Long-term Effects Of Pregnancy Research Articles

Knowledge and worries on motherhood choice in multiple sclerosis - a cross-sectional study on patient-reported outcome measures.

Since multiple sclerosis (MS) is often diagnosed in young women, pregnancy is a common topic for women with MS (wwMS). The study aimed to assess the measurement properties of two patient-reported outcome measures on motherhood choice in MS, and to explore the information and support needs of wwMS concerning motherhood. We conducted an anonymous web-based survey to validate the motherhood/pregnancy choice and worries questionnaire (MPWQ, 31 items plus up to 3 additional items) and the motherhood choice knowledge questionnaire (MCKQ, 16 items). We used mailing lists and social media for nationwide recruitment in Germany, and included women of childbearing age with relapsing-remitting MS, clinically isolated syndrome or suspected MS who were considering pregnancy or were pregnant. For the MPWQ, we assessed item difficulty, discriminatory power, and internal consistency (Cronbach's alpha; CA). We analysed construct validity using the Leipzig Questionnaire of Motives to have a Child, the Decisional Conflict Scale, the Hospital Anxiety and Depression Scale, and the Pregnancy-Related Anxiety Questionnaire-revised2. We studied the structural validity using exploratory factor analysis (EFA). The MCKQ was evaluated descriptively. We explored the information and support needs of wwMS on motherhood descriptively. We examined correlations between MCKQ, MPWQ and clinical characteristics and performed exploratory group comparisons considering the following binary variables: having children and being pregnant. 325 wwMS started the survey; 232 wwMS met our inclusion criteria and were analysed. Their mean age was 30 years (SD 5). Most women had relapsing-remitting MS (n=218; 94%), 186 (80%) had no children, and 38 (16%) were pregnant. Internal consistency was good for the worries subscale (CA>0.8), while it was unsatisfactory for the attitude and coping subscales (CA<0.7). The EFA did not support the three-scale structure (coping, attitude, and worries). Due to these findings, we decided to keep the worries scale without any subscale. The items from the coping scale and attitude scale could be assessed as additional descriptive items. Convergent and divergent construct validity of the MPWQ was satisfactory. 206 wwMS (89%) completed the MCKQ. On average, 9 of 16 (56%) items were answered correctly (range 2-15), and the questionnaire showed a good balance between easy and difficult items. Questions on immunotherapy, disease activity, and breastfeeding were the most challenging. WwMS were confident in getting pregnant and raising a child (n=222; 96%). Most wwMS were worried about postpartum relapses (n=200; 86%) and the long-term effects of pregnancy on disease evolution (n=149; 64%). About half of the wwMS (n=124; 54%) did not know where to find professional help and 127 (55%) had no strategies to cope with future impairments so that they could take care of a child. Our results support the suitability and acceptability of both questionnaires as potential patient-reported measures for assessment of knowledge and worries around motherhood/pregnancy in MS. The survey results highlight the need for evidence-based information on motherhood in MS to increase knowledge, reduce worries and support wwMS in making informed decisions.

Long-term association of pregnancy and maternal brain structure: the Rotterdam Study

The peripartum period is the highest risk interval for the onset or exacerbation of psychiatric illness in women’s lives. Notably, pregnancy and childbirth have been associated with short-term structural and functional changes in the maternal human brain. Yet the long-term effects of pregnancy on maternal brain structure remain unknown. We investigated a large population-based cohort to examine the association between parity and brain structure. In total, 2,835 women (mean age 65.2 years; all free from dementia, stroke, and cortical brain infarcts) from the Rotterdam Study underwent magnetic resonance imaging (1.5 T) between 2005 and 2015. Associations of parity with global and lobar brain tissue volumes, white matter microstructure, and markers of vascular brain disease were examined using regression models. We found that parity was associated with a larger global gray matter volume (β = 0.14, 95% CI = 0.09–0.19), a finding that persisted following adjustment for sociodemographic factors. A non-significant dose-dependent relationship was observed between a higher number of childbirths and larger gray matter volume. The gray matter volume association with parity was globally proportional across lobes. No associations were found regarding white matter volume or integrity, nor with markers of cerebral small vessel disease. The current findings suggest that pregnancy and childbirth are associated with robust long-term changes in brain structure involving a larger global gray matter volume that persists for decades. Future studies are warranted to further investigate the mechanism and physiological relevance of these differences in brain morphology.

