8. Multiple sclerosis and pregnancy

Abstract

Many women with multiple sclerosis do become pregnant, though there are some controversies about fertility, immunomodulating therapy, conceptions, or decision making to become pregnant. During pregnancy the number of MS relapses is reduced, but after delivery the curve of disease activity rises steeply There are some therapeutic schedules recommended for the post-delivery period and couple of advice for breastfeeding. In a retrospective study we registered and analyzed a subgroup of pregnant women in a MS Centre in Pardubice. We were searching for course of pregnancy, abortions, complications of pregnancy, relapses of MS, therapy during pregnancy and lactation periods. In a 5-year period (2008–2012) we treated49 pregnant women from 950 patients in MS Centre (690 women). There were only 4 abortions, and no occurrence of newborn malformations. During pregnancy only 4 relapses were treated by high doses of intravenous methylprednisolone (3–5 g during 8–10 days). One relaps was severe and 3 moderate (on?) clinical grade. After delivery only 3 relapses were found, one of them was severe and 2 of mild severity. All 49 women were given 10 g of intravenous immunoglobuline within first 48 h after delivery. Pregnancy should no longer be looked at as a factor provoking relapses and worsening MS. In our subgroup of pregnant MS patient we encountered only few attacks and more than 90% of pregnant women gave birth of a healthy newborn.