1
|
Vacchi L, Zirone E, Strina V, Cavaletti G, Ferrarese C. Mobile Applications to Support Multiple Sclerosis Communities: The Post-COVID-19 Scenario. Telemed J E Health 2024; 30:e1615-e1628. [PMID: 38452336 DOI: 10.1089/tmj.2023.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Introduction: The increase in the use of mobile apps since the COVID-19 pandemic, even among people with multiple sclerosis (PwMS) and health care providers (HCPs), has enabled access to reliable information, symptoms monitoring and management, and social connections. The pandemic has undoubtedly contributed to the acceleration of the "digital revolution." But how far has it progressed for the MS communities? Methods: Italian Google Play and App Store were queried, selecting MS-specific apps in English or Italian language and usable by a wide public. Results: Fifty-four (n = 54) MS-specific apps were identified; most were PwMS-oriented (83%), free of charge (94%), and in English language (76%). The 45 PwMS-oriented apps focused on increasing MS knowledge (71%), tracking symptoms (33%), and promoting networking with peers or HCPs (38%). The 13 HCPs-oriented tools addressed education and updates on MS (62%), disease assessment and management (54%), and research (15%). Google Search tool was also queried to find non-MS-specific apps to fulfill some unmet domains (as sleep, pain, sexual or mental health). Twenty-four additional apps were listed to provide a valuable contribution. Conclusion: The "digital revolution" led to increasingly customized tools for PwMS, especially as m-health or social-networking apps. However, apps to support other specific MS-relevant domains, appealing HCPs-oriented apps, and specific mobile tools for MS caregivers are still lacking. The absence of data assessing the usability and quality of MS apps in ecologically contexts leads to not reliable conclusions about potential benefits. A strong dialogue between MS communities and the digital industry is encouraged to fill this gap.
Collapse
Affiliation(s)
- Laura Vacchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
| | - Eleonora Zirone
- Department of Neuroscience and Mental Health, Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Strina
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience-NeuroMI, Milan, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| |
Collapse
|
2
|
Fragkoudi A, Rumbold AR, Burke T, Grzeskowiak LE. "A qualitative study of multiple sclerosis specialists' experiences and perspectives in managing family planning in people with multiple sclerosis". Mult Scler Relat Disord 2024; 82:105409. [PMID: 38176286 DOI: 10.1016/j.msard.2023.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Managing multiple sclerosis (MS) in people of reproductive age can be challenging as treatment decisions often need to balance efficacy, safety to reproductive health and an understanding of reproductive intentions. There has been limited examination of how family planning (FP) is approached in people with MS (pwMS) in Australia. This study aimed to explore the experiences and perspectives of Australian MS clinical specialists on managing FP in the context of MS. METHODS We conducted one-on-one semi-structured interviews with nine neurologists and ten MS nurses across Australia who regularly provide care to pwMS of reproductive age. Interview topics examined current approaches to managing FP, availability of FP resources, and opportunities for improvement. Interview recordings were transcribed verbatim and analysed thematically. RESULTS Two main themes emerged. First, 'inconsistent approaches in providing family planning', where neurologists and MS nurses recognised FP provision as essential but revealed differences in the content, timing and extent of FP discussions; conflicts between reproductive considerations and DMT prescriptions according to teratogenic risk; and variable implementation of interdisciplinary approaches. Second, 'barriers in providing family planning' emerged which included a lack of local information resources on FP, lack of contemporary data on safety of DMTs, and a range of patient and professional factors, including time constraints. CONCLUSION MS clinical specialists saw FP as an essential part of the care of their patients and expressed a need for information and service provision consistency in order to improve FP and reproductive care to pwMS.
Collapse
Affiliation(s)
- A Fragkoudi
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
| | - A R Rumbold
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - T Burke
- School of Nursing, University of Notre Dame, Sydney, Australia
| | - L E Grzeskowiak
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| |
Collapse
|
3
|
Wang Y, Wang J, Feng J. Multiple sclerosis and pregnancy: Pathogenesis, influencing factors, and treatment options. Autoimmun Rev 2023; 22:103449. [PMID: 37741528 DOI: 10.1016/j.autrev.2023.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated degenerative disease of the central nervous system, characterized by inflammatory demyelination. It is primarily found in women of childbearing age, making pregnancy a significant concern for both patients with MS and clinicians. To assist these patients in achieving their desire for pregnancy, reducing MS relapses during all stages of pregnancy, preventing the progression of MS, mitigating the impact of MS treatment on the course and outcome of pregnancy, and a thorough understanding of the relationship between pregnancy and MS, as well as specific management and the application of relevant medications for MS patients at each stage of pregnancy, are essential. This article provides an update on pregnancy-related issues in women with MS, including the general recommendations for management at each stage of pregnancy.