Effect of the number of parity on right heart chamber quantification

Abstract Introduction Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. Methods This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. Results In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the 4 independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10 – 1.20), body mass index (OR: 1.05, CI: 1.02 to 1.08), smoking (OR: 1.87, CI: 1.28 to 4.02), and giving a birth (OR: 3.94 CI: 1.82 – 8.81). There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. Conclusion Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes. Funding Acknowledgement Type of funding sources: None.

34 Long term effects of pregnancy on cardiovascular function: serial echocardiograms in non-hypertensive and hypertensive mice

The specific impact of pregnancy on long term cardiovascular function (CVF) is challenging to study due to multiple confounders. A mouse model allows us to study the effect of pregnancy while controlling other factors. Our aim was to evaluate CVF in pregnancy and up to the equivalent of 1 year postpartum (PP) in non-hypertensive and hypertensive murine models compared to non-pregnant (NP) controls. Wild type (WT) and endothelial nitric oxide synthase (eNOS) heterozygous females were used to generate the non-hypertensive and moderately hypertensive models, respectively. Mice were divided between pregnant/PP and NP groups. Mice underwent echocardiography (echo) at age-matched time points: 0 = baseline (10 weeks of age), 1 = gestational day 18.5, 2 = 1 week PP or 4 months of life, 3 = 2 months PP or 6 months of life. After assessing mouse weights, echos were performed under anesthesia using the Vevo system. Left ventricle (LV) parameters were measured three times and averaged: ejection fraction (EF), fractional shortening (FS), cardiac output (CO), stroke volume (SV), LV mass index (LVMI), and ascending aortic (AA) diameter and velocity. Two-way and RM ANOVA were used for statistical analysis, followed by Holm-Sidak post hoc test. 121 murine echos were performed. In WT mice, pregnancy significantly increased LVMI, a measure of LV hypertrophy (Fig. 1A). Pregnancy had no effect on LVMI in the hypertensive eNOS mice (Fig. 1B). EF and FS was not different between the pregnant and NP groups in both WT and eNOS animals. In WT mice, CO, SV, and AA diameter and velocity were persistently increased PP compared to the NP; while in the eNOS mice, they were increased only in the initial PP period (Table 1). Mouse weights were not different among groups. In these animal models, pregnancy persistently adversely impacts CVF in non-hypertensive mice. However, only vascular function is altered after pregnancy in the setting of preexisting hypertension (eNOS). A longer study period is needed to determine if these findings contribute to early-onset of maternal cardiovascular disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Long term follow-up after pregnancy in Fontan patients

Abstract Background Patients with single ventricle physiology who have benefited from the Fontan procedure are reaching childbearing age. In this population, complications are common around pregnancy, but the long term effect of pregnancy is unclear. Purpose To evaluate functional and structural changes several years after pregnancy in patients with Fontan circulation. Methods Women with Fontan circulation who had a pregnancy beyond the 20 weeks of gestation followed at our centre between 2005–2019 were included. The following data were collected before pregnancy and at the last follow up (f-up): cardiac anatomy, type of Fontan procedure, resting O2 saturation (O2sat), NYHA class, systemic atrioventricular valve (SAVV) regurgitation, ventricular function, history of arrhythmias, heart failure (HF), thromboembolism, Fontan-related liver disease (FLD), protein-losing enteropathy (PLE), plastic bronchitis and cardiopulmonary test data. Results 12 patients had 18 pregnancies, giving birth to 17 live newborns (1 newborn death at 24 weeks of gestation). 7 (58.3%)patients had a total cavo-pulmonary connection, 3 (25%)an atrio-pulmonary connection and 2 (16.7%)a Bjork type Fontan. Tricuspid atresia was the most common anatomy (6, 50%). Before pregnancy, O2sat was 95.4±1.9%and all patients were in NYHA class I or II. All patients (12, 100%)had a normal or mildly impaired ventricular function and 3 (25%)had a moderate or severe SAAV regurgitation. 6 (50%)patients had 2 pregnancies. Mean age at first pregnancy was 29.9±4.4 years. Cardiac events occurred in 7 (38%)pregnancies, most commonly atrial arrhythmia (4, 57%), 2 (16.6%)patients developed new cyanosis and 1 had a thromboembolic event. No maternal death occurred and 1 patient had severe haemorrhage. After a mean f-up of 84±48 months, there was no significant worsening in O2sat (94.3±3.1 at f-up, p=1) and all patients remained in NYHA class I or II (12, 100%, p=1). At f-up all patients (12, 100%)continued to have a normal or mildly impaired ventricular function (p=1) and there was no significant worsening in the SAAV regurgitation (3 patients with moderate or severe regurgitation, p=1). 3 (25%)patients developed FLD (p=0.3), 3 (25%) a new episode of atrial arrhythmia (p=0.3). There were no significantly differences in peak VO2 (22.5±3.8 pre-pregnancy, 22.8±5.5 at f-up, p=0.4) and VE/VCO2 slope (34.9±11.2 pre-pregnancy, 36.3±11.8 at f-up, p=0.2)before pregnancy and during f-up. Conclusions In this small cohort of Fontan patients who successfully completed at least 1 pregnancy, there was no significant decline in functional or structural cardiac parameters long term after delivery. Funding Acknowledgement Type of funding source: None

