- The Causes Multiple Sclerosis
- Symptoms MS
- Influence of Pregnancy on Multiple Sclerosis
- Complications of Pregnancy
- The Consequences for the Fetus
- Principles of Treatment and Management of Pregnancy
Pregnancy and Multiple Sclerosis
Multiple sclerosis – a chronic autoimmune disease characterized by damage to the myelin sheath of the brain and spinal cord fibers. The disease often occurs at a young age, including pregnant women and those who are just planning to conceive a child. How does multiple sclerosis affect pregnancy and fetal development?
The Causes Multiple Sclerosis
The exact causes of multiple sclerosis are yet to be discovered. Currently, experts tend to believe that the disease is associated with the immune system aggressively reacting to own cells. In this situation a large number of dangerous autoantibodies it produced to destroy the membrane of nerve fibers. Demyelination or else the disintegration of the myelin (the main component in the nerve sheath) starts develop all the characteristic symptoms of multiple sclerosis.
Multiple sclerosis has nothing to do with Alzheimer's disease, impaired memory and attention. In this case we are talking about the formation of multiple foci of destruction of myelin sheath on nerve fibers of brain and spinal cord . The disease occurs predominantly in young people aged 20 to 40 years. Women suffer more than men. The disease occurs mainly among Caucasians.
Multiple sclerosis – a slowly progressive disease. Once occurred, the disease inevitably expands, gradually leading to a deterioration of health and general condition. Competent drug therapy and supervision from an experienced specialist enable slow down the process and improve the patient's quality of life.
There is a certain genetic predisposition to develop multiple sclerosis. Father, mother or close relatives having the disease will increase the probability of its occurrence up to at least 20 %.
Other risk factors for multiple sclerosis:
- Viral and bacterial infections;
- Radiation exposure;
- Lack of sunlight (multiple sclerosis is more common in people living far from the equator in regions with insufficient sunny days per year).
In recent years, much has been said about hepatitis B vaccination linked to the development of multiple sclerosis. Some scientific works mention the vaccination as a risk factor of the disease. However, the World Health Organization does not support this theory claiming to have no current evidence that hepatitis B vaccination does increase the risk of developing multiple sclerosis in young people.
The manifestations of multiple sclerosis are associated with the damage to brain and spinal cord. Demyelinating nerve fibers can occur in various regions.
Depending on where the pathological process takes place one or more symptoms may develop:
- Lack of coordination in movements of various muscular groups;
- Strengthening of reflexes;
- Muscle weakness (most often of the lower extremities);
- Paralysis and paresis;
- Slurred speech;
- Reduced skin sensitivity;
- Numbness, tingling or burning fingers and toes;
- Difficulty in swallowing;
- Spontaneous urination and defecation, delayed stool and urine;
- Decreased intelligence;
- Behavioral changes.
Multiple sclerosis, often results in neurosis-like states. Some women may have astheno vegetative syndrome (weakness, apathy, fatigue). Depression or euphoria may arise as well. There are quite frequent hysterical conditions associated with both organic changes in the brain, and with individual psyche response to the diagnosis. 80% of all women have sharp mood swings throughout the day.
There are several variants of the disease:
- Remitting-relapsing. The most frequent clinical type. Periods of exacerbation are replaced by complete remission with no symptoms at all. From attack to attack the woman's condition does not deteriorate.
- Primary-progressive. From the first days of illness there is a continuous increase of neurological symptoms and the deterioration of women's health. Periods of remission are not typical.
- Secondary-progressive. It occurs in 5-10 years aftert the disease onset. No more periods of remission, the disease is in the progressive stage gradually aggravating general condition and increasing negative symptoms.
The disease is individual in each woman. There are no two patients with identical symptoms and a similar rate of the disease progression. Multiple sclerosis is virtually impossible to predict in terms of the development rate.
Influence of Pregnancy on Multiple Sclerosis
As is the other autoimmune diseases, pregnancy exerts a positive effect on multiple sclerosis. Anticipation of the baby develops natural immunosuppression. Immune suppression leads to a reduced or zero symptoms of the disease at the time of carrying the child. Exacerbation of multiple sclerosis during pregnancy occurs in only 5-10% of women mostly in the 1st trimester.
It is noticed that in most cases an exacerbation of multiple sclerosis occurs soon after delivery (85% – in the first three months). At this time, as the hormone level returns to the original state, the immune system is gaining momentum causing attacks more severe than those before pregnancy. The instrumental examination (MRI) shows active pathological process and severe demyelination of nerve fibers. The risk of disease exacerbation after an abortion is the same as after a successful pregnancy.
At the same time, there are studies showing reduced risk of disease in women who have children. The birth of the second child reduces the chance of developing the disease by 2.5 times. Multiple sclerosis is milder and less often leads to disability is in multiparous women.
Complications of Pregnancy
Multiple sclerosis does not influence the course of pregnancy . The number of spontaneous abortions, gestosis and other gestation complications in this pathology is not superior to other extragenital diseases. Multiple sclerosis is not an indication for abortion. Childbirth in this pathology is usually held in due time (in the absence of other complications of pregnancy and satisfactory condition of the fetus).
The Consequences for the Fetus
Multiple sclerosis is not a genetic disease. Despite this, there is a high probability to transmit predisposition to this disease in children. There are familial cases of multiple sclerosis. The probability of getting ill is drastically increased if the close relatives suffer from this disease.
By itself, the MS does not affect the fetal development. Even in exacerbations of the disease the baby is not getting worse. Women with multiple sclerosis, in most cases, give birth to healthy full-term children (in the absence of other extragenital diseases and complications of gestation).
Principles of Treatment and Management of Pregnancy
Multiple sclerosis is a chronic disease. The complete recovery is unattainable. All the doctor can do is to slow down the progression of the disease and reduce its symptoms. Hormonal and immunosuppressive drugs are used for the purpose. This helps slow down the pathological process developing in the nerve fibers of the brain and spinal cord.
The use of immunosuppressants or similar drugs is contraindicated during pregnancy. These medications have a negative effect on gestation and fetal development. If the expectant mother was taking cytostatics, immunosuppressants or hormones, with the onset of pregnancy, she should discontinue their use. To other alternative means you should consult a doctor.
Since pregnant women mostly have a disease remission, the need for taking potent drugs disappears by itself. In some cases, interferons and other drugs affecting the immune system may be administered. Drugs are prescribed individually, taking into account the duration of pregnancy and disease progression.
After the delivery the multiple sclerosis therapy is conducted in the normal way. In case of exacerbation the woman should consult a therapist or rheumatologist.
Video: Multiple Sclerosis and Pregnancy Stories