assessing outcomes for women who were pregnant during panel participation. We used chi-square tests and multivariable logistic regression to compare disability groups on pregnancy outcomes. Results Among women with a recorded pregnancy outcome, women with disabilities were less likely to have live births (80.8% of women with basic action difficulties and 75.3% of women with complex activity limitations versus 85.0% of women without disabilities), but differences related to disability were not significant when adjusting for covariates. Women with complex activity limitations were significantly more likely to report miscarriages, even when controlling for covariates. Disability was not significantly associated with abortion in the adjusted analysis. Conclusions Our findings add to the growing literature on pregnancy outcomes among women with disabilities, providing important information about outcomes that are not reflected in delivery records. We found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.

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“…These patients experience clinical improvement during pregnancy followed by a temporary ‘rebound’ exacerbation postpartum. Increased levels of a variety of pregnancy-related factors including estrogens (i.e., estradiol and estriol) are detected in maternal blood during pregnancy and many, including cortisol, progesterone, vitamin D, early pregnancy factor, and α-Fetoprotein, have been shown to be immunomodulatory and possess potential neuroprotective properties[82]. Estrogens downregulate the T cell-mediated adaptive immune response, simultaneously activate the innate immune response that tolerates, supports, and regulates fetal development, and confer neuroprotection and reduce relapses in pregnant women with MS[83].…”

Section: Estrogens and Msmentioning

confidence: 99%

Nudging oligodendrocyte intrinsic signaling to remyelinate and repair: Estrogen receptor ligand effects

Khalaj

Hasselmann

Augello

et al. 2016

The Journal of Steroid Biochemistry and Molecular Biology

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Demyelination in multiple sclerosis (MS) leads to significant, progressive axonal and neuronal degeneration. Currently existing immunosuppressive and immunomodulatory therapies alleviate MS symptoms and slow, but fail to prevent or reverse, disease progression. Restoration of damaged myelin sheath by replenishment of mature oligodendrocytes (OLs) should not only restore saltatory axon conduction, but also provide a major boost to axon survival. Our previous work has shown that therapeutic treatment with the modestly selective generic estrogen receptor (ER) β agonist diarylpropionitrile (DPN) confers functional neuroprotection in a chronic experimental autoimmune encephalomyelitis (EAE) mouse model of MS by stimulating endogenous myelination. Recently, we found that the more potent, selective ERβ agonist indazole-chloride (Ind-Cl) improves clinical disease and motor performance. Importantly, electrophysiological measures revealed improved corpus callosal conduction and reduced axon refractoriness. This Ind-Cl treatment-induced functional remyelination was attributable to increased OL progenitor cell (OPC) and mature OL numbers. At the intracellular signaling level, transition of early to late OPCs requires Erk1/2 signaling, and transition of immature to mature OLs requires mTOR signaling; thus, the PI3K/Akt/mTOR pathway plays a major role in the late stages of OL differentiation and myelination. Indeed, therapeutic treatment of EAE mice with various ERβ agonists results in increased brain-derived neurotrophic factor (BDNF) and phosphorylated (p) Akt and p-mTOR levels. It is notable that while DPN’s neuroprotective effects occur in the presence of peripheral and central inflammation, Ind-Cl is directly neuroprotective, as demonstrated by remyelination effects in the cuprizone-induced demyelination model, as well as anti-inflammatory. Elucidating the mechanisms by which ER agonists and other directly remyelinating agents modulate endogenous OPC and OL regulatory signaling is critical to the development of effective remyelinating drugs. The discovery of signaling targets to induce functional remyelination will valuably contribute to the treatment of demyelinating neurological diseases, including MS, stroke, and traumatic brain and spinal cord injury.

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Pregnancy in Multiple Sclerosis

Cited by 57 publications

References 7 publications

Pregnancy Data in a Turkish Multiple Sclerosis Population

Pregnancy Data in a Turkish Multiple Sclerosis Population

Live birth, miscarriage, and abortion among U.S. women with and without disabilities

Nudging oligodendrocyte intrinsic signaling to remyelinate and repair: Estrogen receptor ligand effects

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