Long-term Graft Survival and Graft Function Following Pregnancy in Kidney Transplant Recipients: A Systematic Review and Meta-analysis.

The incidence of pregnancy in kidney transplantation (KT) recipients is increasing. Studies report that the incidence of graft loss (GL) during pregnancy is low, but less data are available on long-term effects of pregnancy on the graft. Therefore, we performed a meta-analysis and systematic review on GL and graft function, measured by serum creatinine (SCr), after pregnancy in KT recipients, stratified in years postpartum. Furthermore, we included studies of nulliparous KT recipients. Our search yielded 38 studies on GL and 18 studies on SCr. The pooled incidence of GL was 9.4% within 2 years after pregnancy, 9.2% within 2-5 years, 22.3% within 5-10 years, and 38.5% >10 years postpartum. In addition, our data show that, in case of graft survival, SCr remains stable over the years. Only within 2 years postpartum, Δ SCr was marginally higher (0.18 mg/dL, 95%CI [0.05-0.32], P = 0.01). Furthermore, no differences in GL were observed in 10 studies comparing GL after pregnancy with nulliparous controls. Systematic review of the literature showed that mainly prepregnancy proteinuria, hypertension, and high SCr are risk factors for GL. Overall, these data show that pregnancy after KT has no effect on long-term graft survival and only a possible effect on graft function within 2 years postpartum. This might be due to publication bias. No significant differences were observed between pre- and postpartum SCr at longer follow-up intervals.

Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers.

To examine the changes in mothers' and fathers' sleep satisfaction and sleep duration across prepregnancy, pregnancy, and the postpartum period of up to 6 years after birth; it also sought to determine potential protective and risk factors for sleep during that time. Participants in a large population-representative panel study from Germany reported sleep satisfaction and sleep duration in yearly interviews. During the observation period (2008-2015), 2541 women and 2118 men reported the birth of their first, second, or third child and provided longitudinal data for analysis. Fixed-effects regression models were used to analyze changes in sleep associated with childbirth. Sleep satisfaction and duration sharply declined with childbirth and reached a nadir during the first 3 months postpartum, with women more strongly affected (sleep satisfaction reduction compared with prepregnancy: women, 1.81 points on a 0 to 10 scale, d = 0.79 vs. men, 0.37 points, d = 0.16; sleep duration reduction compared with prepregnancy: women, 62 min, d = 0.90 vs. men, 13 min, d = 0.19). In both women and men, sleep satisfaction and duration did not fully recover for up to 6 years after the birth of their first child. Breastfeeding was associated with a slight decrease in maternal sleep satisfaction (0.72 points, d = 0.32) and duration (14 min, d = 0.21). Parental age, household income, and dual vs. single parenting were unrelated, or only very weakly related, to improved sleep. Following the sharp decline in sleep satisfaction and duration in the first months postpartum, neither mothers' nor fathers' sleep fully recovers to prepregnancy levels up to 6 years after the birth of their first child.

The Short and Long-Term Effects of Pregnancy on Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis.