Collapse
Affiliation(s)
- Yinxiang Wang
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China
| | - Jue Wang
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao St., Shenyang 110004, China.
| |
Collapse
|
4
|
Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:293-311. [PMID: 36803817 DOI: 10.1016/b978-0-323-85555-6.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The improved understanding of multiple sclerosis (MS) neurobiology alongside the development of novel markers of disease will allow precision medicine to be applied to MS patients, bringing the promise of improved care. Combinations of clinical and paraclinical data are currently used for diagnosis and prognosis. The addition of advanced magnetic resonance imaging and biofluid markers has been strongly encouraged, since classifying patients according to the underlying biology will improve monitoring and treatment strategies. For example, silent progression seems to contribute significantly more than relapses to overall disability accumulation, but currently approved treatments for MS act mainly on neuroinflammation and offer only a partial protection against neurodegeneration. Further research, involving traditional and adaptive trial designs, should strive to halt, repair or protect against central nervous system damage. To personalize new treatments, their selectivity, tolerability, ease of administration, and safety must be considered, while to personalize treatment approaches, patient preferences, risk-aversion, and lifestyle must be factored in, and patient feedback used to indicate real-world treatment efficacy. The use of biosensors and machine-learning approaches to integrate biological, anatomical, and physiological parameters will take personalized medicine a step closer toward the patient's virtual twin, in which treatments can be tried before they are applied.
Collapse
Affiliation(s)
- Marianna G Rispoli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Maria D'Apolito
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valeria Pozzilli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy.
| |
Collapse
|
5
|
Pregnancy planning and management for women with multiple sclerosis: what has changed over the last 15 years? An Italian single-center experience. Mult Scler Relat Disord 2023; 70:104526. [PMID: 36689891 DOI: 10.1016/j.msard.2023.104526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pregnancy planning is a relevant issue in the management of Multiple Sclerosis (MS), which commonly involves women of childbearing age. Increased knowledge and a wider therapeutic scenario could have changed the approach of neurologists towards this topic over time. Our aim was to describe how pregnancy planning and management for women with MS have changed in the last 15 years. METHODS We retrospectively collected clinical data of female patients with relapsing-remitting MS (RRMS), referred to the Neurology Clinic of the University-Hospital "Policlinico G. Rodolico" of Catania, who became pregnant between 2005-2020. We compared data about MS and pregnancy between two time periods according to pregnancy onset (2005-2012; 2013-2020). RESULTS 190 patients with RRMS carried 253 pregnancies in the observation period. Women undergoing a pregnancy in the last period (2013-2020), as compared to women who had pregnancy in the first period (2005-2012), were older (p<0.01), more often treated before and during pregnancy with high-efficacy disease-modifying drugs (DMD) (p<0.001), and exhibited lower annualized relapse rates (ARR) before (p=0.01) and after pregnancy (p<0.001). CONCLUSION Results from our experience suggest that nowadays DMD are more frequently used in women of childbearing age, even during pregnancy, leading to a reduced ARR before and after delivery in absence of increased obstetric complications.
Collapse
|
6
|
Hassoun HK, Almahdawi A, Al-Bajalan SJ, Sheaheed NM, Kamil MA, Saeed Ridha SM, Al-Owath MM, Abd MF, Al-Khammasi B, Hasan ZN, Hatem AO, Al-Naqshbandi M, Rieckmann P. Expert opinion on the pharmacological management of multiple sclerosis in women of childbearing age in Iraq. Heliyon 2023; 9:e13350. [PMID: 36816245 PMCID: PMC9932647 DOI: 10.1016/j.heliyon.2023.e13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 01/02/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background Multiple sclerosis (MS) is often diagnosed in women of childbearing age (WCBA), with a mean age of onset of 30 years. Women with MS have long been cautioned to carefully plan their pregnancies and, traditionally, disease-modifying therapies (DMTs) have not been recommended for use in patients engaged in family planning. In 2020, the United States Food and Drug Administration (FDA) approved a label update for interferon beta (IFN ß) by adding new safety data on pregnancy and breastfeeding. Because current management guidelines do not yet reflect the recent label update, a panel of neurology experts from Iraq decided to discuss the potential need for changes in treatment strategies in Iraq. Methods A panel of experts consisting of 8 neurologists from Iraq and one international neurology expert from Germany convened to develop an expert opinion that would provide practical guidance for the pharmacological management of WCBA with MS in Iraq. They considered the latest label update and relevant published literature, along with local clinical practice and available resources. Results Interferon and Glatiramer acetate have no evidence of harm during pregnancy. IFN β can be continued safely through pregnancy. Switching treatment during pregnancy is generally not recommended. Short-term intravenous methylprednisolone can be used to treat disabling relapses. Conclusion Given the complexity of managing MS in pregnant women, it is the opinion of the expert panel that family planning should be discussed early in the disease course, planned pregnancy should be encouraged, and open communication with patient for her treatment decisions is paramount. Patients who are engaged in family planning are no longer discouraged from treatment with some of the currently available DMTs.
