Who was helped by pregnancy to get rid of multiple sclerosis? Multiple sclerosis and pregnancy. Features of the course of pregnancy, childbirth and the postpartum period in women with multiple sclerosis. The results of observations of patients in this group in

Pregnancy and multiple sclerosis - with this combination, a person must consciously approach the solution of the problem. Future parents are worried about whether their child will inherit this disease, whether they will be able to raise it to their feet, and give everything their children need. The fears are quite justified, but the risk that the child will suffer from multiple sclerosis is small, although such a possibility is not excluded. Doctors say MS is not hereditary. But still, there were cases when a child born from a sick mother with age also suffered from multiple sclerosis. The risk of developing sclerosis in a child increases if there are several people in the family with this ailment.

In addition, when planning a pregnancy, it is worth considering further actions. After all, a mother or parents, perhaps, can become disabled - can they give a full-fledged upbringing to a child, from whom help will follow in case of unpredictable consequences. The financial issue is also important.

Multiple sclerosis is one of the diseases of the central nervous system. It is characterized by the onset of inflammation in the brain and spinal cord. Inflammation is a demyelinating process. Myelin is a lipid substance that serves as an insulator for nerve fibers and helps nerve impulses to be quickly transmitted along them. It is myelin that ensures the speed and safety of the transmission of impulses throughout the body, thanks to which a person is able to make quick movements. If a person has multiple sclerosis, then myelin is destroyed, and impulses in the body, coming from the brain, begin to be transmitted more slowly.

Where myelin used to be, scars form, that is, connective tissue grows and turns into areas of sclerosis. Such areas at different times can appear in several areas of the spinal cord and brain. They are scattered in many places, hence the name - multiple sclerosis.

The disease is chronic in nature, in the process the nervous system is slowly destroyed, from which the moral and physical state of a person suffers. MS affects people of all ages. If it appeared at a young age, then from the moment of exacerbation to the next outbreak of the disease, it can take a long time, up to several years of remission. But when the disease returns again, it will manifest itself in full force. In modern society, more and more patients with MS appear, and the bulk of them are women.

Multiple sclerosis in pregnancy is beneficial in the sense that the woman is healed at this time. Prolactin released during pregnancy helps to restore dead nerve cells. And myelin starts to be produced again.

As you know, the destruction of myelin occurs due to the extinction of the immune system, and during pregnancy, the body begins with renewed vigor to produce all the missing substances in the body, preparing for the birth of a baby.

Therefore, we can conclude that pregnancy during MS is not dangerous, but in a sense it is also beneficial.

Multiple sclerosis can coexist with pregnancy quite calmly; no exacerbations of the disease occur during this period. MS does not affect gestation or childbirth. Experience shows that there is no risk of complications during pregnancy, however, in the first six months after the birth of a child, there is a possibility of an exacerbation of the disease.

Other unforeseen circumstances due to the fault of multiple sclerosis cannot occur. It does not cause miscarriages, congenital anomalies, infertility or other perinatal problems.

Symptoms and signs of multiple sclerosis in pregnancy

Symptoms of the disease can be different depending on the severity of the disease. If the disease is at an initial stage, then it may be numbness of the limbs, weakness in the muscles. With a progressive condition, paralysis, tremors and partial or complete loss of vision occur. The disease is not fatal, but you cannot completely get rid of it.

Symptoms may disappear and reappear because MS is characterized by flare-ups and remissions.

With minor symptoms, it is quite difficult to diagnose the disease, usually patients write off the unpleasant sensations for fatigue or other illnesses, without consulting a doctor for a long time. This is especially difficult during pregnancy, since the following symptoms are typical for this period:

1. Numbness.
2. Bowel disorder.
3. Frequent urge to urinate.
4. Feeling tired.
5. Frequent mood swings.
6. Impaired concentration, forgetfulness.

Pregnancy planning

If multiple sclerosis was diagnosed before pregnancy, then the woman is already undergoing treatment. If pregnancy is planned, you must first consult a doctor. Many medications used for MS are not compatible with pregnancy. In addition, other medical procedures and dietary nutrition can negatively affect the development of the fetus.

Any drug prescribed for the treatment of multiple sclerosis should be discussed with your doctor. Be sure to find out how it might affect your child's development.

Medication use during pregnancy

It is known that during pregnancy it is better to stop taking medications or limit their dosage. Here is a list of medications prescribed for MS that are not recommended when taking a baby:

1. Interferon. Interferon is allowed until the exact definition of pregnancy; as soon as a woman found out about her situation, his reception should be canceled.
2. Glatiramer acetate. It is also contraindicated in pregnancy, while planning for conception, its use is allowed.
3. Natalizumab. There is no data available on this drug during pregnancy. In order not to risk it, it should not be used, but if the need arises, it is allowed in small doses.
4. Fingolimod. The drug is considered toxic, therefore it is contraindicated during pregnancy. The drug should be canceled two months before planning conception.

