AN HISTORICAL AND CLINICAL REVIEW OF THE INTERACTION OF LEPROSY AND PREGNANCY - A CYCLE TO BE BROKEN

Since earliest history the person with leprosy has been shut out from society. Laws have prohibited marriage and allowed divorce of those wi th leprosy. Segregation of the sufferer from the rest of society has b een followed by separation of the sexes, and of leprous parents from t heir children. With the advent of antileprotic drugs, first dapsone th en multidrug therapy (MDT), infection can be treated, individuals made non-infectious, and the pool of infection in the community reduced. T he clinical signs of leprosy are due not to the degree of infection bu t to the immunological status of the host. Hormonal changes at puberty and in pregnancy can cause variation of the host's immune status. Pre gnancy in women with leprosy is a hazardous undertaking. First appeara nce of leprosy, reactivation of the disease and relapse in 'cured' pat ients is likely to occur particularly in the third trimester of pregna ncy. Leprosy reactions caused by variation in cell mediated and humora l immunity are triggered off by pregnancy: type 1 reaction (reversal r eaction, RR) occurs post partum, while type 2 reaction (erythema nodos um leprosum, ENL) peaks in late pregnancy. Both types of reaction cont inue long into lactation. Neuritis with loss of both sensory and motor function is associated with relapse and reaction. Relapse, reaction a nd nerve damage, especially 'silent neuritis', with subsequent deformi ty and disability, occur not only in women on apparently effective tre atment but also in those who have received MDT and have been released from treatment (RFT). To prevent disability, research is urgently need ed into the mechanisms of early and late reaction. and neuritis. Pregn ancy is not only a trigger factor for reaction but an ideal in vivo mo del for research. Up to 20% of children born to mothers with leprosy m ay develop leprosy by puberty. While early leprosy in young children i s self-healing, when marriage and childbearing take place at an early age the daughters of mothers with leprosy are likely to run the risk o f experiencing the adverse effects of pregnancy on leprosy. Increased awareness and health education, as well as long term surveillance of ' cured' leprosy patients, are essential to break a potentially vicious cycle of leprosy and pregnancy. Women with cured leprosy could play an important role in screening for and detection of both early leprosy i n children and late, post-MDT RFT, nerve damage ii their mothers.