The role of pregnancy in multiple sclerosis (MS) is of importance because many patients with MS are young women in the childbearing age who require information to inform their reproductive decisions. Pregnancy is now well-known to be associated with fewer relapses of MS and reduced activity of autoimmune encephalomyelitis (EAE). However, in women with multiple sclerosis, this benefit is not always sufficient to protect against a rebound of disease activity if disease-modulating therapy is ceased for pregnancy. There is concern that use of assisted reproductive therapies can be associated with relapses of MS, but more data are required. It is thought that the beneficial effects of pregnancy are due to the pregnancy-associated changes in the maternal immune system. There is some evidence of this in human studies and studies of EAE. There is also evidence that having been pregnant leads to better long-term outcome of MS. The mechanism for this is not fully understood but it could result from epigenetic changes resulting from pregnancy or parenthood. Further studies of the mechanisms of the beneficial effects of pregnancy could provide information that might be used to produce new therapies.

A case-control study on pregnancy in Italian Cystic Fibrosis women. Data from the Italian Registry.

Pregnancy in CF women is no longer an exceptional event, but few information on its effect on clinical status in European CF patients are available. This study describes Italian CF pregnant population, to investigate its effect on CF woman. Data were collected (2010-2015) by the Italian CF Registry. A case-control study was performed between pregnant and never pregnant women. A total of 81 pregnant women (aged 18-45ys) were identified with a mean age at pregnancy of 31ys. Median age at diagnosis resulted higher in cases (P = 0.010). A decline from 6 to 12 months before pregnancy to one year after delivery in BMI (P = 0.034), in FEV1 (P < 0.001) and FVC (P < 0.001) was registered among cases. Difference in change between cases and controls was found for the BMI (P = 0.006); weak evidence of difference in FEV1 (p = 0.080) and FVC (p = 0.056) were noted between the groups. Data from ICFR show that CF women can become mother with only slight adverse effect on their nutritional status. Further study should be carried out to investigate long term effect of pregnancy on lung function.

Outcomes and Long-term Effects of Pregnancy in Women With Biologic and Mechanical Valve Prostheses

The optimal choice of prosthetic heart valve for women of child-bearing age is not well established. We conducted this retrospective cohort study to compare pregnancy outcomes and maternal mortality and morbidity, including long-term valve reoperation, between women with biologic and mechanical valve replacements. Women ≤50 years of age with prosthetic heart valve implantation and subsequent pregnancy in California, New Jersey, and New York State between 1990 to 2015 were identified using mandatory state inpatient databases. Average follow-up time was 9.4 years (SD 6.7 years). Of 11,930 women who underwent 14,017 valve replacements, pregnancies in 417 women with 241 biologic valves, and 217 mechanical valves were identified. Women with mechanical prostheses experienced significantly higher rates of pregnancy loss, with almost 2/3 of pregnancies ending in either spontaneous or induced abortion, and hemorrhage and thromboembolic events during delivery. Delivery was a significant risk factor for reoperation for both biologic (hazard ratio 2.5, 95% confidence interval 1.6 to 3.8 after time-dependent propensity matching) and mechanical (hazard ratio 2.3, 95% confidence interval 1.3 to 4.1 after time-dependent propensity matching) prostheses. Half of reoperations in women with mechanical valves who experienced pregnancy occurred within 1 year after delivery, and most were associated with mitral valve thrombosis. In conclusion, pregnancy accelerates time to reoperation for both biologic and mechanical prostheses. Mechanical valves are at particular risk for near-term valve failure after delivery, and compared with bioprostheses, are associated with higher rates of adverse events during pregnancy.

The long-term effect of pregnancy on weight loss after sleeve gastrectomy

BackgroundPregnancy outcomes after bariatric surgery have been addressed extensively; however, the impact of pregnancy on long-term outcomes after bariatric surgery has only been sparsely studied. ObjectivesWe explored the effects of pregnancy on weight loss outcomes after laparoscopic sleeve gastrectomy (LSG). SettingUniversity hospital. MethodsA cross-sectional case-control study. Eighty women who became pregnant after LSG were matched by preoperative body mass index, age, and follow-up duration to 80 post-LSG patients who did not conceive after surgery (control group). ResultsThe median follow-up duration was 5.2 years for the study group and 5.3 years for the control group (P = .73). For the study group, the median time from surgery to conception was 508 (interquartile range 372–954) days and the median gestational weight gain was 9 (6–12) kg. Comparing the study with the control group, median percentage total weight loss was similar, 31% versus 30% (P = .77); as was percentage excess weight loss (EWL%) 72% versus 71% (P = .77). For the study group, a multivariable analysis showed EWL% at the end of follow-up to be directly correlated with the lowest EWL% achieved before pregnancy (β = .78, P < .0001), and inversely correlated with time lapsed from surgery (β = −.26, P < .0001); yet EWL% was not found to be associated with surgery-to-conception time interval, gestational weight gain, breastfeeding, co-morbidities, smoking, occupational status, physical activity, and dietary habits. ConclusionsPregnancy after LSG does not affect long-term weight results. Coupled with the positive reports of improved pregnancy outcomes after bariatric surgery, these data should reassure women who wish to conceive after surgery.