Collapse
Affiliation(s)
- Hayder K. Hassoun
- Kufa University, Kufa College of Medicine, Al-Najaf, Iraq
- Corresponding author.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
The Rate of Hospitalization of Pregnant Women with Multiple Sclerosis in Poland. J Clin Med 2022; 11:jcm11195615. [PMID: 36233482 PMCID: PMC9572960 DOI: 10.3390/jcm11195615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
Multiple sclerosis (MS) is most often diagnosed in women of childbearing age. Therefore, it is important to examine the impact of pregnancy on the course of MS and to enable patients to make decisions about motherhood based on reliable data. The main objective of this study was to assess the impact of pregnancy on the course of MS by comparing the frequency of MS-related hospitalizations during pregnancy and 40 weeks postpartum versus 40 weeks before pregnancy. We used administrative health claims to identify female patients with MS, their deliveries, and their MS-related hospital admissions and calculated the frequency of MS-related hospital admissions before, during, and after pregnancy. We observed that MS is diagnosed approximately three times less often during pregnancy than before or after pregnancy. The number of MS-related hospital admissions decreased during pregnancy, especially in the third trimester. In contrast with other studies, we did not observe an increased level of MS-related admissions postpartum. The number of hospitalizations reported with steroid injections and emergency department visits also decreased during pregnancy. Our results show that pregnancy has a protective effect on the course of MS.
Collapse
|
8
|
MAROZIO L, CAVALLA P, SOTTEMANO S, VERCELLINO M, FEDERICI F, COSMA S, PEILA C, CRESI F, COSCIA A, CAPOBIANCO M, BOSA C, SCHILLACI V, BELLISARIO V, MIGLIARETTI G, BENEDETTO C. Fetal and post-natal growth in infants of mothers with multiple sclerosis. A case-control study. Mult Scler Relat Disord 2022; 65:104087. [DOI: 10.1016/j.msard.2022.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
|
9
|
Villaverde-González R. Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy. Degener Neurol Neuromuscul Dis 2022; 12:1-21. [PMID: 35023987 PMCID: PMC8743861 DOI: 10.2147/dnnd.s203406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory, and degenerative disease that is up to three times more frequent in young women. MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth. The Pregnancy in Multiple Sclerosis Study in 1998 showed that pregnancy, mostly in untreated women, did not adversely affect MS, as disease activity decreased during pregnancy (although it significantly increased in the first trimester postpartum). These findings, together with the limited information available on the potential risks of fetal exposure to disease modifying treatments (DMTs), meant that women were advised to delay the onset of DMTs, stop them prior to conception, or, in case of unplanned pregnancy, discontinue them when pregnancy was confirmed. Now, many women with MS receive DMTs before pregnancy and, despite being considered a period of MS stability, up to 30% of patients could relapse in the first trimester postpartum. Factors associated with an increased risk of relapse and disability during pregnancy and postpartum include relapses before and during pregnancy, a greater disability at the time of conception, the occurrence of relapses after DMT cessation before conception, and the use of high-efficacy DMTs before conception, especially natalizumab or fingolimod. Strategies to prevent postpartum activity are needed in some patients, but consensus is lacking regarding the therapeutic strategies for women with MS of a fertile age. This, along with the increasing number of DMTs, means that the decision-making processes in aspects related to family planning and therapeutic strategies before, during, and after pregnancy are increasingly more complex. The purpose of this review is to provide an update on pregnancy-related issues in women with MS, including recommendations for counseling, general management, use of DMTs in pre-pregnancy, pregnancy, and postpartum periods, and breastfeeding-related aspects of DMTs.
Collapse
|
10
|
Lamaita R, Melo C, Laranjeira C, Barquero P, Gomes J, Silva-Filho A. Multiple Sclerosis in Pregnancy and its Role in Female Fertility: A Systematic Review. JBRA Assist Reprod 2021; 25:493-499. [PMID: 34061482 PMCID: PMC8312296 DOI: 10.5935/1518-0557.20210022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a neurological disease that typically affects young women of reproductive age. There are still many questions and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. For many years, women with MS have been discouraged from getting pregnant for fears that the disease might negatively affect the fetus or increase their obstetric risk or for claims that the disease might decrease fertility. However, fertility does not seem to be impaired to a larger extent in women with MS. Therefore, all healthcare providers involved in the follow-up of multiple sclerosis patients must be prepared to discuss future fertility, pregnancy, and others matters, in addition to providing them with the best possible counseling. This study presents data based on updated evidence and discusses fertility and pregnancy in patients with MS with respect to the impacts of pregnancy on the risk and prognostic factors tied to MS, and the impact of MS on pregnancy outcomes and fertility treatments administered to females with MS. In conclusion, a clear relationship between infertility and MS has not been established. There seems to exist a link between disease aggressiveness and progression with several processes that might impair fertility. However, MS does not stand as a contraindication to assisted reproductive technology. From the several studies analyzed, it is possible to conclude that pregnancy is possible in women with MS. It is important to discuss and plan the ideal moment to start treatment and managing pregnancy and contraception aiming at better results.
