How pregnancy affects multiple sclerosis. Not a contraindication: pregnancy and childbirth with multiple sclerosis

Multiple sclerosis, intimate sphere and pregnancy. Part 2. Planning. Contraception. Pregnancy. Childbirth. After childbirth.
Published on 01/08/2014 by admin
Planning a pregnancy

A woman planning a pregnancy or maintaining an existing pregnancy should, together with her husband, weigh their strengths in raising a child and assess the availability of support from family and friends.

It is necessary to discuss with a neurologist the possibility of continuing any treatment methods during pregnancy, as well as conducting a course of treatment before a planned pregnancy. Receiving DMT during pregnancy is prohibited. Drug withdrawal is carried out 3 months before the planned pregnancy.

If an exacerbation (manifestation) of multiple sclerosis occurs for the first time, then it is necessary to abstain from pregnancy for the time necessary to clarify the course of the disease. If there is a rapidly progressing course, then pregnancy planning should be postponed and inpatient treatment should be carried out. In general, this question is complex, individual and requires trusting relationship with a doctor and a competent approach on his part.

Contraception

While taking medications (DMTs, cytostatics, and others) or when there is an exacerbation of the disease, it is important to use a reliable method of birth control. The calendar method of birth control is extremely unreliable, since almost all women experience cycle disorders.

Antisperm pastes and vaginal suppositories do not affect multiple sclerosis, but they are unreliable and their use in some cases of multiple sclerosis is physically difficult. If suppositories and pastes are combined with the vaginal diaphragm, the reliability of contraception increases.

The intrauterine device is quite effective, can be used in a woman with multiple sclerosis for any treatment (hormones, immunomodulators...), and does not require any manipulation before or after sexual intercourse. But if sensitivity in the perineal area is impaired and there are severe spasms of the thigh muscles, it is not advisable to use an intrauterine device, because With this method of contraception, possible complications cannot always be identified in time. When treated with immunosuppressants (including corticosteroids), the risk of infections is increased. If there is a spiral, the woman should be observed by a gynecologist more often.

Hormonal contraception is quite effective. No availability data negative influence on the course of multiple sclerosis. Moreover, hormonal changes when taking contraceptives resemble those during pregnancy, when improvement is noted. When taking glucocorticosteroids (prednisolone, metipred...), the effectiveness of hormonal contraception may decrease, and then it is necessary to use additional methods of contraception. In addition, of the many medications taken, there may be those that, against the background of hormonal contraception, exhibit more severe side effects or themselves affect the activity of contraceptives. The attending physician must be warned about taking hormonal contraceptives.

Modern contraceptive hormonal drugs have an absolute contraceptive effect and at the same time the possibility of ovarian cancer, benign and malignant diseases of the mammary glands is significantly reduced, the condition of the skin improves... For patients with multiple sclerosis, it is better to use drugs that have a minimal hormonal load per cycle. For example, femoden, triquilar, triziston, triregol, miniziston, mersilon, microgynon, marvelon, regividon, cilest. The choice of drug is made by a gynecologist.

Inheritance of the disease

Multiple sclerosis is not a hereditary disease. A predisposition to autoimmune and allergic diseases may be inherited.

Pregnancy

Since 1980, 22 international studies have been conducted, covering a total of more than 13 thousand observations of pregnant women with multiple sclerosis. As a result, it turned out that during pregnancy, exacerbations of the disease occur less frequently, and in the first few months after childbirth, somewhat more often than in women who have not had pregnancy. After childbirth, in subsequent years, the frequency of exacerbations does not change. Exacerbations that develop after childbirth do not affect the long-term risk of disability. There is no evidence that with multiple sclerosis the risk of miscarriages, congenital anomalies, fetal death, complications of labor and delivery is greater than in the population.

Of course, with pronounced clinical changes and a malignant course of the disease, planning a pregnancy is categorically not recommended.

