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Vol 54, No 2 (2020)
Guidelines
Submitted: 2019-07-17
Accepted: 2019-11-18
Published online: 2020-02-21
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Recommendations for neurological, obstetrical and gynaecological care in women with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society

Alicja Kalinowska1, Alina Kułakowska2, Monika Adamczyk-Sowa3, Krzysztof Czajkowski4, Katarzyna Kurowska5, Bronisława Pietrzak6, Piotr Radziszewski7, Konrad Rejdak8, Halina Bartosik-Psujek9
DOI: 10.5603/PJNNS.a2020.0015
·
Pubmed: 32083716
·
Neurol Neurochir Pol 2020;54(2):125-137.
Affiliations
  1. Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan Univerisity of Medical Sciences, 49, Przybyszewskiego st., 60-355 Poznan, Poland
  2. Department of Neurology, Medical University of Bialystok, Poland
  3. Department of Neurology, Zabrze; Medical University of Silesia, Katowice, Poland
  4. II Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
  5. Institute of Psychiatry and Neurology, Warsaw, Poland
  6. I Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
  7. Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland
  8. Department of Neurology, Medical University of Lublin, Poland
  9. Medical Faculty, University of Rzeszow, Poland

open access

Vol 54, No 2 (2020)
Guidelines
Submitted: 2019-07-17
Accepted: 2019-11-18
Published online: 2020-02-21

Abstract

Introduction. Multiple sclerosis (MS) is the most common non-traumatic neurological cause of disability in young adults, affecting women 1-3 times more often than men. Several specific challenges arise from the fact that young women diagnosed with MS often have to make decisions related to treatment and family planning at the same time. These issues are connected with fertility, the impact of pregnancy on disease course, the choice of pregnancy timing, and the optimal mode of disease-modifying therapy in the context of a planned pregnancy, contraception, urological complaints, and sexual dysfunction.

State of the art. While MS does not in itself adversely affect fertility, pregnancy or childbirth, pregnancy needs to be carefully planned. This requires the interdisciplinary co-operation of a neurologist, gynaecologist and psychologist. Data on the impact of disease-modifying drugs on foetal development are very limited, and none of these drugs is 100% safe during pregnancy. In the second and third trimesters, MS relapse rate decreases. Unfortunately, it increases within the first 3-6 months after delivery. Adequate disease control should be achieved before pregnancy, as relapse rate in the period of two years preceding pregnancy is one of the strongest predictive factors for post-partum relapses.

Clinical implications. The following is a statement by a working group of experts in neurology, gynaecology, obstetrics and urology, convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society, addressing the issues that are specific to the female MS population. The aim of this statement is to provide guidance in pregnancy planning and disease management, both during pregnancy and post-partum.

Future directions. This statement reflects expert opinion and is not intended to be read as guidelines. It rather provides up-to-date information on how to optimise care of female MS patients of childbearing age.

Abstract

Introduction. Multiple sclerosis (MS) is the most common non-traumatic neurological cause of disability in young adults, affecting women 1-3 times more often than men. Several specific challenges arise from the fact that young women diagnosed with MS often have to make decisions related to treatment and family planning at the same time. These issues are connected with fertility, the impact of pregnancy on disease course, the choice of pregnancy timing, and the optimal mode of disease-modifying therapy in the context of a planned pregnancy, contraception, urological complaints, and sexual dysfunction.

State of the art. While MS does not in itself adversely affect fertility, pregnancy or childbirth, pregnancy needs to be carefully planned. This requires the interdisciplinary co-operation of a neurologist, gynaecologist and psychologist. Data on the impact of disease-modifying drugs on foetal development are very limited, and none of these drugs is 100% safe during pregnancy. In the second and third trimesters, MS relapse rate decreases. Unfortunately, it increases within the first 3-6 months after delivery. Adequate disease control should be achieved before pregnancy, as relapse rate in the period of two years preceding pregnancy is one of the strongest predictive factors for post-partum relapses.

Clinical implications. The following is a statement by a working group of experts in neurology, gynaecology, obstetrics and urology, convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society, addressing the issues that are specific to the female MS population. The aim of this statement is to provide guidance in pregnancy planning and disease management, both during pregnancy and post-partum.

Future directions. This statement reflects expert opinion and is not intended to be read as guidelines. It rather provides up-to-date information on how to optimise care of female MS patients of childbearing age.

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Keywords

multiple sclerosis, women, pregnancy, childbearing age

About this article
Title

Recommendations for neurological, obstetrical and gynaecological care in women with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 2 (2020)

Article type

Guidelines

Pages

125-137

Published online

2020-02-21

Page views

2108

Article views/downloads

1744

DOI

10.5603/PJNNS.a2020.0015

Pubmed

32083716

Bibliographic record

Neurol Neurochir Pol 2020;54(2):125-137.

Keywords

multiple sclerosis
women
pregnancy
childbearing age

Authors

Alicja Kalinowska
Alina Kułakowska
Monika Adamczyk-Sowa
Krzysztof Czajkowski
Katarzyna Kurowska
Bronisława Pietrzak
Piotr Radziszewski
Konrad Rejdak
Halina Bartosik-Psujek

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