Krysko Kristen M, Graves Jennifer S, Dobson Ruth, Altintas Ayse, Amato Maria Pia, Bernard Jacqueline, Bonavita Simona, Bove Riley, Cavalla Paola, Clerico Marinella, Corona Teresa, Doshi Anisha, Fragoso Yara, Jacobs Dina, Jokubaitis Vilija, Landi Doriana, Llamosa Gloria, Longbrake Erin E, Maillart Elisabeth, Marta Monica, Midaglia Luciana, Shah Suma, Tintore Mar, van der Walt Anneke, Voskuhl Rhonda, Wang Yujie, Zabad Rana K, Zeydan Burcu, Houtchens Maria, Hellwig Kerstin
Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 675 Nelson Rising Lane, Suite 221, San Francisco, CA 94158, USA.
Department of Neurosciences, University of California San Diego, UCSD ACTRI, La Jolla, CA, USA.
Ther Adv Neurol Disord. 2020 Jul 1;13:1756286420936166. doi: 10.1177/1756286420936166. eCollection 2020.
Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.
多发性硬化症（MS）是一种自身免疫性炎症性脱髓鞘中枢神经系统疾病，在女性中更为常见，发病通常在生育年龄。在上个世纪，MS的女性与男性比例在几个地区有所上升，这表明可能存在性别与环境的相互作用，增加了女性患MS的风险。由于许多MS患者处于生育年龄，计划生育，包括避孕和疾病修正治疗（DMT）咨询，是女性MS护理的重要方面。虽然一些DMT可能对发育中的胎儿有害，但其他一些可以在怀孕确认前不久或直到怀孕确认时使用。总体而言，怀孕会降低MS复发的风险，而产后复发风险可能会增加，尽管怀孕似乎对MS的长期预后无害。然而，卵巢衰老可能会导致MS女性患者的残疾进展。在这里，我们回顾了MS女性患者一生中的性别影响，包括性别对MS易感性的影响、怀孕对MS疾病活动的影响，以及围绕怀孕的管理策略，包括怀孕前和怀孕期间以及母乳喂养期间使用DMT的相关风险。我们还回顾了MS女性患者的生殖衰老和性功能障碍。
