SUNDAY May 30 is World Multiple Sclerosis Day. A chronic and progressive inflammatory disease of the nervous system that affects about 118 thousand people in Italy, of which the great majority are women: 79 thousand.
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And the diagnosis often arrives between the ages of 20 and 40, that is, at the height of the fertile age. That is why, on the occasion of this anniversary, the Rare Diseases Observatory (O.Ma.R) organized an online event precisely to clarify the doubts of women with multiple sclerosis who wish to have a child, or who find themselves managing a maternity scheduled. The webinar “Multiple sclerosis and pregnancy: yesterday, today and tomorrow”, created thanks to the non-conditioning contribution of Bayer, is available on facebook page of the Observatory.
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To address the needs of women with MS who wished to have children, in primis the need for information, in 2016 theSMamma Outpatient Clinic at the Regional Reference Center for Multiple Sclerosis of the Tor Vergata Polyclinic in Rome: an innovative public project to support women in parenting, taking care of them in all aspects, both physical and psychological. SMamma, which currently follows about 130 patients, provides an integrated path of multidisciplinary care in which the patient can directly access counseling with various specialists: neurologists, nurses, gynecologists, obstetricians, immunologists and specialized psychiatrists. The project is both clinical and research, and also includes territorial support initiatives after childbirth, carried out in collaboration with the Italian Multiple Sclerosis Association (Aism). Here are some of the issues addressed during the webinar by the specialists of the MS-Mamma clinic, and beyond, to answer the most frequent doubts of women with MS.
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Is pregnancy not recommended for those with multiple sclerosis?
No. It was until a little over 20 years ago, because it was feared that it could worsen the course of the disease. The scenario has changed radically since 1998 thanks to an important scientific study, PRIMS, which has undermined this paradigm. It was understood that during pregnancy multiple sclerosis tends to go into remission, because the immune system becomes “quiescent” thanks to a new hormonal structure also linked to the presence of the placenta, to prevent it from “attacking” the fetus. For women with MS, however, pregnancy planning is key. “The desire for maternity should be addressed and discussed with your neurologist from the moment of the communication of the diagnosis, to plan a shared strategy with the couple and, when possible, to establish from the beginning a therapy that can be compatible with conception and , if necessary, continued even in pregnancy. Today we have drugs that can be used because they are safe for the unborn child, but not all of them are “, explains Girolama Alessandra Marfia, Adjunct Professor of Neurology at Tor Vergata University and Head of the Multiple Sclerosis Unit of the Tor Vergata Polyclinic in Rome:” The evaluations they must be done on a case-by-case basis “.
Does the risk of disease recurrence or progression increase at the end of pregnancy?
After childbirth, a phase could open in which relapses of the disease occur, but this happens less frequently in women who arrive at conception with the disease well controlled by therapy. Relapses, however, can be prevented with early drug resumption, experts say.
Does having multiple sclerosis reduce the chances of getting pregnant?
No, any fertility problems are not related to the disease. Always, and even more so in case of difficulty in conception, it is important that the gynecologist knows about multiple sclerosis and the drugs used, and coordinates with the neurologist.
Is childbirth dangerous for women with MS?
No. “All forms of anesthesia are considered safe for patients in labor,” explains Herbert Valensise, Professor of Gynecology and Obstetrics at the Tor Vergata University of Rome and Head of the UOC of Gynecology and Obstetrics at the Casilino Polyclinic in Rome. . Furthermore, multiple sclerosis does not increase the risk of complications in pregnancy, but even in this case it is important to make an individual evaluation.
Is it possible to pass multiple sclerosis to a child?
“The risk that a child with a parent suffering from multiple sclerosis could develop the disease during their lifetime is slightly higher than those born to healthy parents, but this is a minimal risk, estimated in the order of 3-4% “, Replies Marfia:” The risk increases a little more if both parents are affected by the disease. To trigger the reaction of the immune system, which is at the basis of multiple sclerosis, in addition to genetic factors, the intervention of environmental factors, which are still being studied, is essential ”.
Is it possible to breastfeed?
A generic answer cannot be given, but the assessment must be made on a case-by-case basis: “Since some drugs may be present in breast milk, it is good to evaluate the type of treatment even at this stage since most therapies are not compatible today. with breastfeeding, ”explains Valensise.
Are women with MS at increased risk of anxiety or depression during and after pregnancy?
Some studies show a greater risk of experiencing depression during pregnancy: this also happens because, in itself, multiple sclerosis increases the risk of anxiety disorders and depression by about 20% compared to the general population. “A woman with multiple sclerosis, when she discovers she is pregnant, can feel anxious because of concern for her own health and that of her unborn child”, explains Cinzia Niolu, Associate Professor of Psychiatry at the Tor Vergata University of Rome, Head of the UOSD SPDC and the SOSmamma Helpdesk: “If the pregnancy has not been planned, she is especially afraid of the repercussions of the therapies on the well-being of the fetus. In general, however, she is worried about the possibility of having a recurrence of the symptoms of the disease during pregnancy or immediately after delivery, or she is distressed by the idea of not being able to carry out the gestation “. In addition to the normal maternal apprehension, therefore, a woman with MS develops anxiety dictated by the particular physical and psychological situation in which she finds herself due to the disease. “The psychological factor is an important factor in multiple sclerosis – conclude the experts – for this reason a 360 degree management is essential”.
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