Collapse
Affiliation(s)
- Rivia Lamaita
- Federal University of Minas Gerais School of Medicine Department of Gynecology and Obstetrics Belo Horizonte Minas Gerais Brazil Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Melo
- Rede Mater Dei de Saúde Belo Horizonte Minas Gerais Brazil Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Cláudia Laranjeira
- Federal University of Minas Gerais School of Medicine Department of Gynecology and Obstetrics Belo Horizonte Minas Gerais Brazil Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Agnaldo Silva-Filho
- Federal University of Minas Gerais School of Medicine Department of Gynecology and Obstetrics Belo Horizonte Minas Gerais Brazil Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
11
|
Alonso R, Patrucco L, Silva B, Quarracino C, Eizaguirre MB, Vrech C, López P, Carnero Contentti E, Deri N, Carrá A, Chercorff A, Tkachuk V, Balbuena ME, Pettinicchi JP, Tavolini D, Barboza A, Rojas JI, Cristiano E, Lázaro L, Garcea O, Fernández Liguori N. Family planning in Argentinian women with multiple sclerosis: An important yet seldom approached issue. Mult Scler J Exp Transl Clin 2021; 7:20552173211025312. [PMID: 34211724 PMCID: PMC8216353 DOI: 10.1177/20552173211025312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to assess family planning (FP) among women with multiple sclerosis (WwMS). Methods We invited 604 WwMS to answer a survey focused on FP: a) Temporal relationship between pregnancy and the diagnosis of multiple sclerosis; b) History of FP; c) Childbearing desire; d) Information on family planning. Comparisons between pregnancy and not pregnancy after MS, as well as, planned and unplanned pregnancy were analyzed. Multivariate and univariate analyses were used to assess the impact of independent variables and FP Result 428 (71.7%) WwMS completed the survey. A 19.1% got pregnant after MS diagnosis and we evaluated FP in the last pregnancy, 56.1% patients had a planned pregnancy. Professional addressing FP (OR = 0.27, 95%-CI 0.08-0.92, p = 0.03) and non-injection drug treatment before pregnancy (OR = 2.88, 95%-CI 1.01-8.21, p = 0.047) were independent predictors of unplanned pregnancy in our multivariate model. Among WwMS ≤ 40 years, 48.7% had future childbearing desire. Young age (p < 0.001), PDDS <3 (p = 0.018), disease duration <5 years (p = 0.02), not childbearing before MS diagnosis (p < 0.001) and neurologist addressing family planning (p = 0.01) were significantly associated with childbearing desire. Conclusions This research highlights that pregnancy remains an important concern among WwMS.
Collapse
Affiliation(s)
- Ricardo Alonso
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Servicio de Neurología. Instituto Alfredo Lanari, Hospital Universitario, Buenos Aires, Argentina
| | - María Barbara Eizaguirre
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Pablo López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Aníbal Chercorff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Lázaro
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Nora Fernández Liguori
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina.,Servicio de Neurología. Hospital Enrique Tornú, Buenos Aires, Argentina
| |
Collapse
|
12
|
Soler B, Ciampi E, Uribe-San-Martín R, Keller K, Astudillo M, Charaf V, Reyes A, Vergara E, Cárcamo C. Pregnancy outcomes in women with Multiple Sclerosis. Mult Scler Relat Disord 2020; 48:102682. [PMID: 33321343 DOI: 10.1016/j.msard.2020.102682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Women represent two-thirds of the MS population and are usually diagnosed during childbearing age. Collection of local information about pregnancy outcomes is fundamental to support individual decision-making. OBJECTIVE To explore the trends in pregnancy decision making and pregnancy outcomes before (PreMS) and after (PostMS) MS diagnosis. METHODS We developed a questionnaire for retrospective assessment of pregnancy outcomes in PreMS and PostMS patients under regular care at the Programa de Esclerosis Multiple UC in Chile. RESULTS From the 218 women who responded to the questionnaire, 67 women did not have pregnancies. The total number of pregnancies registered was 299, 223 were PreMS (97 women, mean 2.5 ± 1.3 per/woman), and 76 PostMS (59 women, mean 1.9 ± 1.1 per/woman, p = 0.003). Mean age at first pregnancy was 27.6 ± 6.2 in PreMS, and 32.6 ± 4.6 years in PostMS women (p < 0.001). Significant differences between PreMS and PostMS pregnancy outcomes were cesarean section (37% vs. 66%; OR 2.74 95%CI(1.5-52), p=0.002), suspected relapse during 6 months after birth (7% vs. 18%, p<0.001), and breastfeeding (83% vs 67%, p=0.005). Gestational age, weight/size at birth, were not different between groups. Major malformations were observed similarly in both groups. CONCLUSIONS Changes in pregnancy decision-making after MS diagnosis occur, having fewer children and at an older age. It also changes obstetrician decisions for cesarean sections, with a 3 fold increase. Regarding newborn outcomes, there were no differences between groups.
