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Semin Neurol 2016; 36(02): 154-162
DOI: 10.1055/s-0036-1579736
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Women's Issues in Multiple Sclerosis

Riley Bove
1   Department of Neurology, Harvard Medical School, Boston, Massachusetts
2   Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
26 April 2016 (online)

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Abstract

Multiple sclerosis (MS) typically affects 3 times more women than men during the reproductive years. The author describes what is known about the effects of various reproductive exposures on MS course, including menarche, childbearing, and menopause. Then, the management of childbearing is reviewed. Topics include preconception counseling, prenatal care, discontinuation of MS therapies, and management of postpartum relapses. Overall, most women with MS can be encouraged to become pregnant and breastfeed their children, should they choose to do so.

Keywords

pregnancy - menopause - quality of life - estrogens - sex differences
 

  • References

  • 1 Orton SM, Herrera BM, Yee IM , et al; Canadian Collaborative Study Group. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006; 5 (11) 932-936
    CrossrefPubMedGoogle Scholar
  • 2 Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 2014; 20 (5) 520-526
    CrossrefPubMedGoogle Scholar
  • 3 Marrie RA, Horwitz RI, Cutter G, Tyry T, Vollmer T. Association between comorbidity and clinical characteristics of MS. Acta Neurol Scand 2011; 124 (2) 135-141
    CrossrefPubMedGoogle Scholar
  • 4 Marrie RA, Horwitz R, Cutter G, Tyry T. Cumulative impact of comorbidity on quality of life in MS. Acta Neurol Scand 2012; 125 (3) 180-186
    CrossrefPubMedGoogle Scholar
  • 5 Dobos K, Healy B, Houtchens M. Access to preventive health care in severely disabled women with multiple sclerosis. Int J MS Care 2015; 17 (4) 200-205
    CrossrefPubMedGoogle Scholar
  • 6 Horner-Johnson W, Dobbertin K, Andresen EM, Iezzoni LI. Breast and cervical cancer screening disparities associated with disability severity. Womens Health Issues 2014; 24 (1) e147-e153
    CrossrefPubMedGoogle Scholar
  • 7 Whitacre CC, Reingold SC, O'Looney PA. A gender gap in autoimmunity. Science 1999; 283 (5406) 1277-1278
    CrossrefPubMedGoogle Scholar
  • 8 Papenfuss TL, Powell ND, McClain MA , et al. Estriol generates tolerogenic dendritic cells in vivo that protect against autoimmunity. J Immunol 2011; 186 (6) 3346-3355
    CrossrefPubMedGoogle Scholar
  • 9 Ramagopalan SV, Valdar W, Criscuoli M , et al; Canadian Collaborative Study Group. Age of puberty and the risk of multiple sclerosis: a population based study. Eur J Neurol 2009; 16 (3) 342-347
    CrossrefPubMedGoogle Scholar
  • 10 Lulu S, Graves J, Waubant E. Menarche increases relapse risk in pediatric multiple sclerosis. Mult Scler 2015;
    PubMedGoogle Scholar
  • 11 Sloka JS, Pryse-Phillips WE, Stefanelli M. The relation between menarche and the age of first symptoms in a multiple sclerosis cohort. Mult Scler 2006; 12 (3) 333-339
    CrossrefPubMedGoogle Scholar
  • 12 Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics 2008; 121 (Suppl. 03) S208-S217
    CrossrefPubMedGoogle Scholar
  • 13 Holmqvist P, Hammar M, Landtblom AM, Brynhildsen J. Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis. Fertil Steril 2010; 94 (7) 2835-2837
    CrossrefPubMedGoogle Scholar
  • 14 Alonso A, Jick SS, Olek MJ, Ascherio A, Jick H, Hernán MA. Recent use of oral contraceptives and the risk of multiple sclerosis. Arch Neurol 2005; 62 (9) 1362-1365
    CrossrefPubMedGoogle Scholar
  • 15 Villard-Mackintosh L, Vessey MP. Oral contraceptives and reproductive factors in multiple sclerosis incidence. Contraception 1993; 47 (2) 161-168
