Multiple sclerosis (MS) sufferers should not be discouraged from having families, as the view on the prospect of women with MS carrying pregnancies to term is shifting.
Speaking at the recent Cipla Neurology Forum 2017, Dr Tatiana Gorokhova, Medical Director, Growth Markets at Teva Pharmaceuticals, explained that MS patients that want to have children should not be discouraged from doing so. “The facts are that MS is much more prevalent among women than in men, and that at least 50% of pregnancies are unplanned. Research has, however, shown that MS sufferers that receive adequate medical advice before and throughout a pregnancy, can expect to have normal pregnancies,” she says.
Gorokhova explains that a Pregnancy In Multiple Sclerosis (PRIMS) study (performed by Confavreux et al. in 1998) has shown that the mean relapse rate after pregnancy is consistent with this rate in a pre-pregnancy period. “The view in the medical community regarding pregnancy and MS has very much moved away from advising against it, as our understanding of this condition improves. With that said, there are no disease modifying therapies (DMT) that are approved for use during pregnancies. Women with MS would therefore ideally need to halt their DMT treatments when they are trying to get pregnant, and only resume after they have stopped breastfeeding.”
Gorokhova adds that this is likely to lead to relapses, which is why doctors have to advise on when to stop, as well as when and how to resume MS treatments. “Interestingly, the research has also revealed that female MS sufferers experience fewer relapses during pregnancy, owing to hormonal changes leading to restoration of immunotolerance during this period,” she says. According to the doctor, severe relapses of MS during pregnancy can be treated with short courses of corticosteroids. “It is important, however, to note that in the first trimester, corticosteroids are associated with a risk of cleft palate in infants.”
It should be a priority for all female MS patients between the ages of 20 and 49 to receive counselling with regards to family planning and their condition, but there is no reason for any MS sufferer to expect that they have a decreased chance at successful pregnancy.
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