Multiple sclerosis

Management issues during pregnancy

Simone Ferrero, Stefano Pretta, Nicola Ragni

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Care of pregnant women with multiple sclerosis (MS) is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months post-partum before coming back to its level prior to pregnancy. Gestational history has no influence on long-term disability and MS does not seem to influence pregnancy or the child's health. Apart from methotrexate and cyclophosphamide, most drugs used regularly to treat MS can safely be used by pregnant women. Intravenous steroids may be used with relative safety during pregnancy. Maternal use of azathioprine is not associated with an increased risk of congenital malformations, though impaired foetal immunity, intrauterine growth retardation and prematurity are occasionally observed. Cyclosporin is not teratogenic, but may be associated with growth retardation and prematurity. Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. Cyclophosphamide is teratogenic in animals, but population studies have not conclusively demonstrated its teratogenicity in humans. Until information is available regarding safety, glatiramer acetate, mitoxantrone, interferon-β-1a and interferon-β-1b should be discontinued before an anticipated pregnancy. Women with MS are no more likely to experience delivery complications than are women without MS and the mode of delivery should be decided strictly on obstetrical criteria. Spinal, epidural and general anaesthesia can all be used safely in MS patients. Young women with MS who desire children can be reassured that their infants are not at increased risk of malformations, preterm delivery, low birth weight, or infant death. The progressive nature of the disease may motivate affected women to start or complete their families as soon as possible.

Original languageEnglish
Pages (from-to)3-9
Number of pages7
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume115
Issue number1
DOIs
Publication statusPublished - Jul 15 2004

Fingerprint

Multiple Sclerosis
Pregnancy
Methotrexate
Cyclophosphamide
Interferons
Pregnant Women
Abortifacient Agents
Safety
Mitoxantrone
Fetal Growth Retardation
Epidural Anesthesia
Spinal Anesthesia
Azathioprine
Low Birth Weight Infant
General Anesthesia
Cyclosporine
Immunity
Fetus
History
Steroids

Keywords

  • Birth outcomes
  • Multiple sclerosis
  • Pregnancy
  • Pregnancy complications
  • Prognosis

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Multiple sclerosis : Management issues during pregnancy. / Ferrero, Simone; Pretta, Stefano; Ragni, Nicola.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 115, No. 1, 15.07.2004, p. 3-9.

Research output: Contribution to journalArticle

@article{326d6a37b6374b3dbaa34b24d65fcee7,
title = "Multiple sclerosis: Management issues during pregnancy",
abstract = "Care of pregnant women with multiple sclerosis (MS) is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months post-partum before coming back to its level prior to pregnancy. Gestational history has no influence on long-term disability and MS does not seem to influence pregnancy or the child's health. Apart from methotrexate and cyclophosphamide, most drugs used regularly to treat MS can safely be used by pregnant women. Intravenous steroids may be used with relative safety during pregnancy. Maternal use of azathioprine is not associated with an increased risk of congenital malformations, though impaired foetal immunity, intrauterine growth retardation and prematurity are occasionally observed. Cyclosporin is not teratogenic, but may be associated with growth retardation and prematurity. Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. Cyclophosphamide is teratogenic in animals, but population studies have not conclusively demonstrated its teratogenicity in humans. Until information is available regarding safety, glatiramer acetate, mitoxantrone, interferon-β-1a and interferon-β-1b should be discontinued before an anticipated pregnancy. Women with MS are no more likely to experience delivery complications than are women without MS and the mode of delivery should be decided strictly on obstetrical criteria. Spinal, epidural and general anaesthesia can all be used safely in MS patients. Young women with MS who desire children can be reassured that their infants are not at increased risk of malformations, preterm delivery, low birth weight, or infant death. The progressive nature of the disease may motivate affected women to start or complete their families as soon as possible.",
keywords = "Birth outcomes, Multiple sclerosis, Pregnancy, Pregnancy complications, Prognosis",
author = "Simone Ferrero and Stefano Pretta and Nicola Ragni",
year = "2004",
month = "7",
day = "15",
doi = "10.1016/j.ejogrb.2003.10.020",
language = "English",
volume = "115",
pages = "3--9",
journal = "European Journal of Obstetrics, Gynecology and Reproductive Biology",
issn = "0028-2243",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Multiple sclerosis

T2 - Management issues during pregnancy

AU - Ferrero, Simone

AU - Pretta, Stefano

AU - Ragni, Nicola

PY - 2004/7/15

Y1 - 2004/7/15

N2 - Care of pregnant women with multiple sclerosis (MS) is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months post-partum before coming back to its level prior to pregnancy. Gestational history has no influence on long-term disability and MS does not seem to influence pregnancy or the child's health. Apart from methotrexate and cyclophosphamide, most drugs used regularly to treat MS can safely be used by pregnant women. Intravenous steroids may be used with relative safety during pregnancy. Maternal use of azathioprine is not associated with an increased risk of congenital malformations, though impaired foetal immunity, intrauterine growth retardation and prematurity are occasionally observed. Cyclosporin is not teratogenic, but may be associated with growth retardation and prematurity. Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. Cyclophosphamide is teratogenic in animals, but population studies have not conclusively demonstrated its teratogenicity in humans. Until information is available regarding safety, glatiramer acetate, mitoxantrone, interferon-β-1a and interferon-β-1b should be discontinued before an anticipated pregnancy. Women with MS are no more likely to experience delivery complications than are women without MS and the mode of delivery should be decided strictly on obstetrical criteria. Spinal, epidural and general anaesthesia can all be used safely in MS patients. Young women with MS who desire children can be reassured that their infants are not at increased risk of malformations, preterm delivery, low birth weight, or infant death. The progressive nature of the disease may motivate affected women to start or complete their families as soon as possible.

AB - Care of pregnant women with multiple sclerosis (MS) is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months post-partum before coming back to its level prior to pregnancy. Gestational history has no influence on long-term disability and MS does not seem to influence pregnancy or the child's health. Apart from methotrexate and cyclophosphamide, most drugs used regularly to treat MS can safely be used by pregnant women. Intravenous steroids may be used with relative safety during pregnancy. Maternal use of azathioprine is not associated with an increased risk of congenital malformations, though impaired foetal immunity, intrauterine growth retardation and prematurity are occasionally observed. Cyclosporin is not teratogenic, but may be associated with growth retardation and prematurity. Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. Cyclophosphamide is teratogenic in animals, but population studies have not conclusively demonstrated its teratogenicity in humans. Until information is available regarding safety, glatiramer acetate, mitoxantrone, interferon-β-1a and interferon-β-1b should be discontinued before an anticipated pregnancy. Women with MS are no more likely to experience delivery complications than are women without MS and the mode of delivery should be decided strictly on obstetrical criteria. Spinal, epidural and general anaesthesia can all be used safely in MS patients. Young women with MS who desire children can be reassured that their infants are not at increased risk of malformations, preterm delivery, low birth weight, or infant death. The progressive nature of the disease may motivate affected women to start or complete their families as soon as possible.

KW - Birth outcomes

KW - Multiple sclerosis

KW - Pregnancy

KW - Pregnancy complications

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=3042561472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3042561472&partnerID=8YFLogxK

U2 - 10.1016/j.ejogrb.2003.10.020

DO - 10.1016/j.ejogrb.2003.10.020

M3 - Article

VL - 115

SP - 3

EP - 9

JO - European Journal of Obstetrics, Gynecology and Reproductive Biology

JF - European Journal of Obstetrics, Gynecology and Reproductive Biology

SN - 0028-2243

IS - 1

ER -