John Radcliffe Hospital, University of Oxford Medical School, Oxford, UK.
Curr Opin Obstet Gynecol. 2011 Dec;23(6):435-9. doi: 10.1097/GCO.0b013e32834cef8f.
Multiple sclerosis (MS) is a chronic inflammatory neurological condition typically affecting women of childbearing age. This review addresses questions that often arise in this patient group during pregnancy including the effects of pregnancy on relapse rates and long-term disease course, up-to-date advice on the use of disease-modifying MS treatments during pregnancy, the management of relapses in pregnancy and postpartum and current advice on breast feeding.
Pregnancy is associated with a reduction in relapse frequency most marked in the final trimester with a comparable increase in relapse risk in the first 3 months postpartum. Studies examining exposure to MS therapies glatiramer acetate and interferon-beta during pregnancy have produced few negative outcomes offering the possibility of offering treatment until conception. Although initial data suggested breast feeding reduced MS relapses, the latest study demonstrated no significant benefit.
Pregnancy is safe in most MS patients and does not negatively influence MS disease course overall. Use of disease-modifying treatments around conception should be considered on a case-by-case basis, weighing risks of drug exposure against risks of relapses. Whether breast feeding produces beneficial effects on MS relapses remain inconclusive.
多发性硬化症（MS）是一种慢性炎症性神经系统疾病，通常影响育龄妇女。这篇综述讨论了该患者群体在怀孕期间经常出现的问题，包括妊娠对复发率和长期疾病进程的影响、目前关于在怀孕期间使用疾病修正型多发性硬化症治疗的建议、妊娠和产后期间的复发管理以及目前关于母乳喂养的建议。
妊娠与复发频率的降低相关，在最后一个孕期最为明显，产后前 3 个月的复发风险增加相当。研究检查了妊娠期间接触醋酸格拉替雷和干扰素-β的情况，结果很少出现不良结局，这为直到受孕前接受治疗提供了可能。虽然最初的数据表明母乳喂养可降低多发性硬化症的复发，但最新的研究表明没有显著益处。
在大多数多发性硬化症患者中，妊娠是安全的，总体上不会对多发性硬化症的病程产生负面影响。应根据具体情况考虑在受孕前后使用疾病修正治疗，权衡药物暴露的风险与复发的风险。母乳喂养对多发性硬化症的复发是否有有益影响仍不确定。