In general, almost all publications on the Internet are unanimous that pregnancy and childbirth do not in themselves cause exacerbation of multiple sclerosis. Moreover, in most cases there is improvement in this disease. This is associated with significant changes in hormonal conditions and natural immunosuppression. The mother's body suppresses cellular defenses so as not to “attack” the fetus.

In 3-12% of cases, a mild, short-lived exacerbation may occur in the first trimester, with complete recovery to its original state. The likelihood of these exacerbations depends on the frequency of exacerbations before pregnancy. If they are frequent, then the likelihood of exacerbation in the first trimester is greater. Termination of pregnancy, especially in the later stages, can cause severe exacerbation.

During pregnancy, women feel severe weakness. Especially in the first three months. Urinary incontinence increases due to the enlargement of the uterus and increased pressure on the bladder. Constipation and urinary tract infections may occur, especially with pelvic disorders. Given the presence of ataxia (unsteadiness), women need to be careful when moving and use the help of loved ones.

If there is sufficiently pronounced muscle weakness (paresis) and sensory disturbances, the woman should be under constant supervision in the last trimester and especially in the last month of pregnancy. This is necessary in order not to miss the onset of contractions. The neurologist, together with the obstetrician-gynecologist, decides on the method of delivery. If there is a neurological deficit that prevents natural childbirth, a caesarean section with epidural anesthesia is performed.

The method of pain relief does not affect the risk of exacerbation of multiple sclerosis. Both general anesthesia and epidural are used. I would like to note the negative impact of general anesthesia on the cognitive functions of the brain (memory, ability to concentrate).

After childbirth

In the first three months after childbirth, 20-40%, in the absence of prevention, experience “postpartum exacerbations.” They are associated with increased workload, deterioration of sleep, increased stress, reverse changes in hormonal conditions with the disappearance of natural immunosuppression. There are studies on the administration of intravenous immunoglobulins (Intraglobin, Intragam, Venimmun) after childbirth in order to prevent postpartum exacerbation. In case of exacerbation, pulse therapy with hormones is carried out (in this case, breastfeeding is avoided). After cessation of lactation, PMTRS is resumed.

Breastfeeding also does not cause exacerbation, but if fatigue is severe, a woman may decide to switch to artificial feeding.

So, in most cases, a woman suffering from multiple sclerosis can carry a pregnancy to term and achieve the happiness of Motherhood.

Human health consists of many components, and the state nervous system plays a significant role in overall well-being.

After all, it is with its help that impulses are quickly transmitted to destination points, mood changes are controlled, and signals are also transmitted to the brain.

And therefore, any disturbances in the functioning of the nervous system should be carefully monitored in order to begin treatment in a timely manner, as well as to prevent possible serious consequences for the entire body.

Basic concepts about multiple sclerosis

Multiple sclerosis is an autoimmune disease of the nervous system and has a chronic course.

The main characteristics of the disease can be given as follows.

In a normal state, the human immune system controls the effects of extraneous negative factors on the body’s tissues and actively fights them.

When a malfunction of the immune system occurs, the opposite reaction occurs: the immune system begins to react aggressively, and the aggression is directed towards its own tissues in the body.

This disease most often affects young women, whose age category is from 18 to 25 years. What are the main symptoms of this terrible disease?

An important psychological aspect

When conducting a health examination of a woman with multiple sclerosis and who wants to have a baby, you should know that many specialists are of the older generation, as well as those who do not have sufficient information about modern methods maintaining and managing pregnancy with multiple sclerosis, may voice their recommendations in an incorrect, inconsistent form.

Today, a proven important fact is the information that gestation and birth healthy child will be in question only if the stage of the disease is already serious and the pregnancy can cause serious harm to the health of the pregnant woman. Or the woman’s condition is such that even movement is difficult for her.

It is also important to remember that the inheritance of multiple sclerosis is extremely low and does not exceed 2-6%. And this allows us to speak with confidence about the possibility of giving birth to an absolutely healthy baby if the father or mother is sick with this disease. In addition, medical abortion harms a woman’s health even more significantly than the risks possible complications during pregnancy and childbirth with multiple sclerosis.