Multiple sclerosis childbirth

Since the woman in labor is not easy, the medical staff must be aware of the disease. The development of paralysis is not uncommon in this disease, in addition, sensitivity may be absent, a woman should be constantly monitored by experienced doctors. In this state, a woman may not feel the onset of labor or the need to urgently induce labor. Such women in labor also have problems with the introduction of epidural anesthesia, this issue is decided by the anesthesiologist on an individual basis.

After the birth of the baby, a woman can safely start breastfeeding. It is believed that there are no contraindications to this, lactation cannot affect the frequency of attacks and exacerbation of the disease. Some mothers may experience increased fatigue when feeding; in this case, the transition to artificial feeding of the child is not prohibited.

Sclerosis attacks after childbirth

It is believed that MS attacks occur more frequently in the first 6 months after childbirth. However, such indicators are observed in only 30% of women.

Possible reasons for this feature include:

1. The woman suffered from frequent seizures even before pregnancy.
2. During pregnancy, the seizures were repeated several times.
3. Before pregnancy, a woman was given a predisposition to disability.

Sometimes a woman may mistakenly believe that pain relievers during pregnancy and lactation can affect the frequency of attacks. This is not true.

It occurs more often in women who are of childbearing age than in anyone else. Pregnancy does not cause sclerosis, but because the disease affects women in their 20s and 50s, some can get sick during pregnancy.

Symptoms and signs of multiple sclerosis in pregnancy

Symptoms of this disorder are mild (lung numbness, muscle weakness) and quite severe (paralysis, tremors, and loss of vision). Although the disease is not fatal, it is chronic, that is, people who are sick with it are not able to recover until the end of their lives.

Symptoms may come and go for months or more. Multiple sclerosis can be difficult to diagnose if symptoms are mild, especially during pregnancy. Some of the signs of the disease - numbness, bowel and bladder problems, fatigue and frequent mood swings, inability to concentrate and forgetfulness - are very similar to conditions associated with pregnancy.

Treatment of multiple sclerosis in pregnancy

Scientists have developed several drugs that help change the usual course of the disease. These medications are more beneficial if taken in the early stages of the disease. If you have symptoms of the disease, see your doctor.

How multiple sclerosis affects pregnancy

For women who become pregnant with multiple sclerosis or get sick during pregnancy, there is good news: studies have shown that the disease does not harm the baby. In fact, pregnancy may even help some sick women. It has been observed that during pregnancy, some patients have fewer seizures than usual. A woman suffering from this disease requires special attention during childbirth. After she gives birth to a baby, exacerbations may occur more often, 3-6 months after childbirth. However, long-term studies have shown that patients with multiple sclerosis who have given birth to a child suffer less from this pathology than those who did not give birth.

For citation: S.V. Kotov, T.I. Yakushina Multiple sclerosis and pregnancy. Features of the course of pregnancy, childbirth and the postpartum period in women with multiple sclerosis. The results of observations of patients in this group in the Moscow region // RMZh. 2015. No. 12. P. 720

Introduction

Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system that mainly affects young people of working age and leads to the gradual development of permanent disability. The disease is characterized by a variety of clinical manifestations. The lack of a complete understanding of the etiology and pathogenesis of the disease, the difficulties of treatment, as well as significant economic costs in providing assistance to such patients make the problem of MS therapy relevant in all countries of the world. Recent epidemiological studies have shown that in terms of the prevalence of this disease, Russia is in the zone of medium risk, and, according to various authors, the frequency of MS varies from 15.4 to 54.4 per 100 thousand population. Women suffer from this disease more often (ratio of men to women 1: 1.99). It is noted that 70% of patients with MS begin between the ages of 20 and 40.

In recent years, the following trends have been observed: an increase in its prevalence rate, an increase in the number of MS cases in “atypical” age groups, ie, with onset at the age of under 18 and over 45, especially the number of patients among children and adolescents has increased. The increase in the total number of MS patients is associated both with a true increase in the incidence and life expectancy of patients, and with an improvement in the diagnosis of the disease.

The diagnosis of MS is made on the basis of clinical follow-up of patients and data from magnetic resonance imaging (MRI) with contrast. MS is considered confirmed when the process is spread in space and in time (McDonald criteria 2005 and 2010). The disease proceeds in waves with exacerbations and remissions, or has a primary or secondary progressive course.

Pathogenetic immunomodulatory therapy for MS is aimed at treating exacerbations, preventing them, and increasing the period of remission. Exacerbations of the disease are stopped by short courses of hormonal therapy (pulse therapy with methylprednisolone) and / or plasmapheresis. In order to prevent exacerbations, drugs are prescribed that change the course of MS (abbreviated PITRS), which are divided into drugs of the first (interferons beta, glatiramer acetate) and second (new) (natalizumab, fingolimod) generations, immunoglobulins. In addition, patients need to undergo symptomatic treatment in order to eliminate those symptoms of the disease that interfere with their daily life. Social adaptation is also necessary, allowing them to adapt to the existing manifestations of the disease and maximize the quality of life.