    CrossrefPubMedGoogle Scholar
  • 16 Thorogood M, Hannaford PC. The influence of oral contraceptives on the risk of multiple sclerosis. Br J Obstet Gynaecol 1998; 105 (12) 1296-1299
    CrossrefPubMedGoogle Scholar
  • 17 Hernán MA, Hohol MJ, Olek MJ, Spiegelman D, Ascherio A. Oral contraceptives and the incidence of multiple sclerosis. Neurology 2000; 55 (6) 848-854
    CrossrefPubMedGoogle Scholar
  • 18 Sena A, Couderc R, Vasconcelos JC, Ferret-Sena V, Pedrosa R. Oral contraceptive use and clinical outcomes in patients with multiple sclerosis. J Neurol Sci 2012; 317 (1–2) 47-51
    CrossrefPubMedGoogle Scholar
  • 19 Gava G, Bartolomei I, Costantino A , et al. Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remitting multiple sclerosis. Fertil Steril 2014; 102 (1) 116-122
    CrossrefPubMedGoogle Scholar
  • 20 D'hooghe MB, Haentjens P, Nagels G, D'Hooghe T, De Keyser J. Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis. J Neurol 2012; 259 (5) 855-861
    CrossrefPubMedGoogle Scholar
  • 21 Birk K, Ford C, Smeltzer S, Ryan D, Miller R, Rudick RA. The clinical course of multiple sclerosis during pregnancy and the puerperium. Arch Neurol 1990; 47 (7) 738-742
    CrossrefPubMedGoogle Scholar
  • 22 Bernardi S, Grasso MG, Bertollini R, Orzi F, Fieschi C. The influence of pregnancy on relapses in multiple sclerosis: a cohort study. Acta Neurol Scand 1991; 84 (5) 403-406
    CrossrefPubMedGoogle Scholar
  • 23 Sadovnick AD, Eisen K, Hashimoto SA , et al. Pregnancy and multiple sclerosis. A prospective study. Arch Neurol 1994; 51 (11) 1120-1124
    CrossrefPubMedGoogle Scholar
  • 24 Worthington J, Jones R, Crawford M, Forti A. Pregnancy and multiple sclerosis—a 3-year prospective study. J Neurol 1994; 241 (4) 228-233
    CrossrefPubMedGoogle Scholar
  • 25 Roullet E, Verdier-Taillefer MH, Amarenco P, Gharbi G, Alperovitch A, Marteau R. Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients. J Neurol Neurosurg Psychiatry 1993; 56 (10) 1062-1065
    CrossrefPubMedGoogle Scholar
  • 26 Salemi G, Callari G, Gammino M , et al. The relapse rate of multiple sclerosis changes during pregnancy: a cohort study. Acta Neurol Scand 2004; 110 (1) 23-26
    CrossrefPubMedGoogle Scholar
  • 27 Fragoso YD, Finkelsztejn A, Comini-Frota ER , et al. Pregnancy and multiple sclerosis: the initial results from a Brazilian database. Arq Neuropsiquiatr 2009; 67 (3A): 657-660
    CrossrefPubMedGoogle Scholar
  • 28 Fernández Liguori N, Klajn D, Acion L , et al. Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study). Mult Scler 2009; 15 (5) 555-562
    CrossrefPubMedGoogle Scholar
  • 29 Neuteboom RF, Janssens AC, Siepman TA , et al. Pregnancy in multiple sclerosis: clinical and self-report scales. J Neurol 2012; 259 (2) 311-317
    CrossrefPubMedGoogle Scholar
  • 30 Hellwig K, Brune N, Haghikia A , et al. Reproductive counselling, treatment and course of pregnancy in 73 German MS patients. Acta Neurol Scand 2008; 118 (1) 24-28
    CrossrefPubMedGoogle Scholar
  • 31 Paavilainen T, Kurki T, Parkkola R , et al. Magnetic resonance imaging of the brain used to detect early post-partum activation of multiple sclerosis. Eur J Neurol 2007; 14 (11) 1216-1221
    CrossrefPubMedGoogle Scholar
  • 32 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) 790-797
    CrossrefPubMedGoogle Scholar
  • 33 D'hooghe MB, D'Hooghe T, De Keyser J. Female gender and reproductive factors affecting risk, relapses and progression in multiple sclerosis. Gynecol Obstet Invest 2013; 75 (2) 73-84
    CrossrefPubMedGoogle Scholar
  • 34 Vukusic S, Hutchinson M, Hours M , et al; The Pregnancy In Multiple Sclerosis Group; Pregnancy In Multiple Sclerosis Group. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 2004; 127 (Pt 6): 1353-1360