And the negative attitude of others towards a woman with multiple sclerosis who wants to have a baby can put significant pressure on the psyche and worsen the course of pregnancy.

For these reasons, one should be very critical of the possible negativity both from ignorant doctors and from the environment.

Physiological aspect

In both cases there will be certain risks.

However, a larger number of them is not observed in the case of complications with multiple sclerosis, so there is no reason for unnecessary worry.

With multiple sclerosis, a pregnant woman should be constantly under the supervision of doctors, and at the slightest deterioration of her condition, contact a medical facility.

At the same time, the number of pregnancies for such a woman is not limited, and the possibility of complications, missed pregnancies and spontaneous miscarriages is approximately the same as for a healthy pregnant woman.

• During the first third of pregnancy, the risk of complications of any nature is up to 55%. Most often, exacerbations occur if a woman suffered from frequent exacerbations of the disease before pregnancy.
• At the end of the first third of pregnancy, the overwhelming majority of pregnant women report excellent health and an unprecedented increase in vitality - this is a completely normal state, since thanks to the miraculous processes occurring in the body of a pregnant woman, there is maximum consistency of all physiological processes.
• The subsequent risky period begins, according to medical research, immediately before childbirth, when the body produces a significant amount of hormones responsible for preparing the body for the upcoming birth. Hormonal changes in the body occur, which can provoke an exacerbation of the disease.

The condition during pregnancy in women with multiple sclerosis should not cause serious concern; the main condition is constant monitoring of health.

In addition, the doctor will prescribe a treatment regimen for the underlying disease during pregnancy, because during this period, some of the medications prescribed to stabilize the condition in multiple sclerosis are discontinued.

Video on the topic

Because of this, the nerve cannot conduct impulses. Multiple sclerosis occurs when the immune system begins to destroy myelin. And during pregnancy, a woman’s immune system stops doing this. So, pregnancy with multiple sclerosis Not only is it not dangerous, it also helps to heal.

Planning a pregnancy

A woman with multiple sclerosis undergoes certain treatment. When planning a pregnancy, she should definitely consult a doctor. Some drugs prescribed to such patients can affect the development of the fetus. Special diets or treatments may be incompatible with healthy pregnancy. Expectant parents are required to discuss taking any medication with their doctor. Find out whether their treatment can affect the development of the fetus.

Childbirth and multiple sclerosis

Childbirth in women with multiple sclerosis should only take place in a hospital. At the same time, doctors must be fully aware of the course of the disease in the woman in labor. If a woman has pronounced paralysis, loss of sensitivity, then recent months pregnancy she should be in the hospital. Such a woman in labor may simply not feel the onset of contractions. It may be necessary to artificially induce labor. Breastfeeding is not contraindicated for women suffering from multiple sclerosis. But often the attending doctors convince you to switch to formula, since after feeding the mother becomes very tired.

In a family where one of the parents has multiple sclerosis, having a child is a big responsibility. You need to carefully plan a change in your treatment, regularly check-up with a doctor and go into conservation. But these are only additional requirements for future parents, and not a reason to abandon the child. Perhaps pregnancy will bring healing to the sick mother.

Multiple sclerosis is an autoimmune disease. The cause of the disease is genetic predisposition (the presence of pathology in the family). There is also data on the viral etiology of the disease.

The body's immune system produces antibodies and inflammatory cytokines that destroy brain cells. Under the influence of cytokines, the myelin (protective) sheath of the long processes of neurons is destroyed, which leads to a slowdown in the transmission of nerve impulses.

Over time, the axons die without protection, and the conduction of impulses stops. Depending on the location of the affected area of ​​the brain, various clinical symptoms are observed.

What a woman needs to know

During pregnancy, multiple sclerosis usually does not appear. In addition, the disease is not a direct indication for caesarean section.

Childbirth is a completely autonomous process that is not affected by damage to the myelin sheath. The uterus contracts under the influence of hormones.

Epidural anesthesia, according to many doctors from Western countries, is completely safe, but the right of choice still remains with the patient.

