Abstract
Nowadays, women diagnosed with multiple sclerosis and belonging to the reproductive age group have high pregnancy rates, thus increasing the need of a careful pregnancy management in order to avoid maternal and fetal complications. The challenge of the chosen subject consists in identifying the available treatment that can be used during pregnancy time, emphasizing the need of a rigorous care during the preconceptional and postpartum period. The aim of the current review is to describe the management of a pregnant woman diagnosed with multiple sclerosis, in regards of treatment, anesthesia, mode of delivery and management and prevention of relapses during the postpartum period.
Highlights
More than twenty years have passed by since Confavreux et al introduced into the world the reference study on multiple sclerosis in pregnancy, studying 254 pregnant females diagnosed with multiple sclerosis during 269 pregnancies, in over 12 European countries, establishing the rate of relapse per trimester and correlating it with the rate during the year before the pregnancy and concluding that the rate of relapse diminishes during parturiency, notably during the last trimester and enhances in the puerperium period, before restoring to the pre-pregnancy rate [1]
In 2009, Langer-Gould released the axiom that exclusive breastfeeding has a protective role against postpartum relapses of multiple sclerosis, 36% of the women diagnosed with multiple sclerosis who breastfed exclusively for at least 2 months postpartum experienced relapses of the disease, while complementary suppression of menses seemed to contribute to this positive result [28]
In opposition to the use of intravenous immunoglobulins for the prevention of relapse that needs to be further investigated, in a 2004 study conducted by de Seze, during the postpartum period, women diagnosed with multiple sclerosis who were monthly administered 1 g of intravenous corticosteroids for 6 months, experienced a smaller relapse rate [30]
Summary
More than twenty years have passed by since Confavreux et al introduced into the world the reference study on multiple sclerosis in pregnancy, studying 254 pregnant females diagnosed with multiple sclerosis during 269 pregnancies, in over 12 European countries, establishing the rate of relapse per trimester and correlating it with the rate during the year before the pregnancy and concluding that the rate of relapse diminishes during parturiency, notably during the last trimester and enhances in the puerperium period, before restoring to the pre-pregnancy rate [1]. Described as one of the most frequent neurological diseases, multiple sclerosis is an autoimmune disorder that affects the central nervous system with neurological, physical and cognitive consequences [2]. The downfall of the myelin sheath leads to focal T-lymphocytic and macrophage infiltrations and oligodendrocyte demise, resulting in multifocal zones of inflammation with the final destination of central nervous system plaques, altering the transmission of nerve impulses, leading to cognitive, visual, autonomic and sensorimotor impairment, among others [2]. Multiple sclerosis affects women 2.5 times more frequent than men, pregnancy or menopause implying important changes to the evolution of the disease, multiple sclerosis frequently being detected between 20 and 40 years [4,5]
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