PREGNANCY AND MULTIPLE-SCLEROSIS

In this review, me summarize the available information on the short-an d long-term effects of pregnancy on the course of multiple sclerosis ( MS), Published studies that used established criteria for the diagnosi s of MS were given more weight than studies in which the criteria for diagnosis were unstated or unclear, Population-based studies mere emph asized more than clinic-based studies, unless the clinic base was well defined and thought to be reasonably representative of the MS populat ion in the geographic area, For completeness, small studies were also included but weighted accordingly in our overall conclusions, Methodol ogic limitations and biases inherent in the study methods are discusse d, We conclude that patients with relapsing MS have an increased risk of relapse during the initial 6-month postpartum period, This increase d risk does not seem to have a detrimental effect on the rate of devel oping sustained disability, In fact, a full-term pregnancy may increas e the time interval to reaching a common disability endpoint-walking w ith the aid of a cane or crutch-or to having a secondarily progressive course, Evidence indicates that pregnancy may alter T-lymphocyte func tions and cause clinically relevant consequences, The specific biochem ical mechanisms responsible for these observations, however, remain un defined, Because of limitations of current knowledge, our conclusions are tentative at best, The data are most applicable to patients with r elapsing-remitting MS in its early stages, MS is an unpredictable dise ase and is only one of many factors that patients must consider when a pregnancy is contemplated.