Reciprocal Effects of Multiple Sclerosis, Childbirth, and Postpartum

Authors

1 Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system, which is more prevalent in women than men. Considering the onset of MS in the women of reproductive age, the present study aimed to investigate the reciprocal effects of MS, childbirth, and postpartum.
Methods: This retrospective, descriptive-analytical study was conducted on 110 women diagnosed with MS during pregnancy in Isfahan, Iran during 2016-2017. The subjects had become pregnant within the recent decade and were selected via random sampling. Data on the demographic characteristics, pregnancy and postpartum profile, medicinal changes, symptoms, severity, and attack rates of MS were collected. Data analysis was performed in SPSS version 16.
Results: Mean age at the completion of pregnancy was 38.13 weeks. In total, 63.9% of the deliveries were accomplished via caesarean and 35.1% of the women had natural vaginal delivery. Mean pain intensity at childbirth was 7.11. No symptoms of MS attacks were reported in 86.7% of the subjects during delivery and 90.7% of the women within the first six weeks of childbirth. All the neonates were healthy, and 66.3% of the mothers had no psychological and emotional postpartum complications. In addition, 40.3% of the women started their MS medication within the first six months after childbirth.
Conclusion: According to the results, MS was not associated with the increased risk of preterm or post-term delivery. Moreover, it did not increase the severity of labor pain in the mothers. On the other hand, the rate of elective cesarean section was higher in MS patients compared to the general population, especially in the cases with disabilities. According to the Friedman curve, MS caused no substantial changes in the progression of delivery, and most of the neonates were healthy males with an Apgar score of 10. However, the severity of limb numbness and blurred vision increased in the women with MS in the postpartum period.

Keywords


1. Patas K, Engler JB, Friese MA, Gold SM. Gold Pregnancy and multiple sclerosis: feto-maternal immune cross talk and its implications for disease activity. J Reprod Immunol. 2013; 97(1):140-6.
 2. Ragnedda G, Leoni S, Parpine M, Casetta I, Riise T, Myhr KM, et al. Reduced duration of breastfeeding is associated with a higher risk of multiple sclerosis in both Italian and Norwegian adult males: the EnvIMS study. J Neurol. 2015; 262(5):1271-7.
3. Dimitrios K. The diagnosis of multiple sclerosis and the various related demyelinating syndromes: a critical review. J Autoimmun. 2014; 48-49:134-42.
 4. Belgian MS, Sherri Giger MB, Director MS, Pfohl DC, Mscn M. Multiple Sclerosis International Federation (MSIF). Italy: Multiple Sclerosis International Federation; 2013.
 5. Ashtari F, Valiani M, Mansourian M, Mohammadi S, Sodouri M. Prevalence, severity of pain in patients with Multiple Sclerosis (MS). Biomed Pharmacol J. 2016; 9(1):49-54.
 6. Valiani M, Ashtari F, Mansourian M, Shaygannejad V. Effect of auriculotherapy on multiple sclerosis related pain: a double blind randomized clinical control trial parallel design. Int J Adv Biotechnol Res. 2017; 8(3):1831-40.
7. Tolou-Ghamari Z. A review of geoepidemiological differences of multiple sclerosis in Iran and other Middle East countries. Arch Neurosc. 2015; 2(3):e22028.
 8. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011; 69(2):292-302.
 9. Dunn SE, Steinman L. The gender gap in multiple sclerosis: intersection of science and society. JAMA Neurol. 2013; 70(5):634-5.
 10. Karp I, Manganas A, Sylvestre MP, Ho A, Roger E, Duquette P. Does pregnancy alter the long-term course of multiple sclerosis? Ann Epidemiol. 2014; 24(7):504-8.
 11. Brandt-Wouters E, Gerlach OH, Hupperts RM. The effect of postpartum intravenous immunoglobulins on the relapse rate among patients with multiple sclerosis. Int J Gynecol Obstet. 2016; 134(2):194-6.
12. Neuteboom RF, Janssens AC, Siepman TA, Hoppenbrouwers IA, Ketelslegers IA, Jafari N, et al. Pregnancy in multiple sclerosis: clinical and self-report scales. J Neurol. 2012; 259(2):311-7.
13. Langer-Gould A, Beaber BE. Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin Immunol. 2013; 149(2):244-50.
 14. Lebrun C, Le Page E, Kantarci O, Siva A, Pelletier D, Okuda DT, et al. Impact of pregnancy on conversion to clinically isolated syndrome in a radiologically isolated syndrome cohort. Multiple Scleros J. 2012; 18(9):1297-302.
 15. Pakpoor J, Disanto G, Lacey MV, Hellwig K, Giovannoni G, Ramagopalan SV. Breastfeeding and multiple sclerosis relapses: a meta-analysis. J Neurol. 2012; 259(10):2246-8.
 16. Ferraro D, Simone AM, Adani G, Vitetta F, Mauri C, Strumia S, et al. Definitive childlessness in women with multiple sclerosis: a multicenter study. Neurol Sci. 2017; 38(8):1453-59.
 17. Finkelsztejn A, Brooks JB, Paschoal Jr FM, Fragoso YD. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta‐analysis of the literature. BJOG. 2011; 118(7):790-7.
18. Van der Kop ML, Pearce MS, Dahlgren L, Synnes A, Sadovnick D, Sayao AL, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011; 70(1):41-50.
19. Jalkanen A, Alanen A, Airas L; Finnish Multiple Sclerosis and Pregnancy Study Group. Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler. 2010; 16(8):950-5.
20. Borisow N, Döring A, Pfueller CF, Paul F, Dörr J, Hellwig K. Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy. EPMA J. 2012; 3(1):9.
21. Lu E, Zhao Y, Zhu F, van der Kop ML, Synnes A, Dahlgren L, et al. Birth hospitalization in mothers with multiple sclerosis and their newborns. Neurology. 2013; 80(5):447-52.
 22. Brara SM, Koebnick C, Porter AH, Langer-Gould A. Pediatric idiopathic intracranial hypertension and extreme childhood obesity. J Pediatr. 2012; 161(4):602-7.
 23. Conradi S, Malzahn U, Paul F, Quill S, Harms L, Then Bergh F, et al. Breastfeeding is associated with lower risk for multiple sclerosis. Mult Scler. 2013; 19(5):553-8.
 24. Langer-Gould A, Huang SM, Gupta R, Leimpeter AD, Greenwood E, Albers KB, et al. Exclusive breastfeeding and the risk of postpartum relapses in women with multiple sclerosis. Arch Neurol. 2009; 66(8):958-63.
25. Cunningham FG, Leveno JK, Bloom LS, Spong YC, Dashe SJ, Hoffman LB, et al. William’s obstetrics. 24th ed. New York: McGraw-Hill; 2014.