Saturday, 5 March 2016

ResearchSpeak: having children and MS outcome

Should pregnancy be prescribed as a DMT in MS? #ResearchSpeak #MSResearch #MSBlog

"We have known for sometime that pregnancy has a positive outcome on MS. Relapse rates drop markedly in pregnancy, particularly in the second and third trimesters and tend to rebound after birth. Woman with MS (wwMS) who have no children do worse in the long term compared to wwMS who have multiple pregnancies. In addition, the number of pregnancies add-up; in general the more children you have the better the outcome. The study below from Catania, in Sicily, confirms published findings from other studies. This study is retrospective and hence is not as good as the prospective data on this issue from Sweden and Canada."

"Should we be prescribing pregnancy as a treatment for MS? If only we could work out what it is about pregnancy that has a positive effect on MS we could then create a state of pseudopregnancy as a treatment for MS. Some investigators think it is the hormonal changes that are present in pregnancy that are responsible for the effect, in particular oestradiol. Others suggest the cytokines (immunological messengers) that are produced by the placenta are responsible for the effect. Pregnancy is a state of relative immunosuppression; a pregnant woman's immune system undergoes dramatic changes so as not recognise the placenta and foetus as foreign and reject them. If only we could recreate the pregnancy state without having to be physically pregnant then we would have a new treatment for MS; at least for wwMS."
"The other elephant in the room is that a large number of pwMS decide not to have children or extend their families when they develop MS. The reasons for this are multiple; some of include (1) anxiety about becoming too disabled to manage parenthood, (2) not being able to earn enough money to afford children, (3) anxiety about not having a partner to help with parenthood (pwMS have higher rates of divorce and separation), (4) not wanting to put their own health at risk by having to stop DMTs to fall pregnant, (5) not wanting to expose children to the risks of developing MS themselves, and (6) being depressed and anxious and hence not having the motivation to become a parent. Maybe we should update our survey on parenthood and MS; attitudes may have changed now that we have highly-effective DMTs available. Thoughts?"



OBJECTIVES: Data on pregnancy long-term effects on multiple sclerosis (MS) course are still controversial; whether experiencing more than one pregnancy exposes one to risk of the disability's accrual is still unknown. We investigated differences existing in terms of disability progression among women with MS (wwMS) who had one or more children after their MS onset.

METHODS: Monoparous (one-child) and multiparous (many children) wwMS were enrolled from the Catania MS Center, Italy, in a monocenter retrospective study. A Cox proportional hazards model was used to examine the effect of the number of parities on time from MS disease onset to EDSS 4.0 (walking problems) and 6.0 (walking stick). The study protocol was approved by the local Ethical Committee.

RESULTS: During the seven years of observation, 32.1% and 23.2% of the monoparous group reached expanded disability disease status (EDSS) 4.0 and 6.0 respectively, compared to 13.3% and 3.3% of the multiparous group (p = 0.057 and p = 0.017; respectively). The Kaplan-Meier curve analysis showed no statistically-significant differences between the two groups in reaching the two milestones. The multiparous group showed a longer time to reach the EDSS 4.0 (3.5 vs. 2.6 years, log-rank 0.57, p = 0.45). The Cox regression analysis showed that the EDSS at the time of first pregnancy (Exp(B) 9.4, CI 4.5-19.7, p< 0.001) and the time from MS onset to first pregnancy (Exp(B) 0.96, CI = 0.93-0.98, p < 0.05) were significant predictors of reaching the EDSS 4.0, whereas a model including only the EDSS one year after the first pregnancy significantly predicted (Exp(B) value of 6.4, CI 2.6-15.4, p < 0.001) the reaching of EDSS 6.0.

CONCLUSIONS: Our results suggest that experiencing more than one pregnancy could not convey a different clinical outcome in wwMS. Further research is needed to confirm our results.

11 comments:

  1. Interesting. This is the first time I have read that pregnancy actually has an overall beneficial effect - I knew there was protection during pregnancy, but thought there was no long term change in outcome.

    My firm decision not to have children has many facets, which have nothing to do with MS. But MS has certainly been part of the decision. For example, I know - from a close relative - how devastating and debilitating to a woman prolapse can be, how difficult it is to treat, and I would have expected it to be harder for me, with MS, to regain pelvic floor tone.

    In general, the idea of having children to protect one's own health is unpalatable to me. Although, in the real world, this is of course very unlikely to be anyone's sole, selfish motivation.

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  2. "If only we could recreate the pregnancy state without having to be physically pregnant then we would have a new treatment for MS"

    ProfG - I appreciate your thought process, but we are no where close to understanding the immune process in MS, how can we possibly achieve this for pregnancy?

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  3. I'd love to have children but I'm reluctant for all the reasons you've stated. I worry having children would be selfish of me.

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  4. How about not wanting to have children because they might end up being child carers?

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    1. Although one must acknowledge that MS is but one way in this world to suffer or to possibly become an invalid, and no one, but no one, can know what fate lies before them in life, what illness may await them. If everyone contemplating children really thought about all possible uncertainties of the whole process of life with honesty, how many would still intentionally have children? And to be born of loving parents with a known health affliction but a strong desire to love a child is surely better than being brought up with people who simply don't care, or who are even abusive.

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    2. My choice not to have a child, that would end up being my carer. Small children although loved is difficult when you become disabled after you have children. When I knew I was ill in advance, how unfair would that be to bring a child into a world, where it would be expected by society to be my main carer?

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    3. This is of course a very valid and respectable personal decision. And one I believe many more people ought to make, given overpopulation issues on Earth - but enough of my personal sentiments on that. I think one should remember, if talking in general, that much will depend on individual circumstances - partner, extended family, finances etc. If, through not having children, the obligation for one's care falls to a sibling, or to society - is that fairer? Another point may be that not every person requiring care is considered a burden to those who assist. Regardless of my views on overpopulation, I do not believe that disabled people should feel obliged to justify a decision to have children.

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  5. So how does this relate to a number of women having their first MS symptoms after giving birth?
    A high plant based diet is apparently supposed to help menopause symptoms in the general population. Plant oestrogens act in a similar way to oestrogens which may keep hormones a bit more balanced. So I wonder if this could be any indication on MS. I'm not saying be vegetarian or vegan.

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  6. Could the beneficial effect of MS during the MS be related to cytokines/ HERVs/and placenta?

    Even before EM was not thinking about children ...

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  7. In the Weekend i newspaper 27/2 discussed

    'what ever the reason (choosing not to be a mother, medical reasons or because they left it too late) breeding is gradually losing it's popularity. One in four women in their forties does not have children - the highest proportion ever'.

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    1. It is slightly comforting to know one in four women in their forties does not have children.

      I am in my early forties and don't have children. My MS started severe and rapid. I didn't feel maternal for quite a few years before the MS. With the MS and now I've left it too late, I don't think I will be having children.

      I would need a hands on partner to have a child anyway. I find it hard to lift anything over 1kg so I would not be able to lift a child.

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