Shipley Jessica, Beadnall Heidi, Butzkueven Helmut, van der Walt Anneke, Jokubaitis Vilija
Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.
J Neurol Neurosurg Psychiatry. 2025 May 14;96(6):593-605. doi: 10.1136/jnnp-2024-335319.
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system characterised by inflammatory lesions and neurodegeneration. Diagnosis often occurs in women of childbearing age, and therefore pregnancy is frequently encountered in women with MS. However, the effect of pregnancy on the MS brain is not well understood, including the impact on inflammatory lesion activity and rate of brain atrophy. Determining the effect of pregnancy on the MS brain is complex due to several confounding factors, including dynamic changes in brain volumes in healthy physiological (non-MS) states and the impact of withdrawing disease-modifying therapies for pregnancy on inflammatory lesion activity. This review first provides an in-depth overview of the profound structural neuroplasticity that occurs during pregnancy in healthy women without neurological disease and its association with maternal caregiving behaviours and maternal-infant attachment measures. These findings are integrated with results of MRI studies in pregnant women with MS to provide a perspective on the multifold influences on brain volume changes in this context. This review also explores the increase in inflammatory lesions observed on postpartum MRI in women with MS, which likely accrue in the postpartum phase mirroring clinical relapse dynamics. Key knowledge gaps are identified, and future research pathways are proposed to improve our understanding of how pregnancy impacts the brain in both healthy and MS states.
多发性硬化症（MS）是一种慢性免疫介导的中枢神经系统脱髓鞘疾病，其特征为炎性病变和神经退行性变。诊断通常发生在育龄女性中，因此MS女性患者经常会怀孕。然而，怀孕对MS患者大脑的影响尚未完全了解，包括对炎性病变活动和脑萎缩速率的影响。由于几个混杂因素，确定怀孕对MS患者大脑的影响很复杂，这些因素包括健康生理（非MS）状态下脑容量的动态变化以及为怀孕而停用疾病修正治疗对炎性病变活动的影响。本综述首先深入概述了无神经系统疾病的健康女性在孕期发生的深刻结构神经可塑性及其与母婴护理行为和母婴依恋措施的关联。这些发现与MS孕妇的MRI研究结果相结合，以提供在此背景下对脑容量变化的多重影响的观点。本综述还探讨了MS女性患者产后MRI上观察到的炎性病变增加，这可能在产后阶段出现，反映了临床复发动态。确定了关键的知识空白，并提出了未来的研究途径，以增进我们对怀孕如何影响健康和MS状态下大脑的理解。