Collapse
Affiliation(s)
- Bernardita Soler
- Servicio de Neurología, Hospital Doctor Sótero del Río, Santiago, Chile; Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Servicio de Neurología, Hospital Doctor Sótero del Río, Santiago, Chile; Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Reinaldo Uribe-San-Martín
- Servicio de Neurología, Hospital Doctor Sótero del Río, Santiago, Chile; Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karina Keller
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Macarena Astudillo
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Charaf
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Reyes
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elizabeth Vergara
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Cárcamo
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
13
|
Alroughani R, Inshasi J, Al-Asmi A, Alkhabouri J, Alsaadi T, Alsalti A, Boshra A, Canibano B, Ahmed SF, Shatila A. Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. Neurol Ther 2020; 9:265-280. [PMID: 32564333 PMCID: PMC7606397 DOI: 10.1007/s40120-020-00201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
Most disease-modifying drugs (DMDs) are contraindicated in pregnancy. Management of MS is especially challenging for pregnant patients, as withdrawal of DMDs leave the patient at risk of increased disease activity. We, a group of experts in MS care from countries in the Arab Gulf, present our consensus recommendations on the management of MS in these patients. Where possible, a patient planning pregnancy can be switched to a DMD considered safe in this setting. Interferon β now can be used during pregnancy, where there is a clinical need to maintain treatment, in addition to glatiramer acetate. Natalizumab (usually to 30 weeks' gestation for patients with high disease activity at high risk of relapse and disability progression) may also be continued into pregnancy. Cladribine tablets and alemtuzumab have been hypothesised to act as immune reconstitution therapies (IRTs). These drugs provide a period of prolonged freedom from relapses for many patients, but the patient must be prepared to wait for up to 20 months from initiation of therapy before becoming pregnant. If a patient becomes pregnant while taking fingolimod, and requires continued DMD treatment, a switch to interferon β or natalizumab after a variable washout period may be prescribed, depending on the level of disease activity. Women who wish to breastfeed should be encouraged to do so, and interferon β may also be used during breastfeeding. There is a lack of data regarding the safety of using other DMDs during breastfeeding.
Collapse
Affiliation(s)
| | - Jihad Inshasi
- Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates
- Dubai Medical College, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Taoufik Alsaadi
- Department of Neurology, American Center of Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | | | - Amir Boshra
- Neurology and Immunology Medical Affairs Gulf Region, Merck Serono Middle East FZ LTD, Dubai, United Arab Emirates
| | - Beatriz Canibano
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shatila
- Neurology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
14
|
Villaverde-González R, Candeliere-Merlicco A, Alonso-Frías MA, Aparicio Castro E, Carrillo Alcaraz A, Mallada Frechín J, Pérez Sempere Á. Discontinuation of disease-modifying treatments in multiple sclerosis to plan a pregnancy: A retrospective registry study. Mult Scler Relat Disord 2020; 46:102518. [PMID: 32977075 DOI: 10.1016/j.msard.2020.102518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For safety reasons multiple sclerosis (MS) treatment guidelines recommend stopping or delaying the onset of disease-modifying therapies (DMT) before a planned pregnancy, but disease stability after DMT discontinuation is not well studied. The objective of this study is to describe the course of MS in patients who interrupted DMT before a planned pregnancy. METHODS This was a retrospective study using 2008-2016 data from a multicenter register of pregnancies in women with MS. In this paper, we present data from the subgroup of women with relapsing-remitting MS (RRMS) who interrupted DMT to try to conceive. Data from 1 and 3 years before DMT interruption, the period between DMT interruption and conception or resuming DMT, during pregnancy and one year postpartum were analyzed. Annualized relapse rates (ARR), Expanded Disability Status Scale (EDSS) scores, and magnetic resonance imaging (MRI), obstetric, and neonatal data were collected. RESULTS Twenty-seven women interrupted DMT (19 β-interferon, 5 glatiramer acetate, 2 natalizumab and 1 fingolimod) to try to conceive. After a mean of 10.6 months 6 women stopped trying to conceive and resumed DMT, while 21 women became pregnant after a mean of 7.0 months. In the overall cohort, in the period from when DMT was discontinued to when pregnancy