    CrossrefPubMedGoogle Scholar
  • 35 Portaccio E, Ghezzi A, Hakiki B , et al; MS Study Group of the Italian Neurological Society. Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs. J Neurol Neurosurg Psychiatry 2014; 85 (8) 845-850
    CrossrefPubMedGoogle Scholar
  • 36 Airas L, Saraste M, Rinta S, Elovaara I, Huang YH, Wiendl H ; Finnish Multiple Sclerosis and Pregnancy Study Group. Immunoregulatory factors in multiple sclerosis patients during and after pregnancy: relevance of natural killer cells. Clin Exp Immunol 2008; 151 (2) 235-243
    CrossrefPubMedGoogle Scholar
  • 37 Airas L, Nikula T, Huang YH, Lahesmaa R, Wiendl H. Postpartum-activation of multiple sclerosis is associated with down-regulation of tolerogenic HLA-G. J Neuroimmunol 2007; 187 (1–2) 205-211
    CrossrefPubMedGoogle Scholar
  • 38 Sicotte NL, Liva SM, Klutch R , et al. Treatment of multiple sclerosis with the pregnancy hormone estriol. Ann Neurol 2002; 52 (4) 421-428
    CrossrefPubMedGoogle Scholar
  • 39 Hughes SE, Spelman T, Gray OM , et al; MSBase study group. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 2014; 20 (6) 739-746
    CrossrefPubMedGoogle Scholar
  • 40 Gulick EE, Halper J. Influence of infant feeding method on postpartum relapse of mothers with multiple sclerosis. Int J MS Care 2002; 4 (4) 183-191
    CrossrefPubMedGoogle Scholar
  • 41 Langer-Gould A, Huang SM, Gupta R , et al. Exclusive breastfeeding and the risk of postpartum relapses in women with multiple sclerosis. Arch Neurol 2009; 66 (8) 958-963
    CrossrefPubMedGoogle Scholar
  • 42 Hellwig K, Haghikia A, Rockhoff M, Gold R. Multiple sclerosis and pregnancy: experience from a nationwide database in Germany. Ther Adv Neurol Disord 2012; 5 (5) 247-253
    CrossrefPubMedGoogle Scholar
  • 43 Nelson LM, Franklin GM, Jones MC. Risk of multiple sclerosis exacerbation during pregnancy and breast-feeding. JAMA 1988; 259 (23) 3441-3443
    CrossrefPubMedGoogle Scholar
  • 44 Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T ; Pregnancy in Multiple Sclerosis Group. Rate of pregnancy-related relapse in multiple sclerosis. N Engl J Med 1998; 339 (5) 285-291
    CrossrefPubMedGoogle Scholar
  • 45 Portaccio E, Ghezzi A, Hakiki B , et al; MS Study Group of the Italian Neurological Society. Breastfeeding is not related to postpartum relapses in multiple sclerosis. Neurology 2011; 77 (2) 145-150
    CrossrefPubMedGoogle Scholar
  • 46 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) 2246-2248
    CrossrefPubMedGoogle Scholar
  • 47 Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004; 79 (5) 717-726
    PubMedGoogle Scholar
  • 48 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357 (3) 266-281
    CrossrefPubMedGoogle Scholar
  • 49 Langer-Gould A, Huang S, Van Den Eeden SK , et al. Vitamin D, pregnancy, breastfeeding, and postpartum multiple sclerosis relapses. Arch Neurol 2011; 68 (3) 310-313
    PubMedGoogle Scholar
  • 50 Weinshenker BG, Hader W, Carriere W, Baskerville J, Ebers GC. The influence of pregnancy on disability from multiple sclerosis: a population-based study in Middlesex County, Ontario. Neurology 1989; 39 (11) 1438-1440
    CrossrefPubMedGoogle Scholar
  • 51 Koch M, Uyttenboogaart M, Heersema D, Steen C, De Keyser J. Parity and secondary progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80 (6) 676-678
    CrossrefPubMedGoogle Scholar
  • 52 Ramagopalan S, Yee I, Byrnes J, Guimond C, Ebers G, Sadovnick D. Term pregnancies and the clinical characteristics of multiple sclerosis: a population based study. J Neurol Neurosurg Psychiatry 2012; 83 (8) 793-795
    CrossrefPubMedGoogle Scholar
  • 53 Runmarker B, Andersen O. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain 1995; 118 (Pt 1): 253-261
