Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations
<h3>Objective</h3><p dir="ltr">To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them.</p><h3>Research design and methods</h3><p dir="ltr">A sy...
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2020
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| _version_ | 1864513554565038080 |
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| author | Beatriz Canibaño (18102676) |
| author2 | Dirk Deleu (4919410) Boulenouar Mesraoua (16936932) Gayane Melikyan (14777629) Faiza Ibrahim (18102682) Yolande Hanssens (14151507) |
| author2_role | author author author author author |
| author_facet | Beatriz Canibaño (18102676) Dirk Deleu (4919410) Boulenouar Mesraoua (16936932) Gayane Melikyan (14777629) Faiza Ibrahim (18102682) Yolande Hanssens (14151507) |
| author_role | author |
| dc.creator.none.fl_str_mv | Beatriz Canibaño (18102676) Dirk Deleu (4919410) Boulenouar Mesraoua (16936932) Gayane Melikyan (14777629) Faiza Ibrahim (18102682) Yolande Hanssens (14151507) |
| dc.date.none.fl_str_mv | 2020-02-06T03:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1080/21556660.2020.1721507 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Pregnancy-related_issues_in_women_with_multiple_sclerosis_an_evidence-based_review_with_practical_recommendations/27827400 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Neurosciences Pharmacology and pharmaceutical sciences Reproductive medicine Multiple sclerosis pregnancy breastfeeding delivery newborn disease-modifying therapy postpartum |
| dc.title.none.fl_str_mv | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Objective</h3><p dir="ltr">To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them.</p><h3>Research design and methods</h3><p dir="ltr">A systematic review was performed based on a comprehensive literature search.</p><h3>Results</h3><p dir="ltr">MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not <i>per se</i> high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNβ) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNβ are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn.</p><h3>Conclusions</h3><p dir="ltr">This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Drug Assessment<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1080/21556660.2020.1721507" target="_blank">https://dx.doi.org/10.1080/21556660.2020.1721507</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_ba2e62160ed3f05832841564d8c9d435 |
| identifier_str_mv | 10.1080/21556660.2020.1721507 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/27827400 |
| publishDate | 2020 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendationsBeatriz Canibaño (18102676)Dirk Deleu (4919410)Boulenouar Mesraoua (16936932)Gayane Melikyan (14777629)Faiza Ibrahim (18102682)Yolande Hanssens (14151507)Biomedical and clinical sciencesNeurosciencesPharmacology and pharmaceutical sciencesReproductive medicineMultiple sclerosispregnancybreastfeedingdeliverynewborndisease-modifying therapypostpartum<h3>Objective</h3><p dir="ltr">To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them.</p><h3>Research design and methods</h3><p dir="ltr">A systematic review was performed based on a comprehensive literature search.</p><h3>Results</h3><p dir="ltr">MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not <i>per se</i> high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNβ) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNβ are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn.</p><h3>Conclusions</h3><p dir="ltr">This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Drug Assessment<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1080/21556660.2020.1721507" target="_blank">https://dx.doi.org/10.1080/21556660.2020.1721507</a></p>2020-02-06T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1080/21556660.2020.1721507https://figshare.com/articles/journal_contribution/Pregnancy-related_issues_in_women_with_multiple_sclerosis_an_evidence-based_review_with_practical_recommendations/27827400CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/278274002020-02-06T03:00:00Z |
| spellingShingle | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations Beatriz Canibaño (18102676) Biomedical and clinical sciences Neurosciences Pharmacology and pharmaceutical sciences Reproductive medicine Multiple sclerosis pregnancy breastfeeding delivery newborn disease-modifying therapy postpartum |
| status_str | publishedVersion |
| title | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| title_full | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| title_fullStr | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| title_full_unstemmed | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| title_short | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| title_sort | Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations |
| topic | Biomedical and clinical sciences Neurosciences Pharmacology and pharmaceutical sciences Reproductive medicine Multiple sclerosis pregnancy breastfeeding delivery newborn disease-modifying therapy postpartum |