Pregnancy Safe for Women with Multiple Sclerosis/Epilepsy

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Stanford University School of Medicine has released a new study in the November issue of the journal Neurology that will ease the mind of many young women with multiple sclerosis or epilepsy. Having one of these neurological disorders does not put a mother-to-be at a significant risk for pregnancy related complications.

Researchers used the Nationwide Inpatient Sample for calculating the number of deliveries occurred between 2003 and 2006. Out of 18.8 million women in 38 states, just over 10,000 had multiple sclerosis and 4,700 had epilepsy. After factoring for maternal age, race, and ethnicity, the researchers found that women with MS or epilepsy are not any more likely than healthy women to have blood pressure problems (preeclampsia) or deliver prematurely, and face only a slightly elevated risk of abnormal fetal growth rate, due to intrauterine restriction, and cesarean delivery.

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About 400,000 Americans are estimated to have MS, and it is one of the most common neurological disorders affecting women of childbearing age. Epilepsy affects more than 1 million women and girls in the United States, according to the Epilepsy Foundation.

The National MS Society offers this advice for women with MS contemplating pregnancy:
· There is no evidence that MS impairs fertility.
· Pregnancy has not been shown to worsen symptoms of MS, and some studies have found a reduction in MS exacerbation in the second and third trimester, possibly due to an increase in the levels of natural corticosteroids that circulate during pregnancy.
· Some symptom increase is reported in the first three to six months after delivery, and the risk of relapse in the postpartum period is estimated to be about 20-40%.
· Avonex, Betaseron, Rebif, Copaxone, Novantrone, or Tysabri are not approved for use during pregnancy, so women are advised to discuss their medications with their physicians prior to becoming pregnant. These drugs are also not recommended for use while breastfeeding, because it is not known if they are excreted in the breast milk.
· Women who use steroids for acute MS exacerbations may continue to use them during pregnancy, but should be carefully monitored by their obstetrician.
· Women with gait difficulties may find that this worsens in late pregnancy as they become heavier and their center of gravity shifts. Use of assistive devices for ambulation is advisable, such as a wheelchair or walker.
· Bowel and bladder problems may be aggravated in women with MS who have pre-existing dysfunction.
· MS patients may feel more fatigued during pregnancy than healthy women.

The Epilepsy Foundation offers this advice for women with epilepsy contemplating pregnancy:
· More than 90% of women with epilepsy will have normal, healthy infants.
· Fertility rate may be about 25-33% lower than average, but personal choice may play a role. Also, women with epilepsy have a higher incidence of menstrual irregularities, polycystic ovary disease, or other endocrine disorder that may reduce fertility.
· Folic acid supplementation is especially important for women with epilepsy both prior to conception and during pregnancy to reduce the risk of neural tube defects.
· Trimethadione may be contraindicated in women contemplating pregnancy because it has been associated with a high incidence of fetal loss and congenital malformations.
· During pregnancy, one-fourth to one-third of women will have an increase in seizure frequency despite continued use of medication because of decreased protein binding, increased drug clearance, and increased maternal plasma volume. Women should be closely monitored by their obstetricians during the prenatal period.

Resources for this article include: Stanford University School of Medicine, National MS Society, and the Epilepsy Foundation.

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