Obstet Gynecol. 2020 Mar;135(3):757-758. doi: 10.1097/AOG.0000000000003727.
Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The disease affects more women than men and often is diagnosed during a woman's childbearing years. Typical clinical presentations of the disease are extensive and variable, with symptoms that include dysregulated mood, fatigue, vision problems, weakness, tremor, imbalance, abnormal sensations, bladder dysfunction, and heat sensitivity. If a woman aged 15-50 years experiences these neurologic symptoms in isolation or combination, and the symptoms are not explained by other underlying medical conditions, MS should be suspected. Multiple sclerosis can be divided into four clinical subtypes: 1) relapsing-remitting MS, 2) secondary progressive MS, 3) primary progressive MS, and 4) clinically isolated syndrome. Relapsing-remitting MS at the time of onset is the most common form and accounts for approximately 80% of all cases of MS. Relapsing-remitting MS does not affect life expectancy. However, because of the neurodegenerative and progressive course of the disease, patients accumulate physical and cognitive disabilities over time that result in impaired ability to work, increased financial burden, and slightly increased mortality. A variety of possible risk and prognostic indicators have been identified that may predict the course of disease, particularly the extent of relapses and disability. Multiple sclerosis currently is incurable, but many disease-modifying therapies are available that can reduce the frequency of clinically evident exacerbations and accumulation of disease burden as defined by the number of lesions identified on magnetic resonance imaging. The choice of disease-modifying therapies, contraception use, and treatment of symptoms should be individualized based on age at onset and disease activity and, during pregnancy, the gestational age. Proactive management of MS across the woman's life cycle reduces morbidity, improves maternal and fetal health during pregnancy and the postpartum period, and increases quality-of life-measures for patients and their families.
多发性硬化症（MS）是一种中枢神经系统的慢性炎症性脱髓鞘疾病。这种疾病女性患者多于男性，并且通常在女性生育年龄被诊断出来。这种疾病的典型临床表现广泛且多变，症状包括情绪失调、疲劳、视力问题、虚弱、震颤、失衡、异常感觉、膀胱功能障碍和对热敏感。如果一名年龄在 15-50 岁的女性出现这些神经系统症状，并且这些症状不能用其他潜在的医学疾病来解释，就应怀疑多发性硬化症。多发性硬化症可分为四个临床亚型：1）复发缓解型多发性硬化症；2）继发进展型多发性硬化症；3）原发进展型多发性硬化症；4）临床孤立综合征。在发病时的复发缓解型多发性硬化症是最常见的形式，约占所有多发性硬化症病例的 80%。复发缓解型多发性硬化症不影响预期寿命。然而，由于疾病的神经退行性和进行性病程，患者随着时间的推移会逐渐积累身体和认知障碍，导致工作能力下降、经济负担增加和死亡率略有上升。已经确定了多种可能的风险和预后指标，这些指标可能预测疾病的进程，特别是复发的程度和残疾的进展。多发性硬化症目前无法治愈，但有许多疾病修正疗法可用于减少临床上明显的恶化和疾病负担的积累，这些负担的定义是磁共振成像上识别的病变数量。疾病修正疗法的选择、避孕措施的使用以及症状的治疗应根据发病年龄和疾病活动度，并在怀孕期间根据妊娠周数进行个体化。在女性生命周期中对多发性硬化症进行积极管理可以降低发病率，改善妊娠和产后期间的母婴健康，并提高患者及其家属的生活质量。