With a complicated pregnancy and exacerbation of multiple sclerosis, a woman may not feel the onset of contractions. Therefore, the expectant mother must remain in the hospital for the last few months.

Doctors may need to artificially induce labor. At the same time, a woman with such a diagnosis needs to give birth faster, because the disease greatly tires the body, and fatigue sets in much faster than in healthy patients.

Multiple sclerosis and pregnancy

Many people ask whether it is possible to give birth with multiple sclerosis. The disease affects the course of pregnancy in no more than 10% of women, mainly in the first trimester.

This period accounts for up to 65% of episodes. Some girls suffering from multiple sclerosis experience a worsening of the situation before childbirth.

In other cases, remission is observed throughout the entire period. The likelihood of miscarriage and premature birth in such girls is no higher than in healthy ones. It is noted that exacerbations during this period occur much easier and faster.

The improvement in condition is attributed to two reasons. A genetically determined decrease in immunity occurs - the level of protection against myelin proteins decreases. This is also facilitated by changes in hormonal levels.

Conception and pregnancy are contraindicated only in severe cases. However, in these situations it is often impossible due to disruption of the genital organs.

There is evidence that pregnancy with multiple sclerosis can lead to improvement in women's condition. In general, the pathology has a more stable and benign course during pregnancy.

In the first year after the baby is born, the number of exacerbations may increase. This is due to increased physical and neuropsychic stress on the female body.

Moreover, the incidence rate in women who have given birth to two or more children is 2.5 times less than in those who have not given birth. In addition, conceiving a child leads to a decrease in the incidence of disability and increases life expectancy.

Thus, pregnancy is considered to be an immunosuppressive factor for the disease. This is manifested both in the analysis of clinical symptoms and in instrumental studies.

If an exacerbation is observed at the beginning of pregnancy, it has a mild and short course.

After childbirth, the pathological process may intensify. Exacerbations are much more difficult, and neurological symptoms become more pronounced. Therefore, it is very important to avoid unplanned pregnancies that end in abortion.

In this situation, a strong hormonal imbalance occurs in the woman’s body, which causes the progression of the disease. In the absence of pronounced clinical symptoms in such a situation, the question is raised regarding the continuation of pregnancy.

The use of hormonal drugs also worsens the condition of sick women. If the patient is planning to conceive a child, immunomodulators should not be used three months before the expected pregnancy.

Sirdalud, baclofen, finlepsin are also contraindicated. All these drugs have a teratogenic effect. The use of such medications is resumed after childbirth and completion of breastfeeding.

According to experimental data, Copaxone has no effect on the intrauterine development of the baby. The use of this drug during pregnancy and lactation is currently the subject of debate.

The social aspect of the issue is no less important, because often families where one of the spouses has such a disease breaks up. If the child is desired, then the question of possible pregnancy need to be discussed with a neurologist.

In such a situation, it is very important that the woman is observed by qualified specialists during the period of bearing a child.

Can a woman give birth with multiple sclerosis? For a long time, gynecologists believed that a woman with MS should not bear a child.

Patients were forced to have abortions early stages gestation. Today there is a sufficient clinical base confirming the possibility of bearing a fetus.

The advantage of pregnancy is that it affects the course of MS as an immunosuppressant. During pregnancy, a woman experiences hormonal changes that suppress the formation of inflammatory cytokines and specific antibodies.

/ As a result, MS goes into remission. In addition, the growing fetus itself helps compensate for the mother’s autoimmune reactions.

When planning a pregnancy, the patient should undergo a course of treatment and examination to reduce the likelihood of an aggravated course of the disease.

For a patient wishing to become pregnant, the following examination is indicated:

1. MRI of the brain and spinal cord with contrast agent.
2. Blood test for leukocytes (determination of T- and B-lymphocytes).
3. Blood for immunoglobulins (A, C, M).
4. Determination of circulating immune complexes (CIC).

Differential diagnosis of MS is carried out with brain tumors, arachnoiditis, systemic vasculitis, cerebellar ataxia, and spinal cord damage.