    CrossrefPubMedGoogle Scholar
  • 54 Verdru P, Theys P, D'Hooghe MB, Carton H. Pregnancy and multiple sclerosis: the influence on long term disability. Clin Neurol Neurosurg 1994; 96 (1) 38-41
    CrossrefPubMedGoogle Scholar
  • 55 Keyhanian K, Davoudi V, Etemadifar M, Amin M. Better prognosis of multiple sclerosis in patients who experienced a full-term pregnancy. Eur Neurol 2012; 68 (3) 150-155
    CrossrefPubMedGoogle Scholar
  • 56 D'hooghe MB, Nagels G, Uitdehaag BM. Long-term effects of childbirth in MS. J Neurol Neurosurg Psychiatry 2010; 81 (1) 38-41
    CrossrefPubMedGoogle Scholar
  • 57 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.e2
    CrossrefPubMedGoogle Scholar
  • 58 Bove R, Healy BC, Musallam A, Glanz BI, De Jager PL, Chitnis T. Exploration of changes in disability after menopause in a longitudinal multiple sclerosis cohort. MS Journal 2015;Oct 7. [Epub ahead of print]
    PubMedGoogle Scholar
  • 59 Bove R, Alwan S, Friedman JM , et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol 2014; 124 (6) 1157-1168
    CrossrefPubMedGoogle Scholar
  • 60 Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84 (5) 478-485
    CrossrefPubMedGoogle Scholar
  • 61 Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plann 2010; 41 (4) 241-250
    CrossrefPubMedGoogle Scholar
  • 62 Coyle PK, Christie S, Fodor P , et al; Women Neurologists MS Initiative. Multiple sclerosis gender issues: clinical practices of women neurologists. Mult Scler 2004; 10 (5) 582-588
    CrossrefPubMedGoogle Scholar
  • 63 Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-modifying drugs for multiple sclerosis in pregnancy: a systematic review. Neurology 2012; 79 (11) 1130-1135
    CrossrefPubMedGoogle Scholar
  • 64 Bodiguel E, Bensa C, Brassat D , et al; Groupe de Réflexion sur la Sclérose en Plaques. Multiple sclerosis and pregnancy. Rev Neurol (Paris) 2014; 170 (4) 247-265
    CrossrefPubMedGoogle Scholar
  • 65 Wundes A, Pebdani RN, Amtmann D. What do healthcare providers advise women with multiple sclerosis regarding pregnancy?. Mult Scler Int 2014; 2014 (14) 819216
    PubMedGoogle Scholar
  • 66 Alwan S, Yee IM, Dybalski M , et al. Reproductive decision making after the diagnosis of multiple sclerosis (MS). Mult Scler 2013; 19 (3) 351-358
    CrossrefPubMedGoogle Scholar
  • 67 Beecham AH, Patsopoulos NA, Xifara DK , et al; International Multiple Sclerosis Genetics Consortium (IMSGC); Wellcome Trust Case Control Consortium 2 (WTCCC2); International IBD Genetics Consortium (IIBDGC). Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis. Nat Genet 2013; 45 (11) 1353-1360
    CrossrefPubMedGoogle Scholar
  • 68 Langagergaard V, Pedersen L, Gislum M, Nørgard B, Sørensen HT. Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: a Danish nationwide cohort study. Aliment Pharmacol Ther 2007; 25 (1) 73-81
    PubMedGoogle Scholar
  • 69 Sadovnick AD, Ebers GC. Genetics of multiple sclerosis. Neurol Clin 1995; 13 (1) 99-118
    PubMedGoogle Scholar
  • 70 Ebers GC, Yee IM, Sadovnick AD, Duquette P ; Canadian Collaborative Study Group. Conjugal multiple sclerosis: population-based prevalence and recurrence risks in offspring. Ann Neurol 2000; 48 (6) 927-931
    CrossrefPubMedGoogle Scholar
  • 71 Aventis S . Aubagio (teriflunomide). Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/202992s000lbl.pdf . Accessed June 1, 2015
    PubMed
  • 72 Berger JR, Centonze D, Comi G , et al. Considerations on discontinuing natalizumab for the treatment of multiple sclerosis. Ann Neurol 2010; 68 (3) 409-411
    CrossrefPubMedGoogle Scholar
  • 73 Martinelli V, Colombo B, Dalla Costa G , et al. Recurrent disease-activity rebound in a patient with multiple sclerosis after natalizumab discontinuations for pregnancy planning. Mult Scler 2013;