was confirmed or DMT resumed, the ARR was 1.08, which was significantly higher than the ARR 1 year (0.44; p = 0.01) and 3 years (0.4; p = 0.06) before DMT discontinuation. The mean EDSS score when pregnancy was confirmed or DMT resumed was significantly higher than at DMT discontinuation (1.8 vs 1.36, p = 0.011). In the subgroup of patients who became pregnant, the ARR in the untreated period before pregnancy was 0.98, which was significantly higher than the ARR 1 year (0.38; p = 0.03) and 3 years (0.39; p = 0.0077) before DMT discontinuation. The ARR decreased to 0.51 during pregnancy and then increased to 0.76 during the first postpartum trimester (not significant). One year after delivery, the mean EDSS score (1.86) was significantly higher than at DMT cessation (1.35, p = 0.027) or pregnancy confirmation (1.45, p = 0.026). Patients who suffered relapses following DMT cessation before becoming pregnant had an 11-fold higher risk of relapse during pregnancy (relative risk [RR] = 11.1 [95%CI 1.6, 75], p = 0.002) and a 3-fold higher risk during the postpartum year (RR = 3.0 [95%CI 1.3,6.6], p = 0.007) than those who did not suffer relapses in period between DMT withdrawal and pregnancy. CONCLUSIONS In this retrospective registry study, discontinuation of DMT (mostly immunomodulatory drugs), to try to conceive resulted in an increase in MS relapse rates and disability progression.
Collapse
Affiliation(s)
| | | | | | | | - Andrés Carrillo Alcaraz
- Intensive Care Unit, Hospital General Universitario José María Morales Meseguer, Murcia, Spain.
| | | | - Ángel Pérez Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain.
| |
Collapse
|
15
|
Krysko KM, Graves JS, Dobson R, Altintas A, Amato MP, Bernard J, Bonavita S, Bove R, Cavalla P, Clerico M, Corona T, Doshi A, Fragoso Y, Jacobs D, Jokubaitis V, Landi D, Llamosa G, Longbrake EE, Maillart E, Marta M, Midaglia L, Shah S, Tintore M, van der Walt A, Voskuhl R, Wang Y, Zabad RK, Zeydan B, Houtchens M, Hellwig K. Sex effects across the lifespan in women with multiple sclerosis. Ther Adv Neurol Disord 2020; 13:1756286420936166. [PMID: 32655689 PMCID: PMC7331774 DOI: 10.1177/1756286420936166] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.
Collapse
Affiliation(s)
- Kristen M Krysko
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 675 Nelson Rising Lane, Suite 221, San Francisco, CA 94158, USA
| | - Jennifer S Graves
- Department of Neurosciences, University of California San Diego, UCSD ACTRI, La Jolla, CA, USA
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Neurology, Queen Mary University of London, London, UK
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Jacqueline Bernard
- Department of Neurology, Oregon Health Science University, Portland, OR, USA
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Riley Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco CA, USA
| | - Paola Cavalla
- Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Teresa Corona
- Clinical Laboratory of Neurodegenerative Disease, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Anisha Doshi
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK
| | - Yara Fragoso
- Multiple Sclerosis & Headache Research Institute, Santos, SP, Brazil
| | - Dina Jacobs
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Vilija Jokubaitis
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Doriana Landi
- Department of Systems Medicine, Multiple Sclerosis Center and Research Unit, Tor Vergata University and Hospital, Rome, Italy
| | | | | | | | - Monica Marta
- Neurosciences and Trauma Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Suma Shah
- Department of Neurology, Duke University, Durham, NC, USA
| | - Mar Tintore
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Rhonda Voskuhl
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Yujie Wang
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Rana K Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Burcu Zeydan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Maria Houtchens
- Department of Neurology, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
16
|
Liguori NF, Alonso R, Pinheiro AA, Balbuena ME, Barboza A, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Carrá A, Cristiano E, Curbelo MC, Deri N, Fiol M, Gaitán MI, Garcea O, Halfon M, Hryb J, Jacobo M, José G, Knorre E, López P, Luetic G, Mainella C, Martínez A, Miguez J, Nofal P, Pagani Cassará F, Marcilla MP, Piedrabuena R, Pita C, Quarracino C, Rojas JI, Silva B, Sinay V, Steinberg J, Tarulla A, Tavolini D, Tkachuk V, Tizio S, Villa A, Vrech C, Ysrraelit C, Patrucco L. Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina. Mult Scler Relat Disord 2020; 43:102147. [PMID: 32442883 DOI: 10.1016/j.msard.2020.102147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients. METHODS A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues. CONCLUSION The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.
