Pregnancy and multiple sclerosis. How to avoid complications? 7
Multiple sclerosis and pregnancy. Young women are more often affected by multiple sclerosis than men. The issue of pregnancy and successfully managing pregnancy, and how to help a mother and child comes up in multiple sclerosis. What are your views on how to best manage pregnancy in multiple sclerosis patients? As usual, the first step is that the project of becoming pregnant must be discussed, on the one hand, with the neurologist, and on the other hand, with an obstetrician. Things may be more or less complicated, depending on what type of multiple sclerosis we’re talking about. Let’s go through examples of multiple sclerosis situations if you consider a woman who had a few multiple sclerosis attacks. But she’s now doing well. She’s not taking any multiple sclerosis medications. Things are perfect. It is likely that pregnancy is not going to have any impact on her disease and that her disease is not going to have any impact on her pregnancy. However, it may be reassuring for the woman to deliver her child in a center, in which there are neurologists and obstetricians [familiar with multiple sclerosis]. This is, in general, something that we could consider for psychological reasons rather than for true medical reasons. At the other end of the spectrum, you may have a woman with very severe multiple sclerosis. She is taking complicated MS medications. Dr. Marc Dommergues. We don’t know exactly the impact of multiple sclerosis medications on the fetus. But she has a disability, for example, motor disability, and we know that if she discontinues the medications, things are going to become worse and worse. This is a hard case. This is the type of case that needs to be discussed beforehand. This situation requires very close collaboration between the neurologists and the obstetrical, anesthesia, and pediatric care teams. One of the issues will be this. Can we continue the multiple sclerosis medications, or should we discontinue them? Quite often, we don’t have much data on that. Dr. Anton Titov, MD. So it’s kind of a guess that we do with the woman. It’s also difficult to anticipate for sure what’s going to happen if the medications are discontinued. What’s going to happen maybe terrible. Dr. Marc Dommergues. I remember a case of a woman with multiple sclerosis who had a severe significant motor disability. By the seventh month of pregnancy, she could hardly eat, and she had difficulties breathing. Dr. Marc Dommergues. We reintroduced potentially harmful multiple sclerosis drugs. But eventually, we had to deliver her prematurely, because she was not doing well at all. Here is another example of a woman with a severe form of multiple sclerosis. She was taking medications that we were not quite sure of their impact on the fetus. Dr. Anton Titov, MD. So she discontinued the MS drugs. Then she was very severely affected. She couldn’t walk anymore. She became blind at the beginning of the pregnancy. Dr. Anton Titov, MD. So she had to get very intensive treatment with steroids and other multiple sclerosis drugs that were possible to be used in pregnancy. Eventually, she recovered, and she did well. But some other patients will have a severe worsening of multiple sclerosis not because of pregnancy, but because they are stopping the medications during pregnancy. Dr. Anton Titov, MD. So generally, it’s not the pregnancy that can affect multiple sclerosis, but the alterations in the drug regimen to treat multiple sclerosis during pregnancy. Exactly! On average, pregnancy tends to improve multiple sclerosis. Dr. Marc Dommergues. Medical second opinion. And if we look at the entire life of women with multiple sclerosis, there is no difference between those who become pregnant and those who don’t become pregnant. Dr. Anton Titov, MD. There are two questions. One question is, what’s going to happen if we stop using multiple sclerosis medications during pregnancy. The other question is when we say that multiple sclerosis is improved by pregnancy, this is on average. Dr. Marc Dommergues. Medical second opinion. And it is not true for every single person, of course. Dr. Anton Titov, MD. So again, for multiple sclerosis, a very close interaction between all members of the medical team is required. You discussed two extreme examples. A woman with multiple sclerosis who does well during pregnancy. Dr. Marc Dommergues. Medical second opinion. And a woman who is in a difficult stage of the disease and on multiple medications. If we imagine a pregnant woman with multiple sclerosis who is on disease-modifying medications, but her MS is perfectly well controlled. Dr. Anton Titov, MD. There are no recent flare-ups. Once a baby is delivered, does the same MS medication regimen continue? Or is there a trial of discontinuing the drugs and seeing if the flare-up appears? If we take a middle ground in MS and pregnancy, how does it usually look like? What are the questions to think about? I would say that, but the middle ground and the majority of patients take disease-modifying medications that can be continued throughout pregnancy. MS drugs can be continued during breastfeeding, and usually, things go perfectly well. This is the vast majority. That’s a very hopeful message. You can have a baby if you have multiple sclerosis. If your MS is controlled, you have good chances for a healthy pregnancy and baby. Certainly!
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