Saturday, 7 July 2018

Disease activation after abortion

We know that pregnancy reduces the risk of attacks.

Likewise we know that you are risk of attacks, after the baby has been born.

So what happens after an adorption?
Yes, you guessed it. There is an increase risk of disease activty. 

This is because the attacks are kept at bay by the action of hormones and once  the baby/foetus has gone. The hormones revert to a pre-pregnancy state and MS is off again. Therefore, if you do find yourself making the decision about a termination ensure you discuss this with your neurology team.

Landi D, Ragonese P, Prosperini L, Nociti V, Haggiag S, Cortese A, Fantozzi R, Pontecorvo S, Ferraro E, Buscarinu MC, Mataluni G, Monteleone F, Salvetti M, Di Battista G, Francia A, Millefiorini E, Gasperini C, Mirabella M, Salemi G, Boffa L, Pozzilli C, Centonze D, Marfia GA. 
Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry. 2018 Jul 3. pii: jnnp-2018-318468.

OBJECTIVE:To investigate clinical and radiological outcomes of women with relapsing-remitting multiple sclerosis (RRMS) undergoing abortion.
METHODS: An independent, multicentre retrospective study was conducted collecting data from eight Italian MS centres. We compared the preconception and postabortion annualised relapse rate (ARR) and number of Gadolinium enhancing (Gd+) lesions, by analyses of covariance. Variables associated with postabortion clinical and MRI activity were investigated using Poisson regression models; each abortion was considered as a statistical unit.
RESULTS:

From 1995 to 2017, we observed 188 abortions (17 elective) in 153 women with RRMS. Abortions occurred after a mean time of 9.5 (4.4) weeks from estimated conception date. In 86 events out of 188, conception happened during treatment with disease modifying drugs. The mean postabortion ARR (0.63±0.74) was significantly increased (p=0.037) compared with the preconception year (0.50±0.71) as well as the postabortion mean number of new Gd+ lesions (0.77±1.40 vs 0.39±1.04; p=0.004). Higher likelihood of relapses was predicted by higher preconception ARR, discontinuation of preconception treatment and elective abortion; the occurrence of new Gd+ lesions was associated with higher preconception number of active lesions, discontinuation of preconception treatment, shorter length of pregnancy maintenance and elective abortion.
CONCLUSIONS:

Abortion was associated with clinical and radiological inflammatory rebound remarkably in the first 12 months postevent. Deregulated proinflammatory processes arising at the early stages of pregnancy might play a role both in MS reactivation and abortion. Women with MS should be counselled about these risks of abortion and followed up accordingly.

3 comments:

  1. I think it’s really important to note that in the paper “abortion” covers both miscarriage (171/188) and terminations...

    ReplyDelete
  2. This is quite interesting. Has it been corrected for DMT use? Were women having abortions because they had active disease and were worried about teratogenicity of treatment? Was treatment interrupted when pregnancy discovered?

    ReplyDelete
  3. What are these hormones that keep the disease under control during pregnancy?
    Has anybody tried to administer them to non-pregnant women as a DMT?

    I remember my pregnancies as periods of high energy and mental clarity, quite a contrast to my usual self, and I worked right till the end.

    Later I found it really hard to manage even minor tasks of keeping the house in order while looking after the baby

    This was a long before any hints of MS

    ReplyDelete

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