Dr Marie D'hooghe Discusses How Pregnancy Affects Disease Course in Patients With MS

Some data suggest that pregnancy may be beneficial in the long-term for patients with multiple sclerosis (MS), but there exist periods that may carry an extra risk of relapse, such as before conception and in the postpartum period, according to Marie D’hooghe, MD, PhD, neurologist at the National MS Center, Melsbroek, in Brussels, Belgium, and consultant neurologist at the University Hospital in Brussels, Belgium.

Transcript

What is the current state of knowledge on how pregnancy affects disease course in MS?

There have been some observational studies that have indicated that pregnancy might have maybe a beneficial effect in the long term. But we have to be so careful, because maybe only—and probably only—these patients who have a mild disease course get pregnant, and those patients that have a more severe disease course, they don’t get pregnant. So, the observations might be distorted by the fact that more mild MS patients are choosing pregnancy.

So, that’s a difficult one. In the short term, we know that pregnancy is actually quite well tolerated. Especially in the second and the third trimester; there is even a reduction of relapses. But in the postpartum period, just after giving birth, there is an increased risk of relapses, which is not the case in all patients, but there is some increased relapse risk after giving birth. So, it’s important to support this period and to keep in mind that this might happen—to tell the patient that, in the short term, this is a kind of a risky period.

What is also a risky period is when patients start on a treatment, when they’re getting diagnosed, they start on a treatment, and then they want to get pregnant. So then the question is, do you start treatment that can be continued until conception, or do you start treatment that has to be stopped before conception? Of course, we do not know when the patient will conceive, because the period might change from 6 months to 24 months. So in this period, the patients might have relapses, and might have disease activity.

On the other hand, if we have very active treatments that have to be stopped before pregnancy, we risk some kind of rebound activity, and if this occurs during pregnancy, pregnancy will not protect against this rebound activity, and actually, the patient may do worse.