Analysis of pregnancy and childbirth in women with multiple sclerosis: a prospective study
Introduction. Family planning for patients with multiple sclerosis (MS) raises many questions and requires an integrated approach from neurologists and obstetriciangynaecologists. The study aimed to define possible features of pregnancy and childbirth in patients with MS. Materials and methods. 204 patients with definite moderate MS, who were planning a pregnancy and taking FirstLine DiseaseModifying Therapies (DMTs) before pregnancy. First group included 94 patients with pregnancies; the second group consisted of 110 patients, who failed to conceive within a stated period of time; in the third group there were 50 healthy women with normal pregnancies. Probability of developing pregnancy complications, time and method of delivery, anaesthetic procedures, weight, and height of newborns were assessed, while in the groups of patients with MS the risk of exacerbations and severity of the complications were evaluated. Results and discussion. In the first group, there were more frequent threats of miscarriage and preterm birth, which might have taken place due to a complex of factors (cancellation of DMTs, use of hormonal therapy for exacerbations during pregnancy). The high frequency of caesarean section in the first group was associated with the unreasonable alertness of obstetriciangynaecologists and the fear of the patients that the course of MS would worsen. Frequent exacerbations during pregnancy were associated with the abolition of DMTs before pregnancy and the failure of physiological immunosuppression during pregnancy. Conclusion. In Russia, there is no single protocol for managing patients with MS during the period of family planning, pregnancy, and the postpartum period, which causes certain difficulties. There is emerging evidence that certain DMTs can be prescribed during pregnancy and lactation, which will help minimize the risks of exacerbations and disability increase.