The Effects of Multiple Sclerosis and Disease Modifying Therapy on Pregnancy
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Abstract
Abstract
Multiple sclerosis (MS) is the most common inflammatory condition of the central nervous system. Disease modifying therapy (DMT) aims to reduce relapse rates and decrease the quantity of lesions in the brain and spinal cord. Since MS is more prevalent in women than men, it is important to be aware of the interplay between MS and pregnancy. As MS can engender sexual dysfunction, primarily in the form of decreased desire and fatigue, it thereby affects conception. Hormonal differences between women with MS compared to women without MS include an increase in follicle-stimulating hormone and luteinizing hormone, and a decrease in testosterone. While fluctuations in estrogen result in a reduction in MS relapse rates during pregnancy, a subsequent increase in the post-partum period is observed. The mechanism of action and side effects of DMTs are described in this paper, including interferon, glatiramer acetate, and some newer medications. Although there are no recommended guidelines on the use of DMTs during pregnancy, it is generally agreed upon to cease their use prior to conception if possible, and the decision to continue a DMT should take into account the benefits to the mother and the risks to the fetus. Comprehending the mechanisms of action and teratogenicity indices of DMTs is crucial in understanding their effects on MS during pregnancy, which is an important aspect of providing health care to women with this condition.
Résumé
La sclérose en plaques (SP) est l’affection inflammatoire du système nerveux central la plus commune. Le traitement modificateur de la maladie (DMT, de l’anglais) vise à réduire les taux de poussées et à diminuer le nombre de lésions au cerveau et à la moelle épinière. Comme la SP est plus prévalente chez les femmes que chez les hommes, il est important de reconnaître l’interaction entre la SP et la grossesse. Puisque la SP peut engendrer une dysfonction sexuelle, principalement en raison d’une diminution du désir sexuel et de la fatigue, elle affecte la conception. Les différences hormonales entre les femmes avec la SP et les femmes sans la SP incluent une hausse de l’hormone folliculostimulante et de l’hormone lutéinisante, et une baisse de testostérone. Bien que les fluctuations en œstrogènes entraînent en une réduction des taux de poussées de la SP durant la grossesse, leur augmentation subséquente lors de la période postpartum est observée. Le mécanisme d’action et les effets secondaires des DMTs sont décrits dans cet article, incluant l’interféron, l’acétate de glatiramère, et certains autres nouveaux médicaments. Quoiqu’il n’existe pas de lignes directrices sur l’utilisation des DMTs lors de la grossesse, il est généralement accepté qu’il faut cesser leur utilisation avant la conception si possible, et que la décision de continuer la prise d’un DMT devrait tenir compte des avantages pour la mère et des risques pour le fœtus. La compréhension des mécanismes d’action et des effets tératogènes des DMTs est essentielle pour apprécier leurs effets sur la SP durant la grossesse, ce qui constitue un aspect important dans la prestation des soins de santé aux femmes vivant avec cette maladie.
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