    PubMedGoogle Scholar
  • 74 Sempere AP, Berenguer-Ruiz L, Feliu-Rey E. Rebound of disease activity during pregnancy after withdrawal of fingolimod. Eur J Neurol 2013; 20 (8) e109-e110
    CrossrefPubMedGoogle Scholar
  • 75 Demirkiran M, Sarica Y, Uguz S, Yerdelen D, Aslan K. Multiple sclerosis patients with and without sexual dysfunction: are there any differences?. Mult Scler 2006; 12 (2) 209-214
    CrossrefPubMedGoogle Scholar
  • 76 Grinsted L, Heltberg A, Hagen C, Djursing H. Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis. J Intern Med 1989; 226 (4) 241-244
    CrossrefPubMedGoogle Scholar
  • 77 Lombardi G, Celso M, Bartelli M, Cilotti A, Del Popolo G. Female sexual dysfunction and hormonal status in multiple sclerosis patients. J Sex Med 2011; 8 (4) 1138-1146
    CrossrefPubMedGoogle Scholar
  • 78 Sloka JS, Phillips PW, Stefanelli M, Joyce C. Co-occurrence of autoimmune thyroid disease in a multiple sclerosis cohort. J Autoimmune Dis 2005; 2: 9
    CrossrefPubMedGoogle Scholar
  • 79 Marrie RA, Yu BN, Leung S , et al. The incidence and prevalence of thyroid disease do not differ in the multiple sclerosis and general populations: a validation study using administrative data. Neuroepidemiology 2012; 39 (2) 135-142
    CrossrefPubMedGoogle Scholar
  • 80 Biogen Idec. Tysabri® (natalizumab). Available at: http://wwwaccessdatafdagov/drugsatfda_docs/label/2012/125104s0576lbl.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 81 Biogen Idec. Avonex® (interferon β-1a). Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/103628s5115lbl.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 82 Novartis Pharmaceuticals. Gilenya® (fingolimod). Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022527s008lbl.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 83 Teva Pharmaceuticals. Copaxone® (glatiramer acetate). Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020622s057lbl.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 84 Alroughani R. Fingolimod-associated amenorrhea: a report of three cases. Mult Scler 2014; 20 (12) 1662-1664
    CrossrefPubMedGoogle Scholar
  • 85 Harward LE, Mitchell K, Pieper C, Copland S, Criscione-Schreiber LG, Clowse ME. The impact of cyclophosphamide on menstruation and pregnancy in women with rheumatologic disease. Lupus 2013; 22 (1) 81-86
    CrossrefPubMedGoogle Scholar
  • 86 Cocco E, Sardu C, Gallo P , et al; FEMIMS Group. Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study. Mult Scler 2008; 14 (9) 1225-1233
    CrossrefPubMedGoogle Scholar
  • 87 Linssen WH, Notermans NC, Hommes OR, Rolland R. Amenorrhea after immunosuppressive treatment of multiple sclerosis. Acta Neurol Scand 1987; 76 (3) 204-209
    CrossrefPubMedGoogle Scholar
  • 88 Sutcliffe AG, Ludwig M. Outcome of assisted reproduction. Lancet 2007; 370 (9584) 351-359
    CrossrefPubMedGoogle Scholar
  • 89 Hellwig K, Correale J. Artificial reproductive techniques in multiple sclerosis. Clin Immunol 2013; 149 (2) 219-224
    CrossrefPubMedGoogle Scholar
  • 90 Laplaud DA, Lefrère F, Leray E, Barrière P, Wiertlewski S. [Increased risk of relapse in multiple sclerosis patients after ovarian stimulation for in vitro fertilization]. Gynecol Obstet Fertil 2007; 35 (10) 1047-1050
    CrossrefPubMedGoogle Scholar
  • 91 Hellwig K, Beste C, Brune N , et al. Increased MS relapse rate during assisted reproduction technique. J Neurol 2008; 255 (4) 592-593
    CrossrefPubMedGoogle Scholar
  • 92 Hellwig K, Schimrigk S, Beste C, Muller T, Gold R. Increase in relapse rate during assisted reproduction technique in patients with multiple sclerosis. Eur Neurol 2009; 61 (2) 65-68
    CrossrefPubMedGoogle Scholar
