Barts-MS rose-tinted-odometer: ★★ (Indian summer orange #FF7722)
I have always said that women with early MS who start and extend families should have no reason to worry about additional problems with their pregnancy and childbirth because. It may be different for women with more advanced MS who are disabled. Maybe I should revise this general advice based on the study below.
In this study, 15 women with MS had 16 children. The cesarean section rate was 14 out of 16 deliveries or a staggering 87.5% of pregnancies. The main reason for C-sections was given as chronic fatigue and neurological deficits. The latter is interesting in that the mean disease duration of this cohort was less than 10 years with an average EDSS of 2.0. I suspect this cohort is biased and recruited women with MS via a high-risk clinic or an obstetric unit.
These results are incongruent with my experience as an MSologist. What about you? If there are any women with MS reading this post who have had children after being diagnosed with MS did you have a natural vaginal delivery, assisted delivery or a C-section?
Biringer et al. Fatigue as the limiting factor for vaginal birth in patients with multiple sclerosis. Neuro Endocrinol Lett. 2021 Aug 28;42(4):222-228.
Objectives: Multiple sclerosis (MS) is a chronic autoimmune and neurodegenerative disease. This study evaluated pregnancy-related issues in patients with MS in one perinatological centre.
Material and methods: A single-centre, retrospective study of the perinatal period in patients with MS admitted at the Dpt. of Gynaecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University and the University Hospital in Martin, Slovak Republic, European Union from January 1, 2015 to December 1, 2020 was performed. Selected parameters from personal, obstetric, and neurological histories were analysed.
Results: A cohort of 15 patients (32.5±5.3 years) with a relapsing-remitting form of MS gave birth to 16 children. The mean length of MS at the time of delivery was 9±3.6 years. The severity of the Expanded Disability Status Scale score was 2.0±1.5. Caesarean section (CS) was indicated in 14 deliveries (87.5%). It was elective CS in 10 patients. The most common indication for elective CS was a combination of significant chronic fatigue syndrome and neurological deficit (paresis).
Conclusions: The basis for the management of pregnancy, childbirth, and the postpartum period in women with MS is a planned pregnancy based on close cooperation among patients, gynaecologists, and neurologists. Vaginal delivery is not primarily contraindicated. Indications for CS should be considered individually. One way to minimise the indications for CS is a more accurate diagnosis and personalised treatment of fatigue in pregnant women with MS. Presumably, both obstetricians and neurologists prefer vaginal delivery as the first choice in patients with fatigue syndrome.
General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.