Should pregnancy be prescribed as a DMT in MS? #ResearchSpeak #MSResearch #MSBlog
“We have known for sometime that pregnancy has a positive outcome on MS. Relapse rates drop markedly in pregnancy, particularly in the second and third trimesters and tend to rebound after birth. Woman with MS (wwMS) who have no children do worse in the long term compared to wwMS who have multiple pregnancies. In addition, the number of pregnancies add-up; in general the more children you have the better the outcome. The study below from Catania, in Sicily, confirms published findings from other studies. This study is retrospective and hence is not as good as the prospective data on this issue from Sweden and Canada.”
“Should we be prescribing pregnancy as a treatment for MS? If only we could work out what it is about pregnancy that has a positive effect on MS we could then create a state of pseudopregnancy as a treatment for MS. Some investigators think it is the hormonal changes that are present in pregnancy that are responsible for the effect, in particular oestradiol. Others suggest the cytokines (immunological messengers) that are produced by the placenta are responsible for the effect. Pregnancy is a state of relative immunosuppression; a pregnant woman’s immune system undergoes dramatic changes so as not recognise the placenta and foetus as foreign and reject them. If only we could recreate the pregnancy state without having to be physically pregnant then we would have a new treatment for MS; at least for wwMS.”
“The other elephant in the room is that a large number of pwMS decide not to have children or extend their families when they develop MS. The reasons for this are multiple; some of include (1) anxiety about becoming too disabled to manage parenthood, (2) not being able to earn enough money to afford children, (3) anxiety about not having a partner to help with parenthood (pwMS have higher rates of divorce and separation), (4) not wanting to put their own health at risk by having to stop DMTs to fall pregnant, (5) not wanting to expose children to the risks of developing MS themselves, and (6) being depressed and anxious and hence not having the motivation to become a parent. Maybe we should update our survey on parenthood and MS; attitudes may have changed now that we have highly-effective DMTs available. Thoughts?”
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 (one-child) and multiparous (many children) 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 (walking problems) and 6.0 (walking stick). 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.