Multiple sclerosis, the decision to become pregnant, and factors associated with perinatal relapse

Abstract

Background: Multiple sclerosis (MS) is one of the most common diseases of the nervous system, impacting more than two million people worldwide. Over 400,000 individuals in the United States are diagnosed with MS each year. MS diagnosis is more common (two to three times more) among women than men and it is most commonly diagnosed during the second and third decades of life, prime reproductive years for many women. While research has shown that a diagnosis of MS does not decrease a woman’s ability to have children, the MS diagnosis and pregnancy experience after MS diagnosis may influence the decision to have children. Further, pregnancy may have an impact on the course of MS. Methods: The study was conducted in the setting of the Greater Washington Chapter of the National Multiple Sclerosis Society (NMSS). The current study was conducted among 391 women, community-dwelling participants with MS, who responded to survey questions related to pregnancy and MS. Study participant characteristics (e.g. socio-demographic characteristics), opinion on pregnancy-related decision making, and experience of MS relapse during the perinatal period were summarized using descriptive statistics. Differences in characteristics between women who experienced perinatal MS relapse and women who did not were compared using Student’s T-test and Chi-square tests. Results: The mean age of participants was 52 years. Of the women who participated in the survey, 67 (17.1%) had at least one pregnancy after their MS diagnosis. Women who experienced pregnancy after MS diagnosis were younger at MS diagnosis (28 vs. 40 years) and of lower body mass index (25 vs. 27 kg/m2), compared with women who did not experience pregnancy after MS diagnosis (all p-value<0.05). Married women were more likely to have a pregnancy after their MS diagnosis (80% vs. 67%). Of the women who did become pregnant after their diagnosis, 39.7% indicated that their pregnancy experience influenced their decision to have more children. Of the pregnant women, 36 (53.7%) reported experiencing an MS relapse either during pregnancy (N=2), after delivery (N=26), or both time periods (N=7). Perinatal relapse of MS was potentially related to the course of MS and the marital status of women. Conclusion: Age at MS diagnosis and body mass index are related to experiencing pregnancy after MS diagnosis. MS diagnosis contributes to pregnancy-decision making. Course of MS and marital status are potentially related to perinatal MS relapse. Similar future studies can further our understanding of the relationships between MS diagnosis, pregnancy-decision making, and factors related to perinatal MS relapse, contributing to improved clinical care and development of preventative strategies to reduce MS related burden during the perinatal period.