Long-Term Effects of Pregnancy on Renal Graft Function in Women After Kidney Transplantation Compared With Matched Controls

BackgroundAn important benefit associated with kidney transplantation in women of child-bearing age is increased fertility. We retrospectively evaluated the maternal and fetal complications and evolution of graft function associated with 22 pregnancies post–kidney and kidney-pancreas transplantation, compared with controls without pregnancy post-transplantation, who were matched for gender, year of transplantation, type of donor, age at transplantation, number of transplants, type of transplant (kidney vs kidney-pancreas), and cause of native kidney failure, as well as for renal parameters including serum creatinine and urine protein excretion 1 year before delivery. ResultsThe mean age at time of transplantation was 22.32 (range, 19.45–33.1) years. The mean interval between transplantation and delivery was 75.7 (range, 34–147.8) months. Main maternal complications were pre-eclampsia in 27.3%. The main fetal complications included delayed intrauterine growth (18.2%), preterm deliveries (89.4%), and one death at 3 days postdelivery. The mean serum creatinine level pre-pregnancy was 1.17 (range, 0.7–3.1) mg/dL. Graft failure was higher in the pregnancy group (6 vs 3) but did not differ statistically from the control group, and was associated with creatinine pre-pregnancy (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.15–3.45; P = .04), age at transplantation (1.13 [1.03–1.21]; P = .032), and time of follow-up (2.14 [1.27–2.98]; P = .026). Delta serum creatinine was not different in both groups: 1.05 ± 0.51 versus 0.99 ± 0.92 mg/dL, study versus control group, respectively (P = .17). ConclusionPregnancy after kidney transplantation is associated with serious maternal and fetal complications. We did not observe a significantly increased risk of graft loss or reduced graft function in comparison with recipients with similar clinical characteristics.

High Density Lipoprotein (HDL) Cholesterol levels in young pregnant Women

A woman's reproductive history may affect her risk for coronary heart disease. Parity has been associated with increased coronary disease risk in some studies, while other studies have shown that nulliparous women are at increased risk (1-3). Pregnancy fre­quency (including frequency of spontaneous abortion (4, 5)) and age at first pregnancy (6) have also been associated with increased coronary disease risk. Although reports of associations of coronary disease risk with parity, age at menarche, or incidence of miscar­riage are not all consistent (7, 8), the majority of cohort studies have shown an increased risk of coro­nary disease among women with high gravidity or parity (9). Long-term effects of pregnancy on coronary disease risk factors, such as lipoproteins (10, 11), are potential mechanisms for an association between par­ity and coronary artery disease risk.&#x0D; Marked increases in lipoprotein concentrations oc­cur during pregnancy (12) and have been correlated with pregnancy-related increases in insulin, 17-beta estradiol, progesterone, and human placental lactogen (13). Total and low density lipoprotein (LDL) choles­terol and triglyceride levels progressively increase during gestation (10, 14). Although triglycerides have been reported to decrease rapidly during the postpar­tum period, total and LDL cholesterol levels may require several months to return to baseline (10, 14). High density lipoprotein (HDL) cholesterol, which has been shown to be inversely associated with coronary disease risk among women (15, 16), peaks at mid- gestation and then falls to levels approximately 15 percent above baseline at term (12). Few data are available on the long-term effects of pregnancy on lipoproteins; however, there are reports of inverse associations between parity and postpartum HDL cho­lesterol levels (17-20). In order to examine further relations of parity with lipid risk factors, we assessed plasma lipids at baseline and at the year 1 and year 2 follow-up examinations among young adult women in an ongoing epidemiologic study.