If pregnancy occurs, the patient is allowed an MRI without contrast agent (from the second trimester), a blood test for lymphocytes, and consultation with an ophthalmologist.

The doctor collects anamnesis from the patient for hereditary diseases, conducts an examination (assesses motor functions and muscle strength, the state of the visual organs, coordination of movements, memory).

Management of pregnant women with MS

Treatment of multiple sclerosis involves the administration of glucocorticoid hormones, which reduce the activity of the immune system.

At the stage of pregnancy planning, patients are treated with glucocorticoids (GCS): Methylprednisolone, adrenocorticotropic hormone.

When using Prednisolone, the effectiveness of therapy is lower. The patient is also prescribed plasmapheresis and cytostatics (if intolerant to Methylprednisolone).

Adjuvant therapy includes taking nootropic drugs, antidepressants, and antiplatelet agents.

Symptoms of this disorder can be mild (numbness of the lungs, muscle weakness) and quite severe (paralysis, tremors and loss of vision).

Although the disease is not fatal, it is chronic, meaning people with it are not able to recover for the rest of their lives.

Scientists have developed several drugs that help change the normal course of the disease. These medications are more beneficial if taken on early stages diseases. If you experience symptoms of the disease, contact your doctor.

During pregnancy, it is strictly forbidden to take medications that the woman usually took. The good news is that the risk of exacerbations during pregnancy is naturally reduced.

Scientists from the University of Calgary have proven that the pregnancy hormone prolactin helps in the treatment of women with multiple sclerosis.

In addition, the disease is characterized by the fact that the immune system begins to destroy myelin, and during the period of bearing a child, the woman’s body stops doing this.

Exacerbations cannot be stopped with medications so as not to harm the child’s health. Thirty percent of women experience an exacerbation of the disease immediately after childbirth, and the vast majority - two or three months after the birth of the baby.

In the first trimester, the risk of exacerbation of multiple sclerosis during pregnancy (feedback from women confirms this) is high - up to 65%.

This is why it is so important to undergo a medical examination as early as possible. The condition of those expectant mothers who have experienced frequent exacerbations of MS even before conception worsens more often.

Fortunately, pregnant women tolerate exacerbations more easily, and their bodies recover faster.

What are the consequences of pregnancy with multiple sclerosis? Many experts agree that in case of caesarean section Negative consequences for the mother are reduced to a minimum.

Even in the absence of symptoms, it is necessary to undergo a medical examination, and as a preventive measure, undergo therapy with immunomodulatory drugs.

Pregnancy with multiple sclerosis (life expectancy for this disease is approximately 35 years after diagnosis) can help establish long-term remission.

Before pregnancy, a couple should definitely consult a competent specialist. The husband may have to stop taking medications for a while.

Otherwise there are no risks. The disease is inherited only in three to five percent of cases if one of the parents suffers from multiple sclerosis, in ten percent of cases - if both are diagnosed.

Treatment of multiple sclerosis during pregnancy

At the moment, there are no drugs that can completely cure multiple sclerosis. But the disease is progressive.

Periods of exacerbation constantly alternate with periods of remission. Only adequate treatment can significantly prolong remission.

Therapy is aimed at reducing inflammation and relieving symptoms.

Multiple sclerosis is a type of nervous system disease. This disease usually occurs in at a young age. The specificity of the disease is that simultaneous damage to certain parts of the nervous system occurs. For this reason, the patient exhibits various neurological signs. Multiple sclerosis can manifest itself through periods of remission and deterioration. Damage to the nerve sheaths occurs in the brain and spinal cord. The name for these small spaces is multiple sclerosis plaques. If the patient's condition worsens, the plaques may increase in size and merge with each other.

