Is there any way to prevent exacerbations of multiple sclerosis (MS) during pregnancy and in the postpartum period?
from Patricia K. Coyle, MD, 11/06/01
In general, relapses of MS actually decrease during pregnancy, particularly during the last trimester when they are reduced to 70% below the prepregnancy baseline. This most likely reflects the fact that pregnancy is immunosuppressive. There are no data to show that the unusual relapses that can occur during pregnancy are any different from those that occur prepregnancy, and they can be treated with high-dose steroids once past the first trimester. In the 3 months postpartum, the relapse rate increases to 70% over the prepregnancy baseline, but then returns to the baseline level. Therefore, the several months after giving birth are recognized as a time of high risk for MS disease attacks.
At the current time, an ongoing trial is examining whether intravenous immune globulin (IVIG) given at the time of delivery (at 10 g or 60 g), followed by monthly IVIG (10 g) for 6 months, can prevent relapses. One hundred women with MS are being entered into this trial. If a patient is not going to breastfeed, disease-modifying therapy can be restarted immediately after delivery as well. Theoretically, combination therapy with an A, B, C drug (Avonex, Betaseron, Copaxone) plus IVIG or pulse steroids could be given for 3-6 months postpartum.
Confavreux C, Hutchinson M, Hours MM, et al. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998; 339:285-291.
Elenkov IJ, Wilder RL, Bakalov VK, et al. IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab. 2001;86:4933-4938.
Haas J. High dose IVIG in the post partum period for prevention of exacerbations in MS. Mult Scler. 2000;6(suppl 2):S18-20; discussion S33.
Orvieto R, Achiron R, Rotstein Z, et al. Pregnancy and multiple sclerosis: a 2-year experience. Eur J Obstet Gynecol Reprod Biol. 1999;82:191-194.
Whitaker JN. Effects of pregnancy
and delivery on disease activity in multiple sclerosis. N Engl J Med. 1998;339:339-340.
Copyright © 1994-2001 by Medscape Inc