Multiple Sclerosis (Em) In Pregnancy

Multiple sclerosis (EM) in pregnancy

Multiple sclerosis (EM) is an autoimmune inflammatory disease, of unknown etiology, which destroys myelin sheath in the axons of the central nervous system. Clinically, it is expressed in different ways;However, a common characteristic is neurological dysfunction, of sudden appearance such as exacerbations or outbreaks, whose manifestations include generalized fatigue, paraesthesia and optical neuritis.

Usually, clinical manifestations appear between 20 and 40 years of age, and their prevalence is very high in European countries, since it is associated with genetic factors in Caucasian people. And in Ecuador, patients with EM do not exceed 5 cases per 100.000 inhabitants;However, something common with global epidemiological data is that it affects women in a proportion of 3: 1, regarding men. 

Starting from the fact that EM to a large number of women of childbearing age, it is logical that the scientific community has been interested in the repercussions of the disease during pregnancy, both for the mother and for the development of the fetus. In fact, recently researchers from the Department of Neurosciences of the University of Monash, they have published a macro -state where it was determined that pregnancy can delay the appearance of EM on average 3 years.

The study included the Gyneco-Obstétrico information of 2557 women with EM, between 2016 and 2019 that were registered in the MSBASE International Registry, which coordinates and compars data from more than 160 collaborating clinics in 35 countries around the world.

The researchers concluded that the average of the first episode of the isolated clinical demyelination syndrome is 31 years of age, and that in those women who have had some pregnancy, even if it did not reach the end, the appearance of the disease was delayed inAverage 3.4 years. 

Even when the physiological mechanisms of this phenomenon are unknown, it is known that pregnancy presents a state of transient immune tolerance for the fetus, so it is possible that during gravity this immune advantage extends to the mother, by hormonal mediation. This hypothesis opens a wide range of therapeutic possibilities with hormonal and immunological base, which we did not have before;what constitutes hope for patients with em.

Other research over time, have revealed important data regarding the effects of EM both on the mother and the fetus. Thanks to them we know that the incidence of spontaneous abortions and fetal malformations does not increase in patients with EM with respect to the general population. Although there is a greater predisposition to develop the disease if the child has at least one patient suffering from EM.

Regarding the effects of pharmacological treatment in the fetus, there is currently no medication that the FDA considers category A. However, no adverse or teratogenic effects have been demonstrated by using immunomodulatory agents such as Glatiramer, Natalizumab or Beta interferon acetate.  As for the complications in pregnancy, they are comparable to that of the general population, the only significant difference is the high incidence of cesarean births, since the natives are usually slower and more painful than in healthy patients in patients. For the rest, there is a lower risk of preeclampsia, eclampsia and membrane rupture in patients with multiple sclerosis.