Pregnancy

For many years, pregnancy was considered to have an adverse effect on the course of MS. Several modern studies have re-examined this question both retrospectively (175,215-219) and prospectively (220,221). Pregnancy itself appears to be associated with a lower exacerbation rate than that in age-matched controls. However, the postpartum period, particularly the first three months after delivery, is accompanied by an increase in the frequency of attacks, according to most, but not all, reports (175,215,217,219-221). In the largest study, Confavreux et al. (222) followed 254 women with MS through 269 pregnancies in 12 European countries. Relapse rates were lower during pregnancy, most strikingly in the third trimester, when the attack rate dropped to 0.2 ± 1 compared with 0.7 ± 0.9 during the year before pregnancy (P < 0.001). However, during the first three months postpartum the rate increased to 1.2 ± 2.0, significantly greater than that during the year before pregnancy (P < 0.001). The rate then returned to baseline. Breast-feeding did not have an adverse effect on relapse rate. These data are consistent with most, but not all, earlier reports. Whether the increased postpartum frequency is related to change in immunological status after pregnancy, hormonal alteration, the stress of caring for a newborn, or other factors is unknown (219,222).

No current evidence suggests a long-term negative influence of pregnancy on the disease. In fact, recent reports suggest that it may convey a better prognosis (223,224).

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