Due to the high prevalence of MS among women of reproductive age, the neurologist often has to act as an expert in planning and managing pregnancy. Patients are most interested in questions about the likelihood of inheriting MS, the risks associated with pregnancy, childbirth and the need to discontinue MS modifying drugs (MSMD), the possibility of breastfeeding and the prognosis of the further course of the disease. Until the 90s. In the last century, conflicting opinions have been expressed regarding the impact of pregnancy on the course of MS. Over the past 20 years, there has been a global inversion of views on this problem, due to a number of reasons: the emergence of MDDMS, which significantly improved the quality of life of patients and slowed down the progression of the disease; publication of the results of international observations of the course of pregnancy in patients with MS (PRIMS); certain successes in the study of the pathogenesis of the disease. A number of studies have shown that the incidence of complications during pregnancy and childbirth in patients with MS corresponds to that in the general population, and pregnancy itself has a positive, stabilizing effect on the course of the disease. Despite a large amount of research, the problem of pregnancy in MS remains unresolved.

Let's take a look at the most common questions that patients and medical practitioners inevitably face.

Question 1. Is MS a hereditary disease? What is the risk of having a potentially sick child? What is the likelihood of the disease manifesting in future generations?

MS is not an inherited genetic disorder, but there is a genetic predisposition to its development. A study using the twin method showed that the likelihood of MS in a second monozygous twin was 30%, while in a heterozygous twin it was only 4%. Hereditary predisposition is also confirmed by the fact that, in couples, 14% of clinically healthy monozygotic twins with MS have MRI changes typical of MS.

For the general population, the risk of developing the disease is not so high: it is 0.2%; in families of MS patients, the risk of developing the disease increases to 20%. Recently, however, there has been an increasing number of descriptions of familial MS cases, differing in earlier onset and some features of the course of the disease.

Question 2. Do pregnancy, childbirth and artificial termination of pregnancy affect the frequency of exacerbations? Childbirth or abortion? What is the most adverse effect on the course of the disease?

A few years ago, the question of carrying a pregnancy in MS was decided categorically: it is impossible to become pregnant with MS, and in the event of a pregnancy, it must be terminated. This position was based on the arguments that the risk of exacerbations increases significantly in the postpartum period. This issue has now been revised. According to the Pregnancy in Multiple Sclerosis (PRIMS) study, the frequency of exacerbations during pregnancy decreases by 70% by the third trimester and increases by 70% in the postpartum period, with 30% of exacerbations occurring in the first 3 months. ... The increase in exacerbations in the postpartum period is associated with both a change in the hormonal background of the mother, the stressful influence of the birth itself on the woman's body, and with an increased load due to caring for the child.

Long-term studies show that the presence of MS in a mother does not affect the incidence of preterm birth, mortality or neonatal morbidity. Artificial termination of pregnancy provokes hormonal stress in a woman's body and, conversely, causes a more significant intensification of the disease than its natural completion.

Question 3. How does pregnancy affect the course of MS? Will the woman's condition worsen during pregnancy and in the postpartum period?

From a modern point of view, pregnancy has a beneficial effect on the course of many autoimmune diseases, including MS. The reason for this is the immune restructuring in a woman's body during pregnancy, which is accompanied by immunosuppression. Hormonal changes occurring during this period are accompanied by an increase in the level of estriol, 17-beta-estradiol, progesterone and prolactin. Estrogens and progesterone inhibit nitric oxide and inhibit the production of certain pro-inflammatory cytokines (tumor necrosis factor α) by microglia cells, which ultimately leads to inhibition of immune processes. Increased production of calcitriol, a protein that inhibits lymphocyte production and proliferation of pro-inflammatory cytokines, also contributes to immunosuppression. The effect of pregnancy on the body is in many respects similar to the effect of PITRS, the therapeutic effect of which is realized due to immunosuppression.

After childbirth, the level of these hormones gradually returns to normal and the immune activity increases again. However, with repeated pregnancies, the trace concentration of these substances in the blood of women remains at a higher level than that of nulliparous women.

Question 4. Does pregnancy affect the progression of MS? What is the likelihood of MS progression in the puerperium?

According to the data of many years of research, it has been shown that in most women who have given birth, the disease progresses more mildly, later passes into the stage of secondary progression (compared with nulliparous patients), they remain able to work longer, and later lose social adaptation. At the same time, there is an inverse correlation between the number of births and the degree of disease progression. According to the Moscow Multiple Sclerosis Center, women with MS who have not had pregnancies have a 3.2 times higher risk of transition to a secondary progressive course of the disease than women who have had pregnancies. A full-term pregnancy increases the time interval until the EDSS score is 6.0 points by 50%.

