Pregnancy, sex and hormonal factors in multiple sclerosis

Miller, David H.; Fazekas, Franz; Montalbán, Xavier; Reingold, Stephen C.; Trojano, María

doi:10.1177/1352458513519840

Cited by 80 publications

(63 citation statements)

References 91 publications

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“…Pharmacotherapy for MS symptoms should be evaluated carefully and limited during pregnancy [Miller et al 2014]. Drugs should be used at their minimum effective doses, for as short a time as possible.…”

Section: Disease Symptomsmentioning

confidence: 99%

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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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Section: Disease Symptomsmentioning

confidence: 99%

“…Pregnancy is a major concern for many patients with multiple sclerosis (MS) Carvalho et al 2014;Miller et al 2014]. MS is the most common acquired neurologic disorder of young adults, short of trauma, with at least 2.5 million individuals affected worldwide.…”

Section: Introductionmentioning

confidence: 99%

Management of women with multiple sclerosis through pregnancy and after childbirth

Coyle

2016

Ther Adv Neurol Disord

121

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“…Experimental studies also showed that androgens exert a protective role against the development of EAE, the animal model of MS [30]. Additionally, therapeutic trials with dihydrotestosterone (DHT) in castrated animals ameliorate both symptoms and inflammation [29,30,40].…”

Section: The Role Of Gender Factors In Paediatric Msmentioning

confidence: 99%

“…In female adolescents with MS, a number of genetic, non-genetic and lifestyle factors have possibly sexually dimorphic effects on MS disease predisposition and on its clinical course [29,30].…”

Section: Disease-modifying Therapies In Pediatric Msmentioning

confidence: 99%

“…Oestrogens (17β-estradiol-E2-and estriol-E3), progesterone and testosterone may provide anti-inflammatory and neuroprotective effects on induction and effector phases of experimental allergic encephalomyelitis (EAE) [29,30]. Anti-inflammatory effects appear mainly mediated by oestrogen nuclear receptors alpha (ERα) and beta (ERβ) expressed by regulatory CD4 + CD25+ T cells (Treg), regulatory B (Breg) cells and dendritic cells and may be abrogated in the absence of B cells and the coinhibitory receptor, Programmed Death-1 (PD-1) on CD4+ Foxp3+ Treg cells.…”

Section: The Role Of Gender Factors In Paediatric Msmentioning

confidence: 99%

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The role of puberty and adolescence in the pathobiology of pediatric multiple sclerosis

Salpietro

Polizzi

Recca

et al. 2018

Mult Scler Demyelinating Disord

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Multiple sclerosis (MS) is increasingly recognized in the paediatric age. In a smaller, but well-established, proportion of paediatric MS patients [20% of total paediatric MS cases: 0.2% to 0.7% of the total MS patients] the onset of disease is before 10 years of age [pre-pubescent (childhood) MS]; in the majority [80%] of paediatric MS patients, however [1.7% to 5.6% of the total MS population], the onset of disease is between 10 and 18 years [post-pubertal (juvenile) MS]. Notably, while pre-pubertal MS occurs almost equally in both genders (female/male ratio = 0.9:1; reverting to 0.4-0.6/1 in pre-school MS children) the female/male ratio rises to 2.2/3:1 in the post-pubertal age. Interestingly, precocious puberty has been associated to: (a) a higher risk of developing MS; and (b) a more severe disease course. In addition to that, males are more susceptible to MS (and manifest more neurodegeneration) than females the latter being however more inflammatory than males; pregnancy however reduces MS relapses. All the above findings led to the suggestion of an underlying female sex hormonal involvement in the pathophysiology of MS vs. a protective role of male sex hormones. Epigenetic perspectives indicate that the interplay between genetic background, environmental triggers and neuroendocrine changes, typically occurring around the time of adolescence, could all play a combined role in initiating and/or promoting MS with onset in the paediatric age including many of the most frequent disease-associated risk factors (e.g., overweight/obesity, low vitamin D levels, reduced sunlight exposure, Epstein-Barr virus infection). According to this proposed complex multifactorial model, susceptibility to MS may be thus acquired during pre-pubertal age and children have probably to wait until the adolescence to manifest their first clinical signs/symptoms.

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Association of Pregnancy With the Onset of Clinically Isolated Syndrome

et al. 2020

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IMPORTANCE Multiple sclerosis (MS) is usually diagnosed in women during their childbearing years. Currently, no consensus exists on whether pregnancy can delay the first episode of demyelination or clinically isolated syndrome (CIS).OBJECTIVE To investigate the association of pregnancy with time to CIS onset. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study collected reproductive history (duration of each pregnancy, date of delivery, length of breastfeeding) on all participants between September 1, 2016, and June 25, 2019. Adult women being treated at the MS outpatient clinics of 4 tertiary hospitals in 2 countries (

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Pregnancy, sex and hormonal factors in multiple sclerosis

Cited by 80 publications

References 91 publications

Management of women with multiple sclerosis through pregnancy and after childbirth

Management of women with multiple sclerosis through pregnancy and after childbirth

The role of puberty and adolescence in the pathobiology of pediatric multiple sclerosis

Association of Pregnancy With the Onset of Clinically Isolated Syndrome

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