  • 93 Michel L, Foucher Y, Vukusic S , et al; Club Francophone de la Sclérose En Plaques (CFSEP). Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry 2012; 83 (8) 796-802
    CrossrefPubMedGoogle Scholar
  • 94 Correale J, Farez MF, Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Ann Neurol 2012; 72 (5) 682-694
    CrossrefPubMedGoogle Scholar
  • 95 ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 81, May 2007. Obstet Gynecol 2007; 109 (5) 1233-1248
    CrossrefPubMedGoogle Scholar
  • 96 Brown HL, Graves CR. Smoking and marijuana use in pregnancy. Clin Obstet Gynecol 2013; 56 (1) 107-113
    CrossrefPubMedGoogle Scholar
  • 97 Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169
    CrossrefPubMedGoogle Scholar
  • 98 Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS. The impact of vitamin D on pregnancy: a systematic review. Acta Obstet Gynecol Scand 2012; 91 (12) 1357-1367
    CrossrefPubMedGoogle Scholar
  • 99 Tremlett H, van der Mei IA, Pittas F , et al. Monthly ambient sunlight, infections and relapse rates in multiple sclerosis. Neuroepidemiology 2008; 31 (4) 271-279
    CrossrefPubMedGoogle Scholar
  • 100 Mowry EM, Krupp LB, Milazzo M , et al. Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol 2010; 67 (5) 618-624
    PubMedGoogle Scholar
  • 101 Mowry EM, Waubant E, McCulloch CE , et al. Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis. Ann Neurol 2012; 72 (2) 234-240
    CrossrefPubMedGoogle Scholar
  • 102 Mowry EM. Vitamin D: evidence for its role as a prognostic factor in multiple sclerosis. J Neurol Sci 2011; 311 (1–2) 19-22
    CrossrefPubMedGoogle Scholar
  • 103 Dobson R, Giovannoni G, Ramagopalan S. The month of birth effect in multiple sclerosis: systematic review, meta-analysis and effect of latitude. J Neurol Neurosurg Psychiatry 2013; 84 (4) 427-432
    CrossrefPubMedGoogle Scholar
  • 104 Chaudhuri A. Why we should offer routine vitamin D supplementation in pregnancy and childhood to prevent multiple sclerosis. Med Hypotheses 2005; 64 (3) 608-618
    CrossrefPubMedGoogle Scholar
  • 105 Grytten N, Torkildsen Ø, Aarseth JH , et al. Month of birth as a latitude-dependent risk factor for multiple sclerosis in Norway. Mult Scler 2013; 19 (8) 1028-1034
    CrossrefPubMedGoogle Scholar
  • 106 Staples J, Ponsonby AL, Lim L. Low maternal exposure to ultraviolet radiation in pregnancy, month of birth, and risk of multiple sclerosis in offspring: longitudinal analysis. British Medical Journal 2010; 340: c1640
    PubMedGoogle Scholar
  • 107 ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 495: Vitamin D: screening and supplementation during pregnancy. Obstet Gynecol 2011; 118 (1) 197-198
    CrossrefPubMedGoogle Scholar
  • 108 Thorne-Lyman A, Fawzi WW. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 2012; 26 (Suppl. 01) 75-90
    Google Scholar
  • 109 Achiron A, Kishner I, Dolev M , et al. Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis. J Neurol 2004; 251 (9) 1133-1137
    PubMedGoogle Scholar
  • 110 Haas J, Hommes OR. A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis. Mult Scler 2007; 13 (7) 900-908
    CrossrefPubMedGoogle Scholar
  • 111 Hellwig K, Beste C, Schimrigk S, Chan A. Immunomodulation and postpartum relapses in patients with multiple sclerosis. Ther Adv Neurol Disord 2009; 2 (1) 7-11
    CrossrefPubMedGoogle Scholar
  • 112 Ferrero S, Esposito F, Pretta S, Ragni N. Fetal risks related to the treatment of multiple sclerosis during pregnancy and breastfeeding. Expert Rev Neurother 2006; 6 (12) 1823-1831
    CrossrefPubMedGoogle Scholar
  • 113 Webb JA, Thomsen HS, Morcos SK ; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005; 15 (6) 1234-1240
    CrossrefPubMedGoogle Scholar