Birth characteristics of women with Marfan syndrome, obstetric and neonatal outcomes of their pregnancies—A nationwide cohort and case-control study

ObjectiveThe aim was to investigate birth characteristics, obstetric and neonatal outcomes of the first childbirth in women with Marfan syndrome by use of Swedish national registers since pregnancy-related outcomes in women with Marfan syndrome have only been sparsely investigated. Study designIn this national population-based cohort study and matched case-control study of Swedish women born 1973–1993, women with Marfan syndrome (n=273) were compared to women without the condition (n=1 017 265). The study population was followed until 2013. A total of 364 553 mother-firstborn-offspring pairs were analyzed. Sixty-one women with Marfan syndrome became mothers. Women with Marfan syndrome were also compared to 543 healthy controls. ResultsWomen with Marfan syndrome were more often born preterm (p<0.001), small-for-gestational age (p<0.001), and delivered by cesarean section (p=0.001). Women with Marfan syndrome had no increased risk of giving birth by cesarean section (p=0.079). No increased neonatal risks in their children were found. Women with Marfan syndrome were less likely to give birth than those without (p<0.001). There were no maternal deaths. ConclusionsWomen with Marfan syndrome were more likely to be born preterm, SGA and by cesarean section. These increased risks of preterm birth and SGA babies were not found in connection with their own first childbirth. Pregnancies with known fetal Marfan syndrome have to be carefully monitored.The results are important for obstetricians giving preconception counseling and treating women with Marfan syndrome. Further studies are needed to evaluate risks during pregnancy and long-term effects of pregnancy on the cardiovascular status of women with Marfan syndrome.

Pregnancy persistently affects memory T cell populations

Pregnancy is an immune challenge to the maternal immune system. The effects of pregnancy on maternal immunity and particularly on memory T cells during and after pregnancy are not fully known. This observational study aims to show the short term and the long term effects of pregnancy on the constitution, size and activation status of peripheral human memory T-lymphocyte populations. Effector memory (EM) and central memory (CM) T-lymphocytes were analyzed using flow cytometry of peripheral blood from 14 nulligravid, 12 primigravid and 15 parous women that were on average 18 months postpartum. The short term effects were shown by the significantly higher CD4+ EM cell and activated CD4+ memory cell proportions in primigravid women compared to nulligravid women. The persistent effects found in this study were the significantly higher proportions of CD4+ EM, CD4+ CM and activated memory T cells in parous women compared to nulligravid women. In contrast to CD4+ cells, activation status of CD8+ memory cells did not differ between the groups. This study shows that pregnancy persistently affects the pre-pregnancy CD4+ memory cell pool in human peripheral blood. During pregnancy, CD4+ T-lymphocytes might differentiate into EM cells followed by persistent higher proportions of CD4+ CM and EM cells postpartum. The persistent effects of pregnancy on memory T cells found in this study support the hypothesis that memory T cells are generated during pregnancy and that these cells could be involved in the lower complication risks in multiparous pregnancies in humans.

Parity Associated with Long-Term Disease Progression in Women with Multiple Sclerosis

Background: Pregnancy in multiple sclerosis (MS) is marked by a decrease in relapse activity with a corresponding rebound in the first months postpartum. Because MS typically occurs during childbearing years, it is important to determine the long term effect of pregnancy. Design/Methods: Subjects were part of the New York State Multiple Sclerosis Consortium registry. 1,195 parous and 328 nulliparous women with clinically definite MS age 45 or older were analyzed to determine time to a disability milestone, Expanded Disability Status Scale (EDSS) 6.0. A Cox proportional hazards model was used to examine the effect of parity on time from MS disease onset to EDSS 6.0, adjusted for confounding factors. Results: The average disease duration for 1,523 women was 18.1 years. During a mean follow-up period of 5.6 years 23.1% of the parous group reached EDSS 6.0, compared to 26.5% of the nulliparous women. Cox survival curves between parous and nulliparous women were significantly different (HR=.68, CI=.53-.87, p=.002), with parous women showing a longer time to reach the disability outcome. Follow-up analyses stratified by MS type showed that parity remained a significant predictor of disease progression in relapsing remitting (RRMS) patients, whereas this effect was not observed within progressive subtypes. Conclusions: Our results demonstrate that parous women with RRMS take a longer time to reach a well-defined disability milestone (i.e. use of cane) compared to nulliparous women, suggesting that pregnancy may convey a long term benefit. Further research is needed to determine why pregnancy might be protective against long term MS disability progression.