Collapse
Affiliation(s)
- Nora Fernández Liguori
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Sección Neurología, Hospital Enrique Tornú, Buenos Aires, Argentina.
| | - Ricardo Alonso
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | | | | | | | | | | | - Adriana Carrá
- Fundación Favaloro/INECO, Buenos Aires, Argentina; MS Section Hospital Británico, Buenos Aires, Argentina
| | | | | | - Norma Deri
- Centro de Investigaciones Diabaid, Argentina; Hospital Fernández de Buenos Aires, Argentina
| | - Marcela Fiol
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - María I Gaitán
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con EM), Santiago del Estero, Argentina
| | - Gustavo José
- Servicio de Neurología, Hospital Ángel Padilla, Tucumán, Argentina
| | - Eduardo Knorre
- Servicio de Neurología, Hospital Teodoro Álvarez, Buenos Aires, Argentina
| | - Pablo López
- Department of Neuroscience - Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | | | - Pedro Nofal
- Hospital de Clínicas Ntra. Sra. del Carmen, San Miguel de Tucumán, Argentina
| | | | | | | | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Departamento de neurología, Instituto de Investigaciones Médicas Alfredo Lanari
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | | | - Adriana Tarulla
- Hospital de Agudos Parmenio Piñero, Municipalidad de Ciudad de Buenos Aires, MCBA, Argentina
| | - Darío Tavolini
- INECO Neurociencias Oroño. Fundación INECO Rosario, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | - Santiago Tizio
- Departamento de Neurología, Hospital Italiano y Español de La Plata, Argentina
| | - Andrés Villa
- Sección Neuroinmunología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende Córdoba, Argentina
| | - Célica Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | | |
Collapse
|
17
|
Varytė G, Zakarevičienė J, Ramašauskaitė D, Laužikienė D, Arlauskienė A. Pregnancy and Multiple Sclerosis: An Update on the Disease Modifying Treatment Strategy and a Review of Pregnancy's Impact on Disease Activity. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E49. [PMID: 31973138 PMCID: PMC7074401 DOI: 10.3390/medicina56020049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 01/28/2023]
Abstract
Pregnancy rates are rapidly increasing among women of reproductive age diagnosed with multiple sclerosis (MS). Through pre-conception, pregnancy and post-partum periods, there is a need for disease control management, to decrease chances of MS relapses while avoiding potential risks to the mother and the fetus. However, pregnancy is not always compatible with the available highly effective MS treatments. This narrative review provides the aspects of pregnancy's outcomes and the impact on disease activity, choices of anesthesia and the management of relapses during the pregnancy and breastfeeding period. Available disease modifying treatment is discussed in the article with new data supporting the strategy of continuing natalizumab after conception, as it is related to a decreased risk of MS relapses during the pregnancy and postpartum period.
Collapse
Affiliation(s)
- Guoda Varytė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Jolita Zakarevičienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Diana Ramašauskaitė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Dalia Laužikienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| | - Audronė Arlauskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.Z.); (D.R.); (D.L.); (A.A.)
| |
Collapse
|
18
|
Cesarean section in women with MS: A choice or a need? Mult Scler Relat Disord 2019; 38:101867. [PMID: 31812874 DOI: 10.1016/j.msard.2019.101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
A multidisciplinary approach is needed for the management of pregnancy related issues in women affected by Multiple Sclerosis, however little attention has been devoted to the modality of delivery. Here we aimed to investigate whether the diagnosis of multiple sclerosis (MS) influences delivery modality in MS patients. Patients who received the diagnosis before pregnancy showed a lower frequency of natural delivery and a higher frequency of both planned and urgency caesarean sections. Gestational weeks and birth weight were lower in MS patients when compared with healthy subjects. The diagnosis of MS may drive the decision of the gynaecologist to perform a caesarean delivery.
Collapse
|
19
|
Scratch SE, Rumney P, Agnihotri S, Reed N. Pediatric Concussion: Managing Persistent Symptoms With an Interdisciplinary Approach. J Head Trauma Rehabil 2019; 34:385-393. [DOI: 10.1097/htr.0000000000000542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Shah S, Eckstein C. B cell depletion and pregnancy: Review and applications for MS treatment. Mult Scler Relat Disord 2019; 33:153-157. [PMID: 31202154 DOI: 10.1016/j.msard.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/20/2018] [Accepted: 06/05/2019] [Indexed: 01/04/2023]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune condition primarily affecting young adults. As there are numerous uncertainties faced by young women of childbearing age who are living with this chronic condition and the gender ratio is increasingly skewed towards women, it has become critical to define a clear approach to questions of disease management prior to and during pregnancy. With the approval of B cell depletion therapy for treatment of relapsing remitting and primary progressive MS, we explore the available data on using this type of therapy in the setting of pregnancy. We also provide recommendations regarding use of B-cell depleting therapies for patients who are considering or attempting conception.