  • 114 American College of Radiology. ACR Guidelines and Technical Standards. Practice Guideline for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. 1st ed. Reston, VA: American College of Radiology; 2008
    Google Scholar
  • 115 Kanal E, Shellock FG, Talagala L. Safety considerations in MR imaging. Radiology 1990; 176 (3) 593-606
    CrossrefPubMedGoogle Scholar
  • 116 ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104 (3) 647-651
    CrossrefPubMedGoogle Scholar
  • 117 Lu E, Zhu F, van der Kop M , et al; British Columbia Multiple Sclerosis Clinic Neurologists. Labor induction and augmentation in women with multiple sclerosis. Mult Scler 2013; 19 (9) 1182-1189
    CrossrefPubMedGoogle Scholar
  • 118 Lu E, Zhao Y, Zhu F , et al; British Columbia Multiple Sclerosis Clinic Neurologists. Birth hospitalization in mothers with multiple sclerosis and their newborns. Neurology 2013; 80 (5) 447-452
    CrossrefPubMedGoogle Scholar
  • 119 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) 950-955
    CrossrefPubMedGoogle Scholar
  • 120 Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology 2005; 65 (12) 1961-1963
    CrossrefPubMedGoogle Scholar
  • 121 Kelly VM, Nelson LM, Chakravarty EF. Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology 2009; 73 (22) 1831-1836
    CrossrefPubMedGoogle Scholar
  • 122 Dahl J, Myhr KM, Daltveit AK, Gilhus NE. Planned vaginal births in women with multiple sclerosis: delivery and birth outcome. Acta Neurol Scand Suppl 2006; 183: 51-54
    PubMedGoogle Scholar
  • 123 Chen YH, Lin HL, Lin HC. Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study. Mult Scler 2009; 15 (5) 606-612
    CrossrefPubMedGoogle Scholar
  • 124 Mueller BA, Zhang J, Critchlow CW. Birth outcomes and need for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol 2002; 186 (3) 446-452
    CrossrefPubMedGoogle Scholar
  • 125 van der Kop ML, Pearce MS, Dahlgren L , et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol 2011; 70 (1) 41-50
    CrossrefPubMedGoogle Scholar
  • 126 Lu E, Zhao Y, Dahlgren L , et al. Obstetrical epidural and spinal anesthesia in multiple sclerosis. J Neurol 2013; 260 (10) 2620-2628
    CrossrefPubMedGoogle Scholar
  • 127 Dalmas AF, Texier C, Ducloy-Bouthors AS, Krivosic-Horber R. [Obstetrical analgesia and anaesthesia in multiple sclerosis]. Ann Fr Anesth Reanim 2003; 22 (10) 861-864
    CrossrefPubMedGoogle Scholar
  • 128 Martucci G, Di Lorenzo A, Polito F, Acampa L. A 12-month follow-up for neurological complication after subarachnoid anesthesia in a parturient affected by multiple sclerosis. Eur Rev Med Pharmacol Sci 2011; 15 (4) 458-460
    PubMedGoogle Scholar
  • 129 Drake E, Drake M, Bird J, Russell R. Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience. Int J Obstet Anesth 2006; 15 (2) 115-123
    CrossrefPubMedGoogle Scholar
  • 130 Vukusic S, Confavreux C. [Multiple sclerosis and pregnancy]. Rev Neurol (Paris) 2006; 162 (3) 299-309
    CrossrefPubMedGoogle Scholar
  • 131 Pastò L, Portaccio E, Ghezzi A , et al; MS Study Group of the Italian Neurological Society. Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol 2012; 12: 165
    CrossrefPubMedGoogle Scholar
  • 132 Orvieto R, Achiron R, Rotstein Z, Noy S, Bar-Hava I, Achiron A. Pregnancy and multiple sclerosis: a 2-year experience. Eur J Obstet Gynecol Reprod Biol 1999; 82 (2) 191-194
    CrossrefPubMedGoogle Scholar
  • 133 Poser S, Poser W. Multiple sclerosis and gestation. Neurology 1983; 33 (11) 1422-1427
    CrossrefPubMedGoogle Scholar
  • 134 Finkelsztejn A, Fragoso YD, Ferreira ML , et al. The Brazilian database on pregnancy in multiple sclerosis. Clin Neurol Neurosurg 2011; 113 (4) 277-280
    CrossrefPubMedGoogle Scholar
  • 135 National Institutes of Health LactMed. Available at: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT . Accessed June 1, 2015.