Question 5. What caused exacerbations in the postpartum period? Does the stress associated with caring for a newborn increase the frequency of exacerbations? Will a woman be able to care for a child on her own?

According to the Confavreux study (1998), the most dangerous in terms of exacerbation of the disease is the postpartum period. In France, a Popartmus study was conducted in which pregnant women received 10 mg of progestin and used a patch with 100 μg of estriol throughout pregnancy and in the postpartum period. According to the data obtained, the number of postpartum exacerbations in this group was significantly reduced. Exacerbations occurring in the first months after childbirth can be triggered not only by hormonal changes, but also by the stressful influence of the childbirth itself, as well as a significant increase in physical exertion associated with caring for the child. Increased fatigue after childbirth, lack of sleep, breastfeeding, the danger of a possible postpartum exacerbation of the disease lead to a rapid depletion of the body, can prevent the mother from fully caring for the baby and require a switch to artificial feeding. During this period, active help from relatives and friends is needed. Stress and hormonal changes in the body can serve as an impetus to provoke an exacerbation of the disease.

Question 6. How do drugs that change the course of multiple sclerosis (MSITS) affect the course of pregnancy and the fetus? Can they be used during pregnancy? What is the optimal timing for drug withdrawal? What medicines can be used during pregnancy and lactation? How to stop exacerbations? Is it safe to use hormone therapy during pregnancy and breastfeeding? Alternative treatment?

Currently, MS patients are prescribed medications that modify the course of MS for preventive purposes. All women of childbearing age with MS should be warned about the need to use contraception during treatment and discontinue immunomodulatory and immunosuppressive therapy during pregnancy planning. If pregnancy does occur, treatment should be discontinued before the baby is born and resumed immediately after delivery or after breastfeeding has ended. In the literature, there are fragmentary descriptions of cases of continued treatment with interferons beta and glatiramer acetate during pregnancy, followed by the birth of healthy children. In Europe, 28 women (37 pregnancies) were followed up who continued glatiramer acetate throughout their pregnancy. 28 women gave birth to healthy children at term, in 7 - the pregnancy continues, 2 pregnancies were interrupted when a trisomy of 21 pairs of chromosomes was detected in the fetus (not associated with the use of the drug).

In Novosibirsk, an observational study of 40 pregnant women was carried out on the background of MITRS therapy. 15 patients planned pregnancy and canceled PITMS in advance, 25 women stopped taking drugs in the first trimester of pregnancy. According to the data obtained, long-term previous therapy with immunomodulatory drugs and maintenance of therapy in the first trimester of pregnancy reduced the risk of exacerbations in the postpartum period.

In general, no convincing data on the possibility of using PITMS during pregnancy have been obtained so far. None of the drugs belonging to this group is recommended during pregnancy, therefore, the question of their withdrawal is currently being resolved unequivocally: upon confirmation of pregnancy, the intake of PITMS should be discontinued. Treatment can only be resumed at the end of pregnancy or breastfeeding. According to the recommendations of the National MS Society recommendations (USA), a woman should stop treatment with interferons and glatiramer acetate for one full menstrual cycle before attempting to conceive a child. Fingolimod and natalizumab therapy should be discontinued within 2 months. before the expected pregnancy. It is necessary to take into account the effect of the aftereffect of cytostatics: if the patient received mitoxantrone, cyclophosphamide or methotrexate, then pregnancy is undesirable for six months after their cancellation.

The US Federal Drug Administration (FDA) and the European Medicines Agency (EMA) classify all drugs into different categories based on their effect on the fetus. In animal studies, a minimal teratogenic effect of glatiramer acetate was revealed, which was the reason for its classification by the US FDA as category B (no or minimal effect on the fetus).

Interferons beta, fingolimod, mitoxantrone and natalizumab after numerous studies have been assigned to category C (in animal studies, a negative effect on the fetus has been shown).

The cytostatics cyclophosphamide and methotrexate have an even more pronounced teratogenic effect, and therefore they are classified as category D (a clear risk to the fetus, use during pregnancy is strictly prohibited).

In the event of an exacerbation during pregnancy, it is possible to prescribe short intravenous courses of corticosteroids. Preference is given to the drug methylprednisolone, since, unlike dexamethasone, it is metabolized in the body before passing the placental barrier. Its use is safe from the second trimester. The drug can be prescribed in exceptional cases (for health reasons) and in the first trimester of pregnancy. There are descriptions of individual cases of the use of hormonal therapy and plasmapheresis for the relief of severe exacerbations in early pregnancy with the subsequent birth of healthy children. However, after stopping the exacerbation, such patients should be sent for medical-genetic and gynecological examination to resolve the issue of the possibility of prolonging the pregnancy.

During lactation, if it is necessary to relieve exacerbations, the introduction of methylprednisolone is also not contraindicated.

It is considered safe to use immunoglobulin therapy during pregnancy.