Causes

Multiple sclerosis occurs infrequently during pregnancy. This is explained by the fact that the expectant mother’s immunity is reduced so as not to harm the fetus through autoimmune reactions. The disease does not affect the course of pregnancy, and many mothers noted an improvement in their condition while waiting for the baby. For this reason, it is almost impossible to get multiple sclerosis during pregnancy. But there is a risk of the disease occurring during pregnancy. Multiple sclerosis occurs due to the destruction of the myelin layer of the brain. Sheaths surround nerve fibers, and myelin helps in moving impulses along them. When the myelin sheath is destroyed, the transmission of nerve impulses is disrupted, causing loss of control over the body. Despite the ability to restore myelin, with each attack of multiple sclerosis, scarring occurs on the membrane. The reason why there may be multiple sclerosis during pregnancy is a disruption of the immune system by the expectant mother. Exact reason this phenomenon is still unknown. But many experts explain disruptions in the immune system by the presence viral infections in organism. Moreover, the infection can be transferred much earlier than pregnancy occurs. According to recent studies, the herpes virus affects the damage to the meninges. Experts also suggest that environmental pollution has a direct impact on the occurrence of multiple sclerosis.

Symptoms

If the expectant mother suffered from multiple sclerosis before conception, then during pregnancy she may experience signs of the disease, like other adults. The disease can occur in the early and later pregnancy. Manifestation of sclerosis on initial stage begins with numbness in the limbs, a feeling of muscle weakness. If the meninges are seriously damaged, there may be loss of vision or paralysis. Since the disease is not fatal, symptoms may disappear and reappear. During pregnancy, it is difficult to recognize multiple sclerosis at the initial stage. Weakness, fatigue and other early symptoms of the disease are similar to general signs of pregnancy. Multiple sclerosis in an expectant mother can be determined by the following symptoms:

• Numbness of the limbs;
• Gastrointestinal disorder;
• Weakness and fatigue, fatigue;
• Sudden change of mood;
• Forgetfulness, as well as impaired attention;
• Frequent urge and difficulty urinating.

Diagnosis of multiple sclerosis during pregnancy

The disease can only be diagnosed during pregnancy using magnetic resonance imaging. For this purpose, contrast agents are used to identify lesions in the myelin sheaths. If to the expectant mother Multiple sclerosis was diagnosed before pregnancy; MRI may not be performed until after delivery. An examination by a neurologist and an ophthalmologist is also necessary. The ophthalmologist will check your vision and the condition of the fundus.

Complications

Multiple sclerosis is not fatal. Complications that may arise in the presence of this disease include periodic manifestations of the disease. If you do not adhere to the necessary treatment, multiple sclerosis will manifest itself in a severe form. There is a violation of breathing and cardiac activity, due to which the body will not be able to function fully. In this case, disability is possible, and in some advanced cases, death.

Treatment

What can you do

There is no cure for multiple sclerosis. Despite the fact that many pregnant women do not experience an exacerbation of the disease, it is advisable to adhere to a diet. A special diet for patients with multiple sclerosis involves reducing the consumption of animal fats, red meat, and dairy products. But following a diet during pregnancy is necessary only after consulting a doctor. Since refusing some foods can cause a deficiency of useful elements that the baby needs. You can also consult your doctor about taking vitamin complexes.

What does a doctor do

During pregnancy, periods of exacerbation of multiple sclerosis may not occur. But if this happens, the doctor will prescribe the necessary medications. During pregnancy, the use of corticosteroids and drugs containing interferon is undesirable. Treatment of multiple sclerosis in pregnant women is carried out using plasmapheresis. This is a special device that helps in cleansing the body. If the expectant mother was diagnosed with multiple sclerosis before conception, and she took the necessary medications, then with the onset of pregnancy she needs to completely abandon them. When planning a pregnancy, stopping medications should occur 2 weeks before the expected date of conception.

Prevention

It is impossible to completely prevent the disease. But there is secondary prevention that helps to avoid frequent attacks of relapse. When planning a pregnancy, it is necessary to undergo a complete examination of the whole body. If viral infections occur, they should be eliminated immediately. Also, expectant mothers and those who dream of becoming one need to be less nervous, not smoke and lead healthy image life. Pregnant girls should visit an antenatal clinic for regular examinations, tests and examinations.