  • 136 Hale TW. Medications and Mothers' Milk. 15th ed. Amarillo, TX: Hale Publishing; 2012
    Google Scholar
  • 137 Koren G. Medication Safety in Pregnancy and Breastfeeding. New York: McGraw Hill Professional; 2007
    Google Scholar
  • 138 Houtchens MK, Kolb CM. Multiple sclerosis and pregnancy: therapeutic considerations. J Neurol 2013; 260 (5) 1202-1214
    CrossrefPubMedGoogle Scholar
  • 139 Hellwig K, Gold R. Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J Neurol 2011; 258 (3) 502-503
    CrossrefPubMedGoogle Scholar
  • 140 Hale TW, Siddiqui AA, Baker TE. Transfer of interferon β-1a into human breastmilk. Breastfeed Med 2012; 7 (2) 123-125
    CrossrefPubMedGoogle Scholar
  • 141 World Health Organization. Pregnancy WHO. Childbirth, Postpartum and Newborn Care - A Guide for Essential Practice. 2006 ed. Geneva, Switzerland: World Health Organization, Department of Making Pregnancy Safer; 2006
    Google Scholar
  • 142 American College of Radiology. Administration of contrast media to breast-feeding mothers. In: ACR Manual on Contrast Media. 1st ed. Reston, VA: American College of Radiology; 2013: 97-98
    Google Scholar
  • 143 American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 (3) 776-789
    CrossrefPubMedGoogle Scholar
  • 144 de Seze J, Chapelotte M, Delalande S, Ferriby D, Stojkovic T, Vermersch P. Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis. Mult Scler 2004; 10 (5) 596-597
    CrossrefPubMedGoogle Scholar
  • 145 Haas J. High dose IVIG in the post partum period for prevention of exacerbations in MS. Mult Scler 2000; 6 (2) (Suppl. 02) S18-S20 , discussion S33
    PubMedGoogle Scholar
  • 146 Ost L, Wettrell G, Björkhem I, Rane A. Prednisolone excretion in human milk. J Pediatr 1985; 106 (6) 1008-1011
    CrossrefPubMedGoogle Scholar
  • 147 Hoes JN, Jacobs JW, Boers M , et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007; 66 (12) 1560-1567
    CrossrefPubMedGoogle Scholar
  • 148 Feinstein A. Multiple sclerosis and depression. Mult Scler 2011; 17 (11) 1276-1281
    CrossrefPubMedGoogle Scholar
  • 149 Arnett PA, Barwick FH, Beeney JE. Depression in multiple sclerosis: review and theoretical proposal. J Int Neuropsychol Soc 2008; 14 (5) 691-724
    PubMedGoogle Scholar
  • 150 Gulick EE, Kim S. Postpartum emotional distress in mothers with multiple sclerosis. J Obstet Gynecol Neonatal Nurs 2004; 33 (6) 729-738
    CrossrefPubMedGoogle Scholar
  • 151 Gulick EE. Adaptation of the postpartum support questionnaire for mothers with multiple sclerosis. Res Nurs Health 2003; 26 (1) 30-39
    CrossrefPubMedGoogle Scholar
  • 152 Gulick EE. Postpartum functioning in mothers with multiple sclerosis. West J Nurs Res 2007; 29 (5) 589-602 , discussion 603–612
    CrossrefPubMedGoogle Scholar
  • 153 O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013; 9: 379-407
    CrossrefPubMedGoogle Scholar
  • 154 Ross LE, Grigoriadis S, Mamisashvili L , et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry 2013; 70 (4) 436-443
    CrossrefPubMedGoogle Scholar