Question 7. What examination methods are safe during pregnancy and lactation? Can MRI be done? At what time of pregnancy is MRI safe for the fetus? Can a contrast agent be injected to search for active lesions?

Throughout pregnancy, it is necessary to conduct a dynamic study of the patient's neurological status with a mandatory assessment on the EDSS scale to determine possible exacerbations of the disease and analyze the condition in the postpartum period.

MRI of the brain and spinal cord without contrast enhancement is possible starting from the second trimester of pregnancy. Contrast administration is not indicated throughout pregnancy.

To verify exacerbation, it is possible to study the state of lymphocytes, the activity of which increases during exacerbation (the amplitude of their oscillations in a magnetic field and morphometric indicators of lymphocyte nuclei increase). This type of research is safe for pregnant women, since it consists in taking venous blood from the patient. The preliminary results of the study are ready in a few hours.

Question 8. What methods of obstetrics and pain relief during labor are permissible in MS? Is it possible to give birth on my own or is a caesarean section necessary? What types of anesthesia (general, epidural, local infiltration) are acceptable for MS?

There are no contraindications to spontaneous delivery in a natural way in patients with MS; according to numerous observations, childbirth in patients proceeds without serious complications. Other methods of delivery are prescribed by obstetricians-gynecologists for medical reasons. In the process of obstetrics, all types of anesthesia (general, epidural, local infiltration) can be used. These issues should be addressed individually by the anesthesiologist and obstetrician.

Question 9. Is breastfeeding acceptable? Can MS modifying drugs (MSMD) be used while breastfeeding? What is the optimal timing for resuming MDDMS therapy? What is the optimal timing for breastfeeding in MS?

According to the FDA, all drugs used during lactation are classified according to the degree of safety into different categories (from L1 (the drug is safe) to L5 (the drug is contraindicated)). Drugs: glatiramer acetate, interferons, and natalizumab are categorized as L3 (moderate safety). Fingolimod belongs to the L4 category (high hazard), mitoxantrone - L5 (contraindicated). However, full-fledged studies on this problem have not been carried out, therefore, treatment with immunomodulatory drugs during breastfeeding should be discontinued. The most optimal is considered to be breastfeeding up to 3 months. (in rare cases - up to 6 months), then the child should be transferred to artificial feeding, and the mothers are again prescribed PITRS.

Question 10. Is it necessary to discontinue PITMS therapy for men with MS and planning to conceive a child?

Drugs that alter the course of MS (MITS), of the first and second generation, namely interferon beta 1-a and beta 1-b, glatiramer acetate, fingolimod, natalizumab, do not need to be canceled. These drugs, used by a man, do not enter the fetal bloodstream and, accordingly, do not have a teratogenic effect.

Cytostatics (mitoxantrone, cyclophosphamide) - it is recommended to cancel 6 months before. before the planned conception due to their possible influence on spermatogenesis.

Question 11. How does the disease itself affect the course of pregnancy and fetal development? What are the chances of having a healthy baby? What is the ratio of healthy childbirths in MS patients to healthy women?

This question can be answered based on our own observations. Since 2004, neurologists at the Moscow Regional Research Clinical Institute named after V.I. M.F. Vladimirsky, a targeted consultative reception of patients with MS is under way, and a clinical and epidemiological study of MS is being carried out in the Moscow Region. At the moment, more than 2.5 thousand patients with a reliable diagnosis of MS have been identified in the Moscow region, of which 33.5% are men and 66.5% are women. The average prevalence of MS in the Moscow region over the observation period was 28.7, which makes it possible to classify the Moscow region as a zone of average risk for MS (from 10 to 50 cases per 100 thousand population, according to K. Lauer, 1994). Every year there is an increase in the number of patients suffering from this disease, both due to a true increase in the incidence, and due to an improvement in the quality of diagnosis and treatment.

We examined 81 pregnant women suffering from MS. Of these, 77 had a remitting course, and 4 had a secondary progressive course of the disease. The age of women ranged from 20 to 43 years (average 29.2 years). The duration of the disease at the time of pregnancy ranged from 0 to 15 years. Long-term remission before pregnancy (more than 2 years) was observed in 49 patients, 1 year - in 14, less than 1 year - in 16 people, the onset of the disease during pregnancy - in 2 patients. In 39 women this pregnancy is the first, in 24 - the second, in 9 women - the third, in 4 - the fourth, in 5 - the fifth. 42 patients had the first birth, 24 had the second, 3 had the third, and 4 had the fourth birth. In 12 patients, previous pregnancies ended in abortion (spontaneous miscarriage) in the early stages (frozen pregnancy, fetal death). 48 women have a history of 1 to 3 medical abortions. Exacerbation after termination of pregnancy was noted in 7 patients.

45 women received MDMS therapy, of which 26 people took glatiramer acetate, 12 people received interferon beta 1-a, 3 patients received interferon beta 1-a, and cladribine (Cladribine, Multiple sclerosis, 2005–2007) - 2 human, mitoxantrone - 2 patients. 36 women did not receive PITRS therapy.

