Document Type : Original Article
Authors
- . Freshteh Ashtari 1
- . Fatemeh Mokhtari 2
- . Mahboubeh Valiani 1
- . Mohammad Soudavi 3
- . Homa Saadat 4
- . Hamidreza Tolouei 5
- . Marjan Mansourian 6
1 Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc, Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Deputy of Treatment, Diseases Management Department, Isfahan University of Medical Sciences Isfahan, Iran
4 Deputy of Treatment, Diseases Management Department, Isfahan University of Medical Sciences Isfahan, Iran,
5 Deputy of Treatment, Isfahan University of Medical Sciences Isfahan, Iran
6 Assistant Professor, Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system. Most
women with MS are diagnosed during their reproductive ages. The aim of this study was to evaluate
the interaction between fertility, pregnancy, and MS.
MATERIALS AND METHODS: A retrospective descriptive–analytic study was conducted on 110
women suffering from MS with a history of pregnancy (between 2007 and 2017 years) in Isfahan,
Iran. Samples were selected in a census model. Women completed a researcher-constructed
questionnaire by telephone. The questionnaire consisted of three parts: demographic information, MS
and its symptoms and treatment, and reproductive system and the history of pregnancy associated
with MS. The data were analyzed by SPSS software version 16 using Chi-square, ANOVA, and t-test.
RESULTS: The mean age of women was 32.4 years. In this population, the average number of
pregnancies was 1.61, the number of deliveries was 1.35, the number of abortions was 0.24, the
history of ectopic pregnancy was 0.01, the number of alive children was 1.36, and the number of dead
children was 0.01. The average time of the last MS attack before the pregnancy was 21.36 months.
Fatigue (24.5%) was the most common symptom exacerbated during pregnancy. MS symptoms
improved in 55.0% of women in the second trimester.
CONCLUSIONS: MS had no effect on the pregnancy status, such as the number of abortions,
ectopic pregnancy, alive and dead children, and the duration of pregnancy. Symptoms of the disease
improved during pregnancy. Therefore, pregnancy has a protective role against MS.
Keywords
2. Kingwell E, Marriott JJ, Jette N, Pringsheim T, Makhani N,
Morrow SA, et al. Incidence and prevalence of multiple sclerosis
in Europe: A systematic review. BMC Neurol 2013;13:128.
3. Dimitrios K. The diagnosis of multiple sclerosis and the
various related demyelinating syndromes: A critical review.
J Autoimmunity 2014;48‑9:134‑42.
4. Thompson Alan J, Peer B. Multiple Sclerosis International
Federation (MSIF) Atlas of MS, MSIF Organization; 2013. Available
from: https://www.msif.org/wpcontent/uploads/2014/09/
Atlas‑of‑MS.pdf. [Last accessed 2017 Jan 20].
5. Dunn SE, Steinman L. The gender gap in multiple sclerosis:
Intersection of science and society. JAMA Neurol 2013;70:634‑5.
6. Etemadifar M, Izadi S, Nikseresht A, Sharifian M, Sahraian MA,
Nasr Z. Estimated prevalence and incidence of multiple sclerosis
in Iran. Eur Neurol 2014;72:370‑4.
7. Zahra TG. A Review of geoepidemiological differences of multiple
sclerosis in Iran and other Middle East countries. Arch Neurosci
J 2015;2:E22028.
8. Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sorensen PS,
Thompson AJ, et al. Defining the clinical course of multiple
sclerosis. J Neurol Am Academy Neurol 2014;83:278‑86.
9. Murray ED, Buttner EA, Price BH. Depression and psychosis
in neurological practice. In: J Bradley’s Neurology in Clinical
Practice. 6th ed. Philadelphia, PA: Elsevier/Saunders; 2012.
10. Karp I, Manganas A, Sylvestre MP, Annie H, Roger E, Duquette P.
Does pregnancy alter the long‑term course of multiple sclerosis?
Ann Epidemiol 2014;24 :504‑8.
11. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA,
Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010
revisions to the McDonald criteria. Ann Neurol 2011;69:292‑302.
12. Brandt‑Wouters E, Gerlach O, Hupperts R. The effect of
postpartum intravenous immunoglobulins on the relapse rate
among patients with multiple sclerosis. Int J Gynecol Obstetrics
2016;134:194‑6.
