Pregnancy, sex and hormonal factors in multiple sclerosis
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TLDR
Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery and the use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued.Abstract:
Background: Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors. Objectives: A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment. Methods: Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes. Results and conclusions: Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery. The use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued. Available knowledge about the impact of treatment on the mother, fetus and newborn is discussed. Recommendations for future research to fill knowledge gaps and clarify inconsistencies in available data are made.read more
Citations
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Journal ArticleDOI
Disease modifying therapies for relapsing multiple sclerosis
TL;DR: Methods such as stratifying patients on the basis of estimated risk for future disability, weighing patient specific factors and preferences, and using objective outcomes to adjudicate treatment success are discussed, and emerging drug therapies and strategies are reviewed.
Journal ArticleDOI
Impact of sex hormones on immune function and multiple sclerosis development.
TL;DR: Clinical evidence for the impact of sex hormones (estrogens, progesterone, prolactin, and testosterone) on MS is discussed and the hormonal and immunological mechanisms potentially underlying these changes are elucidated.
Journal ArticleDOI
Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review.
Riley Bove,Sura Alwan,Jan M. Friedman,Kerstin Hellwig,Maria K. Houtchens,Gideon Koren,Ellen Lu,Thomas F. McElrath,Penelope Smyth,Helen Tremlett,A. Dessa Sadovnick +10 more
TL;DR: In this article, the authors examined the evidence guiding management of multiple sclerosis in reproductive-aged women and conducted an electronic literature search using PubMed, ClinicalTrials.gov, and other available resources.
Journal ArticleDOI
Management of women with multiple sclerosis through pregnancy and after childbirth
TL;DR: This review will discuss state-of-the-art family planning counseling in the treatment era, divided into prepregnancy, pregnancy, and postpartum MS issues.
Journal ArticleDOI
The maternal immune system during pregnancy and its influence on fetal development
TL;DR: This work is distributed under the terms of the License http://creativecommons.org/licenses/by-nc/3.0/.
References
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Journal ArticleDOI
Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis
TL;DR: The results of this study suggest that high circulating levels of vitamin D are associated with a lower risk of multiple sclerosis.
Journal ArticleDOI
Rate of Pregnancy-Related Relapse in Multiple Sclerosis
Christian Confavreux,Michael Hutchinson,Martine Hours,Cortinovis-Tourniaire P,Thibault Moreau +4 more
TL;DR: This study studied 254 women with multiple sclerosis during 269 pregnancies in 12 European countries to determine the rate of relapse per trimester and the score on the Kurtzke Expanded Disability Status Scale.
Journal ArticleDOI
Regulatory B cells inhibit EAE initiation in mice while other B cells promote disease progression
TL;DR: It is shown that EAE disease initiation and progression are differentially influenced by the depletion of B cells from mice with otherwise intact immune systems, and reciprocal regulatory roles for B cells during EAE immunopathogenesis are demonstrated.
Journal ArticleDOI
Sex ratio of multiple sclerosis in Canada: a longitudinal study
Sarah M. Orton,Blanca M. Herrera,Irene M. Yee,William Valdar,Sreeram V. Ramagopalan,A. Dessa Sadovnick,George C. Ebers +6 more
TL;DR: The substantial increase in the female to male sex ratio in Canada seems to result from a disproportional increase in incidence of multiple sclerosis in women, which implies that a large proportion of several sclerosis cases may be preventable in situ.
Journal ArticleDOI
Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies
Laura Y. Park-Wyllie,Paolo Mazzotta,Anne Pastuszak,Myla E Moretti,Lizanne Beique,Laura Hunnisett,Mark H. Friesen,Sheila Jacobson,S. Kasapinovic,Debra Chang,Orna Diav-Citrin,David Chitayat,Irena Nulman,Thomas R. Einarson,Gideon Koren +14 more
TL;DR: Although prednisone does not represent a major teratogenic risk in humans at therapeutic doses, it does increase by an order of 3.4-fold the risk of oral cleft, which is consistent with the existing animal studies.
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