Planned pregnancy with early drug withdrawal (from 3 months to 2 years) was registered in 12 cases, drug withdrawal in the first trimester (after pregnancy) - in 29 cases. In 4 cases, there was a late withdrawal of the drug due to subjective reasons at a gestational age of 3-5 months: 3 of them received glatiramer acetate, 1 - interferon beta 1-c.

With the help of IVF, pregnancy occurred in 2 cases. One of the patients, who did not receive immunomodulatory therapy, gave birth to a healthy child. The second patient underwent IVF treatment with glatiramer acetate therapy. In both cases, healthy children were born.

In the observation group, 34 women had pregnancy without complications, 46 had toxicosis in the first trimester, and 5 had a threat of termination in the early stages (from 8 to 12 weeks). In the third trimester, pathological abnormalities were observed in 3 women: 1 - anemia of pregnant women, 1 - toxicosis with the threat of premature birth, 1 woman developed diabetes mellitus.

Exacerbations of the disease during pregnancy were recorded in 7 women: in 2 in the first trimester, in 4 in the second and in 1 in the third. Exacerbations after pregnancy occurred in 21 patients: in 4 - after 1–3 months. after childbirth, in 10 - after 3–6 months, in 6 - after 6–12 months. In 1 woman, exacerbation occurred after 18 months. after childbirth. All patients received pulse therapy with methylprednisolone.

Delivery on time (38–41 weeks) took place in 46 women. 19 patients gave birth at 36–38 weeks, in 4 - at 42 weeks.

Spontaneous childbirth was observed in 44 people. 25 patients underwent a caesarean section for obstetric indications (caesarean section in previous births, the threat of infection of the fetus, abnormal presentation of the fetus, diabetes mellitus, congenital dislocation of the hip joint in the mother, cerebral palsy in the mother, weakness of labor). 12 women are currently at different stages of pregnancy.

In patient M. (39 years old), who received cladribine therapy 5 years before this pregnancy, ultrasound revealed a 6-week delay in fetal development, as well as multiple malformations. In connection with the identified violations, a high risk of intrauterine fetal death to a woman at 37 weeks. stimulation of labor activity was carried out. A boy with a body weight of 1460 g was born with a diagnosis of intrauterine growth retardation, cerebral palsy (left arm paresis), multiple heart defects. The child died in the perinatal period. The second patient T. (39 years old), who also took part in the study of cladribine, delivered on time, without complications. A healthy boy was born weighing 3400 g. In the first trimester, there was a slight toxicosis.

Two women received a history of mitoxantrone therapy. Both drugs were discontinued more than 2 years before pregnancy. Patient E. has VPT disease. EDSS at the time of delivery - 3.0 points. Pregnancy was uneventful, childbirth at the 38th week. A girl weighing 2,920 g was born. Patient L. has a relapsing course of the disease with frequent exacerbations. EDSS at the time of delivery - 3.5 points. Pregnancy proceeded with the threat of premature birth at 28 weeks. Childbirth at 34 weeks A boy weighing 2140 was born. Neonatal pathology was not revealed.

There were no deviations from the normal course of pregnancy and childbirth in women who did not receive MITRS therapy, as well as in women while taking glatiramer acetate and interferons. In total, 46 girls and 25 boys were born. Twins were born in 2 cases. The weight index of newborns ranged from 2800 to 4000 g. Three children were born with a large weight - from 4150 to 4800 g, 9 newborns had a body weight deficit from 1460 to 2770 g.

All children were born alive. However, in patient B., 24 years old, the child died on the 3rd day from a birth injury (severe asphyxia during labor due to breech presentation and entanglement with the umbilical cord). Patient M., 39 years old, who received cladribine therapy, had a boy with intrauterine growth retardation, cerebral palsy (left arm paresis), multiple heart defects. The child died in the perinatal period. Patient Y., 30 years old, the death of a child at the age of 6 months. came as a result of severe hereditary pathology (Werdnig-Hoffmann disease). One newborn was diagnosed with craniostenosis, three were immature at birth, two were hypotonia, and one was diagnosed with spastic torticollis.

Of 69 women who gave birth, 35 breastfeeding lasted up to 3 months, in 14 - up to 6 months, in 12 people - up to 1 year or more. In 8 patients, the lactation period was absent.

Conclusion

MS is not an inherited genetic disorder, but there is a genetic predisposition to its development.

MS and treatment with PITRS are not contraindications to pregnancy and childbirth.

Long-term previous therapy with immunomodulatory drugs significantly reduces the risk of exacerbations in the postpartum period.

The management of pregnancy and childbirth in MS patients does not differ from that in the general population. Patients with MS have no contraindications to spontaneous childbirth.

During pregnancy and lactation, PITMS therapy should be suspended.