13. Ponsonby AL, Lucas RM, van der Mei IA, Dear K, Valery PC,
Pender MP, et al. Offspring number, pregnancy, and risk
of a first clinical demyelinating event: The AusImmune
Study. Neurology 2012;78:867‑74.
14. Patas K, Broder Engler J, Manuel A. Friese, Stefan M. Gold
Pregnancy and multiple sclerosis: feto‑maternal immune cross
talk and its implications for disease activity. J Reproduct Immunol 2013;97:140‑6.
15. Confavreux C, Hutchinson M, Hours MM, Cortinovis‑Tourniaire P,
Moreau T. Rate of pregnancy‑related relapse in multiple
sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med
1998;339:285‑91.
16. International Multiple Sclerosis Genetics Consortium, Wellcome
Trust Case Control Consortium Genetic risk and a primary role for
cell‑mediated immune mechanisms in multiple sclerosis. Nature
2011;476:214‑9.
17. International Multiple Sclerosis Genetics Consortium (IMSGC),
Beecham AH, Patsopoulos NA, Xifara DK, Davis MF,
Kemppinen A, et al. Analysis of immune‑related loci identifies
48 new susceptibility variants for multiple sclerosis. Nat Genet
2013;45:1353‑60.
18. Yazdannik A, Abolhassani S, Taleghani F, Zamani A. The
challenges of healthcare delivery to people with multiple sclerosis
in Iran. J Educ Health Promot 2015;4:83.
19. Kaminska M, Kimoff RJ, Schwartzman K, Trojan DA. Sleep
disorders and fatigue in multiple sclerosis: Evidence for
association and interaction. J Neurol Sci 2011;302:7‑13.
20. Kamal MN, Samouei R, Sarrafzadeh S, Tamannaeifar S, Ghaebi N,
Behrouzi R. Relation between personality disorders and
characteristics of multiple sclerosis patients and their parents.
J Edu Health Promot 2018;7:106.
21. Ferraro D, Maria Simone A, Adani G, Vitetta F, Mauri C,
Strumia S, et al. Definitive childlessness in women with multiple
sclerosis: A multicenter study. Neurol Sci 2017;38:1453‑9.
22. Roux T, Courtillot C, Debs R, Touraine P, Lubetzki C, Papeix C.
Fecundity in women with multiple sclerosis: An observational
mono‑centric study. J Neurol 2015;262:957‑60.
23. Borisow N, Döring A, Pfueller CF, Paul F, Dörr J, Hellwig K.
Expert recommendations to personalization of medical
approaches in treatment of multiple sclerosis: An overview of
family planning and pregnancy. EPMA J 2012;3:9.
24. Alwan S, Sadovnick D. Multiple sclerosis and pregnancy:
Maternal considerations. Women’s Health 2012;8:399‑414.
25. McCombe P, Stenager E. Female infertility and multiple sclerosis:
Is this an issue? Mult Scler J 2015;21:5‑7.
26. Karraker A, Latham K. In sickness and in health? PhysicalIllness
as a Risk Factor for Marital Dissolution at Older Ages. Boston,
USA: Population Association of America 2014 Annual Meeting;
2014. p. 4.
27. Hedström AK, Hillert J, Olsson T, Alfredsson L. Reverse causality
behind the association between reproductive history and MS.
Mult Scler 2014;20:406‑11.
28. Cil AP, Leventoğlu A, Sönmezer M, Soylukoç R, Oktay K.
Assessment of ovarian reserve and Doppler characteristics in
patients with multiple sclerosis using immunomodulating drugs.
J Turk Ger Gynecol Assoc 2009;10:213‑9.
29. Sepúlveda M, Ros C, Martínez‑Lapiscina EH, Solà‑Valls N,
Hervàs M, Llufriu S, et al. Pituitary‑ovary axis and ovarian reserve
in fertile women with multiple sclerosis: A pilot study. Mult Scler
2016;22:564‑8.
30. Hellwig K, Correale J. Artificial reproductive techniques in
multiple sclerosis. Clin Immunol 2013;149:219‑24.
31. Fábregues F, Castelo‑Branco C, Carmona F, Guimerá M,
Casamitjana R, Balasch J. The effect of different hormone therapies
on anti‑müllerian hormone serum levels in anovulatory women
of reproductive age. Gynecol Endocrinol 2011;27:216‑24.
32. Douglass LH, Jorgensen CL. Pregnancy and multiple sclerosis.
Am J Obstet Gynecol 1948;55:332‑6.
)