Dr Patricia Coyle discusses best practices for treatment and family planning in women of reproductive age with multiple sclerosis.
Comprehensive Care Center at Stony Brook University in Long Island, New York. I'm going to be talking about the treatment of women withindicate that it's mandated to discuss family planning in appropriate, newly diagnosed and diagnosed MS individuals.
That's very, very important. The healthcare provider, in discussing family planning, should indicate to the prototypic patient that pregnancy in MS is not considered a high-risk pregnancy. In fact, MS has very little impact on pregnancy. There is. Fertility is not affected. There's no increase in spontaneous abortions. There's no increase in birth defects. You can do any sort ofNow, one of the things that we do want is a planned pregnancy. We don't want a surprise pregnancy in someone with MS where we haven't thought things out. That should be discussed with the individual.any significant disability. We can speak very confidently about what happens in relapsing MS with little-to-no disability with regard to pregnancy, but there's a lack in understanding of more disabled MS individuals and particularly progressive MS. In fact, in pregnancy cohorts,are relapsing MS, not progressive. We really need to have more studies in progressive MS and more disabled MS. Often when we're making the diagnosis of MS, that young individual, when we discuss family planning, may really say that they want to plan to have a child right away. Well, expert consensus indicates that we should. In fact, expert consensus says that the best pathway in a newly diagnosed MS individual is to treat them forearly in the MS disease process to optimally control the damage process. You want to treat early, you don't want patients to wait a couple of years as they try to get pregnant and have a child. They would be better off investing in controlling their MS disease process and then electively going ahead with the pregnancy. What would we counsel in the pre-pregnancy period? First, we need to know about disease activity. There was a famousstudy published in the late 1990s that mapped the annualized relapse rate in French women, largely relapsing MS, and they found it was stable in the pre-pregnancy period. It went down during pregnancy, went further down so that the third trimester had the lowest relapse rate, and then temporarily rebounded after giving birth for a several-month period before ultimately settling down to the pre-pregnancy baseline. Now, why is that? Well, there are immune changes and hormonal changes during pregnancy that could be considered treatments for MS disease activity. You see the disease activity go down during pregnancy. There's really an immune tolerance going on the foreign fetus. There's ain MS, to T helper 2, where you have more humoral antibody immunity that's favorable to MS. Actually, MS disease activity goes down during the pregnancy.can be used in MS, but there should be a discussion in family planning around what the patient is doing to avoid becoming pregnant.] or an implantable rod that is the most effective contraception, and we should actually speak favorably about that to our patients.. Many patients will ask, “Can I pass MS onto my child?” Some may not ask that, but it's a worry for almost everybody. That should be formally discussed. We know there are aboutor more genes that control risk susceptibility, and then there are probably disease severity genes and disease protection genes. You don't have any gene that can pass on MS. MS is not considered an inherited disease, so that's important to emphasize to individuals with MS.“What about disease modifying therapy washouts as a person is preparing for their pregnancy? What DMTs do not need to be washed out?” Withof these agents is an hour or less. It’s washed out within a day, and there are no human pregnancy data suggesting harm from the fumarates. By expert consensus, it's accepted that you would take a fumarate until you got pregnant and then discontinue it.in the United Kingdom has published that they believe that you could try to get pregnant immediately after an anti-CD20 infusion. eggs left and the eggs age. You can collect eggs — it should be done before the age of 37 — and cryopreserve them for a later pregnancy if that is a concern. I finally want to make a point about how dependent we are on getting new information so that we can give the latest updates when counseling our MS individuals. There were several,with much larger numbers of MS individuals who went through IVF, and it turns out that was false. They could not document any increase in relapses whatsoever. In general, there was a tendency totheir disease-modifying therapy right up to, and even through, the IVF technique. Therefore, we've changed our counseling. It turned out, in studies with a larger number of participants, IVF is quite safe for MS individuals.Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication. Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see ourFast Five Quiz: How Do You Manage Multiple Sclerosis Symptoms? Skill Checkup: A 32-Year-Old Woman With Clinically Isolated Syndrome, Coldness in Her Legs, and Facial Twitching Skill Checkup: A 60-Year-Old Man With Depression and Anxiety Presents With Leg Weakness, Fatigue, and Cognitive Issues
Multiple Sclerosis Center Of Excellence Pregnancy Pregnant Family Planning Multiple Sclerosis Multiple Sclerosis (MS) Contraception Birth Control Contraceptive Management Management Of Contraception Multiple Sclerosis Relapse MS Relapse Relapse Of Multiple Sclerosis Relapse Of MS Disease-Modifying Therapy Disease-Modifying Therapy (DMT) Birth Children Child
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