In the event of an exacerbation, a short course of pulse therapy with methylprednisolone is possible.

The risk of complications and pathology in newborns during previous therapy with immunomodulators does not exceed that in the general population. Against the background of immunosuppressive therapy, the risk of having children with pathology (multiple malformations, low birth weight, prematurity) increases.

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18 hours ago, Wave Runner said:

Hello everyone!

I have been reading this forum for a long time, I have been sick with MS for a long time (10 years) and have long dreamed of pregnancy.

The path was difficult and long, and exacerbations, and miscarriages, and attempts at IVF, exacerbations after them, then I took Tizabri for two years and a miracle happened, I became pregnant on my own.

It is now the 5th month, everything is fine with the baby.

I have a question for mothers who have already given birth, what would you do in my place, feed or still not?

My pregnancy has so far passed without exacerbations, but for almost six months now, I've been without Tysabri, and the neurologist says that I need to put an IV drip on the day of birth and no feeding.

The fact is that the last exacerbations (before taking Tysabri) were severe, for two months, I practically did not see and could not walk.

Now I have almost recovered, only a little numbness on the left side.

Reason tells me, and do not think about feeding, the baby needs a healthy mother, and no risks.

well, feelings .. everyone understands everything.

The MRI showed 13 lesions in the head for the last time, 3 in the spinal cord.

Mothers who have been on IV from the very beginning, mothers who have been feeding for only two months, mothers who have been on GW for a long time, knowing about the diagnosis and having a serious history of the disease, answer me everything, please!

Thanks in advance to everyone!

In my experience it is best not to feed and go straight to therapy. I have four children, two of whom I gave birth to with a diagnosis. Looking back, I understand that the first symptoms appeared at school, was registered with a neurologist, but they could not make a diagnosis, did not do an MRI, and as a result, when the diagnosis was made in 2011, there were multiple foci. The first serious exacerbation just hit in 2011, when she was breastfeeding. After the birth of my third child, immediately after discharge from the hospital, they switched to formula and I started giving injections. As a result, the first year of MRI without negative dynamics, the state of health is also normal. Now the fourth child is 2 months old. I wanted to breastfeed for up to six months, but in the end, at 1.5 months, they switched to the mixture, vision began to fall and dizziness began. From personal experience, I can say that first of all you need to look at your well-being, healthy people find it difficult to have such a regime, and if with our diagnosis, then turn off the light altogether. After all, these are night feedings every two hours for 30 minutes on average, colic, diet, you also need to do work around the house, iron diapers and a bunch of other things. So my opinion is that the aggravation from overwork after childbirth and if there are no assistants who will help, then it is better not to take risks, they correctly say that the child needs a mother first of all. By the way, I fed the third child the least of all, only 2 weeks and he is the healthiest for me, and began to develop faster than everyone else, ugh ugh ugh)) health to you and the baby, and most importantly, peace of mind)

Overview of Multiple Sclerosis

Multiple sclerosis- a chronic autoimmune disease of the nervous system. What does this mean? The immune system of healthy people works to protect the body from "uninvited guests" - viruses, bacteria, fungi, protozoa, etc. However, sometimes, due to some combination of factors, this mechanism fails, and the aggression of the immune system turns against the tissues of its own body.

The course of multiple sclerosis can be very clearly demonstrated by comparison with electrical wiring. Nerve fibers, like electrical wires, have a "braid" on the outside. For nerve fibers, myelin serves as such isolation. This sheath helps to delimit the nerves while helping to guide the impulses where they were going. When the immune system fails, myelin is destroyed very quickly, because of this, a "short circuit" occurs in the nervous system - impulses weaken, or do not reach their "destination".

Sadly, it is young people in the 18-25 age group that most often suffer from multiple sclerosis. At the same time, if we consider the gender component, then according to statistics, women get sick more often than men, world statistics speaks of an indicator of 3: 1.

If we talk about the average indicators for different countries, then in Russia every 40 out of 100 thousand are sick with multiple sclerosis. In Norway, this figure is much higher - already 180 people for the same number.

The main multiple sclerosis symptoms, especially in the early stages - a sharp darkening of the eyes, double vision, other vision problems, short-term disorders of speech or coordination of movements. The patient may feel weakness, fatigue in the limbs. However, these symptoms are too general, and in the early stages they can be very mild, which sometimes makes diagnosis very difficult. According to the doctor of medical sciences, professor, neurologist Sergei Kotov, it is not uncommon for the disease to remain “unnoticed” for several years due to the mild severity of symptoms.

The treatment regimen for multiple sclerosis is something like this:

Patients are prescribed MITRS - drugs that change the course of multiple sclerosis. During exacerbations, patients are treated with hormone therapy. Synthetic hormones are aimed at suppressing foci of inflammation, which are always formed during the acute process of demyelization.

To prevent re-exacerbation, immunomodulators are prescribed: beta-interferons.