Long-term Effects of Pregnancy and Motherhood on Disease Outcomes of Women with Cystic Fibrosis

Studies of pregnancy in cystic fibrosis (CF) have shown no short-term harmful effects, but there are no long-term studies on the impact of motherhood. This study sought to evaluate longer-term physiologic and functional outcomes in women with CF reporting a pregnancy, with the intent of assessing how the demands of parenting impacted on disease course. Using 1994 to 2005 Epidemiologic Study of Cystic Fibrosis data, we developed a propensity score to match women reporting a pregnancy at a 1:10 ratio with never-pregnant control subjects and compared clinical outcomes, health-related quality of life, and health care use. One hundred nineteen pregnant women presumed to have become mothers were matched with 1,190 control subjects, a median of 6.0 years (range 1.8-11.1 yr) from the pregnancy. No differences were found in annualized change from baseline FEV1 and body mass index, in respiratory signs and symptoms, or in prescribed chronic therapies. Women who had been pregnant were treated for more pulmonary exacerbations and had more illness-related clinic visits but showed no increase in prescribed chronic therapies. They also reported lower health-related quality-of-life scores for Respiratory Symptoms, Physical Functioning, Vitality, and Health Perceptions. Pregnancy and motherhood do not appear to accelerate disease progression but lead to more illness-related visits, pulmonary exacerbations, and a decrease in some domains of quality of life. These differences presumably reflect the impact of the physical and emotional challenges of early motherhood on disease self-management.

Female reproductive issues in multiple sclerosis

Multiple sclerosis (MS) is more common in females than males and frequently affects women during their reproductive years. Thus, issues surrounding pregnancy and reproduction are of concern to women with MS. This review documents studies that shed light on reproductive issues in women with MS. The available literature was searched for papers relating to pregnancy and MS. Pregnancy is protective in MS in the short term, perhaps due to modulation of the immune system in pregnancy. It also possible that changes in the brain in pregnancy could protect against the effects of inflammation. The long-term effects of pregnancy also seem to be beneficial to MS, perhaps due to long-term epigenetic changes or possibly due to the effects of fetal microchimerism. Obstetric outcomes in women with MS are similar to those in the general population. In addition, there have been no reports of severe fetal abnormalities in babies exposed to first-line MS therapies. There is no good evidence that breast-feeding is protective in MS. There is no evidence that oral contraceptive pill use predisposes to MS, nor influences the clinical course of MS. After menopause, there is possible deterioration of MS, but it’s difficult to disentangle this from the effects of aging and the natural progressive history of MS. The strong biological effect of pregnancy on MS deserves further study, so that these mechanisms can possibly be replicated as therapies for MS.

Postural orthostatic tachycardia syndrome in pregnancy: a case report and review of literature

Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic condition characterised by the increase in heart rate greater than 30 beats per minute with associated orthostatic symptoms including palpitations, dizziness and...

Associations between cardiovascular parameters and uteroplacental Doppler (blood) flow patterns during pregnancy in women with congenital heart disease: Rationale and design of the Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II study

Previous research has shown that women with congenital heart disease (CHD) are more susceptible to cardiovascular, obstetric, and offspring events. The causative pathophysiologic mechanisms are incompletely understood. Inadequate uteroplacental circulation is an important denominator in adverse obstetric events and offspring outcome. The relation between cardiac function and uteroplacental perfusion has not been investigated in women with CHD. Moreover, the effects of physiologic changes on pregnancy-related events are unknown. In addition, long-term effects of pregnancy on cardiac function and exercise capacity are scarce. Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II, a prospective multicenter cohort study, investigates changes in and relations between cardiovascular parameters and uteroplacental Doppler flow patterns during pregnancy in women with CHD compared to matched healthy controls. The relation between cardiovascular parameters and uteroplacental Doppler flow patterns and the occurrence of cardiac, obstetric, and offspring events will be investigated. At 20 and 32 weeks of gestation, clinical, neurohumoral, and echocardiographic evaluation and fetal growth together with Doppler flow measurements in fetal and maternal circulation are performed. Maternal evaluation is repeated 1 year postpartum. By identifying the factors responsible for pregnancy-related events in women with CHD, risk stratification can be refined, which may lead to better pre-pregnancy counseling and eventually improve treatment of these women.