Collapse
Affiliation(s)
- Suma Shah
- Duke Neurology, Division of MS and Neuroimmunology, 122 Baker House, Durham, NC 27710, United States.
| | - Christopher Eckstein
- Duke Neurology, Division of MS and Neuroimmunology, 122 Baker House, Durham, NC 27710, United States
| |
Collapse
|
21
|
No longer rare diseases and obstetric anesthesia. Curr Opin Anaesthesiol 2019; 32:271-277. [PMID: 30893118 DOI: 10.1097/aco.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW With new medical technologies and changing life styles, maternal demographics has changes and consequently older and sicker women are becoming pregnant.In this review, we present these different high-risk parturient populations, which were once considered rare for the practicing obstetric anesthesiologist. RECENT FINDINGS With lifestyle and medical advances, older and sicker women are getting pregnant. Older women are more prone to pregnancy complications. Cancer survivors are becoming pregnant and more pregnant women are being diagnosed with cancer. Previous neurological and cardiac conditions considered not compatible with pregnancy are now seen more frequently. As the rate of obesity increases so does the rate of obstructive sleep apnea, which is known to be associated with many adverse maternal and neonatal sequalae. Finally, increased use of both opioids and marijuana has led to increased number of pregnant women using these illicit substances. SUMMARY Future research and implementation of international guidelines for management of these high-risk parturient population is necessary in order to reduce maternal and neonatal morbidity.
Collapse
|
22
|
Portaccio E, Amato MP. Breastfeeding and post-partum relapses in multiple sclerosis patients. Mult Scler 2019; 25:1211-1216. [PMID: 30793658 DOI: 10.1177/1352458519830588] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
While it is acknowledged that exclusive breastfeeding has well-established benefits for both infant/child and mother health, evidence on the relationships between breastfeeding and disease course in women with multiple sclerosis (MS) is still controversial. On one hand, in the post-partum period, a disease worsening is possible, particularly in women with more active MS. On the other hand, the use of disease modifying drugs is currently contraindicated during lactation. In this topical review, we describe available evidence on the relationship between breastfeeding and disease activity in MS. In some studies, a possible protective role for exclusive breastfeeding against the risk of post-partum relapse has been suggested, while, in others, its impact was neutral. Waiting for definitive evidence on this topic, we propose a pragmatic approach to breastfeeding choice, on a case-by-case basis, considering the disease characteristics before and during pregnancy and the patient therapeutic history.
Collapse
Affiliation(s)
- Emilio Portaccio
- SOC Neurologia - Firenze, Azienda USL Toscana Centro, Florence, Italy
| | - Maria Pia Amato
- Section of Neurosciences, Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
23
|
Attenuation of ALS progression during pregnancy-lessons to be learned or just a coincidence? Neurol Sci 2019; 40:1275-1278. [PMID: 30746559 DOI: 10.1007/s10072-019-03748-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
ALS is the most frequent motor neuron disorder in adults with suggested complex relationship regarding gender. Studies investigating ALS and hormones have provided varying results. ALS onset during pregnancy is uncommon and pregnancy after the ALS symptom onset is even rarer. We present three patients with the onset of ALS symptoms before or during pregnancy and propose a putative disease modifying mechanism leading to attenuation of disease progression that we observed during the pregnancies.
Collapse
|
24
|
Fragoso YD, Adoni T, Brooks JBB, Finkelsztejn A, da Gama PD, Grzesiuk AK, Marques VD, Parolin MFK, Sato HK, Varela DL, Vasconcelos CCF. Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children. Neurol Ther 2018; 7:207-232. [PMID: 30167914 PMCID: PMC6283793 DOI: 10.1007/s40120-018-0110-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.
Collapse
Affiliation(s)
| | - Tarso Adoni
- Hospital Sirio-Libanes de Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Henry K Sato
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
| | | | | |
Collapse
|
25
|
Affiliation(s)
- Floriana De Angelis
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Nevin A John
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Wallace J Brownlee
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| |
Collapse
|
26
|
Cavalla P, Gilmore W. Pregnancy in multiple sclerosis: Data from an administrative claims database. Neurology 2018; 91:771-773. [PMID: 30266884 DOI: 10.1212/wnl.0000000000006371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Paola Cavalla
- From the MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy; and USC MS Center (W.G.), Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Wendy Gilmore
- From the MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy; and USC MS Center (W.G.), Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles.
| |
Collapse
|
27
|
News on the journal Neurological Sciences in 2017. Neurol Sci 2018; 39:15-21. [PMID: 29327225 DOI: 10.1007/s10072-017-3241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|