Relatively recently, drugs that help block aggressive immune cells have been officially registered in Russia. These are monoclonal antibodies that bind to destructive immune cells, thereby helping healthy cells to neutralize them.

Pregnancy and multiple sclerosis:
some psychological aspects

If you take another look at the statistics, it becomes clear that the bulk of patients are women of reproductive age. So the question is, is it possible pregnancy with multiple sclerosis, is quite acute.

In the 50-60s of the last century, multiple sclerosis was almost one hundred percent indication for medical abortion. At the present stage, after conducting various studies, medical scientists argue that pregnancy with multiple sclerosis is not only possible, but in some cases even desirable.

Of course, before planning a pregnancy, or making a decision on its preservation, a woman with multiple sclerosis should undergo a full examination and consult with specialists. But some psychological aspects of this issue play an equally important role.

First of all, you need to be prepared for the fact that some doctors, especially the older generation, or from small towns, do not have full information about modern research. You need to learn to calmly relate to incorrect and sometimes judgmental comments. It is worth remembering once and for all that a contraindication to bearing and giving birth to a baby is only a very severe form of multiple sclerosis, in which a woman is already practically unable to move normally. Fortunately, this severity of the disease does not happen often.

Many obstetricians, psychologists and neurologists argue that a woman's mental anguish often affects the course of the disease much worse than pregnancy and childbirth. When a woman dreams of a baby, but due to the pressure of public opinion, her inner fears, refuses to have a child, this depresses her psyche and nervous system, which negatively affects her condition. And if we consider the situation of medical abortion, then serious hormonal changes are added to the psychological aspects, which significantly worsen the patient's condition.

Many mothers-to-be are afraid that their babies will have a high risk of developing multiple sclerosis. These fears are understandable, but they are not justified. As various studies, including genetic ones, show, the risks that a child, one of whose parents is sick with multiple sclerosis, will suffer from this disease in the future, do not exceed 3-5%. And this, you see, is an insignificant percentage. Thus, doctors officially assure that multiple sclerosis is not a hereditary disease.

Pregnancy with multiple sclerosis

There is no verified evidence that multiple sclerosis can affect the reproductive function of the female body. Such women, along with healthy ones, can easily get pregnant. In addition, none of the studies conducted has established an increased risk of miscarriages, miscarriages, fetal abnormalities, etc. The frequency of such deviations does not exceed the average.

Of course, such a disease brings its own adjustments, and in order for the pregnancy to proceed calmly and the baby to develop healthy, the expectant mother must be constantly monitored by specialists.

If we give a general picture of the condition of pregnant women with multiple sclerosis, then it will be as follows: in the first trimester, the frequency of exacerbations is quite high and reaches 65%. However, as shown by the PRIMS studies (PRIMS Study Group), such exacerbations are characteristic of those patients who had them with a high frequency and before pregnancy. In consolation, you can say. that during pregnancy, exacerbations are much milder, they are characterized by a rather short recovery period.

When the first trimester comes to an end, many patients say that they have never felt so good before. This is indeed the case. The unique biochemical processes in the body of a woman carrying a child have a beneficial effect on her condition. Thus, many of the compounds produced by the child are, in fact, alien to the mother's body. In order that there was no conflict, so that there was no rejection of a new life, nature provided for the process of a certain decrease in immunity, which in a sense is good for a mother with multiple sclerosis. In addition, with an increase in the level of estrogen (female sex hormone), suppression of inflammatory processes is observed. In addition to hormones, the active form of vitamin D is also produced; its level in the body is inversely proportional to the activity of multiple sclerosis.

Thus, during pregnancy there is no serious cause for concern about the course of the disease. A new exacerbation should be expected in the first three months after childbirth, when significant changes in the mother's body begin again. Postpartum exacerbations occur in about 30% of cases. However, at this time, you can already resume taking those drugs that were canceled during pregnancy.

Multiple sclerosis childbirth

Neither neurologists nor obstetricians see any obstacles for a woman with multiple sclerosis to be able to give birth naturally. Caesarean section for multiple sclerosis carried out no more often than in other cases.

The patient should go to the hospital a little earlier to discuss her situation with the doctors.

Specialists should know that during childbirth, a mother with such a diagnosis gets tired more than an ordinary woman, so you need to help her give birth to a baby as soon as possible. To do this, she must push correctly and not "miss" a single contraction during pushing. Breathing technique in such a situation is very important.

Question about epidural anesthesia for multiple sclerosis, in principle, is still open. There are some scientists who do not recommend this type of anesthesia. They argue this with a long period of recovery of the nervous "message". However, most modern scientists do not prohibit such a procedure.

Thus, modern doctors unequivocally advocate that a woman with multiple sclerosis does not deprive herself of the joy of motherhood. They see no critical reasons for this. Of course, this issue will need to be approached very responsibly, perhaps even after going through a certain psychological preparation, but all these difficulties are solved, and great happiness is rarely given easily.

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