MANAGING MULTIPLE SCLEROSIS IN PREGNANCY

Managing Multiple Sclerosis (MS) in Pregnancy

How common is this situation- pregnancy in women with MS?

MS is most often diagnosed between the ages of 20 to 40 years. This is the age when most women plan their pregnancies. Therefore, it is very common to find women with MS, who are pregnant or those who are planning pregnancy.

Which is a better option- starting MS treatment and then planning pregnancy or delaying MS treatments until after completing family?

MS is characterized by multiple relapses (when new symptoms occur). With each relapse, the disability increases. These relapses are often more frequent in the initial years after diagnosis of MS. Disease modifying drugs (DMD) can reduce relapses and disability. Therefore, it is always better to start DMD and then plan pregnancy. One should not postpone starting DMD after pregnancy/delivery.

How does pregnancy affect MS?

Pregnancy does not affect MS in the first trimester.

The MS relapses are lesser in 2^nd and 3^rd trimesters, which is good news.

However, the relapses become more frequent in the post partum period (after delivery) and this higher risk persists until 6 months after delivery.

How does MS affect pregnancy?

By and large, there are no adverse effects of MS on pregnancy. Women with MS have no extra risk of miscarriage or birth defects in their babies; as compared to women without MS. The mode of delivery too need not be altered just because the patient has MS.      

MS has no direct effect on fertility. Women with MS may have sexual dysfunction resulting in lesser libido. Male partners who have MS may suffer from erectile dysfunction.  

What MS medications are safe in pregnancy?

No DMD has yet been tested in pregnancy and hence none can be declared safe. However, recent evidence suggests that some DMDs are less risky than others. Less risky DMDs in pregnant women with MS include beta interferons (Avonex, Rebif, Betaseron) and Glatiramer acetate.

For prospective fathers, beta interferon and Glatiramer acetate as DMD showed no risk to baby’s health. Teriflunomide is detected in semen and it should be discontinued before trying to conceive.

Steroids can be safely used to treat MS relapses during pregnancy.

Will babies born to women with MS have a higher risk of getting MS themselves?

Most cases of MS are sporadic and most women with MS do not have a history of MS in their family members. However, having a relative with MS does slightly increase the risk of being diagnosed with MS.

In UK, the lifetime risk of being diagnosed with MS in general population in 1 in 330. The risk increases to 1 in 48, if one of the first degree relatives has MS. If one of the second-degree relatives has MS, the risk of being diagnosed with MS is 1 in 100.

an women with MS breastfeed?

Breastfeeding is safe and can be continued as usual.

What impact does pregnancy have on the course of MS?

There is limited data on this topic. However, in one study, pregnancy and childbirth were associated with lesser chances of developing severe disability. Women who gave birth at any time (either before or after the onset of MS) were 34% less likely to develop severe disability (as defined by need to use walking aid).

(For more reading, Multiple sclerosis Trust, UK)

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com

IMPORTANT FACTS ABOUT ZIKA VIRUS INFECTION

IMPORTANT FACTS ABOUT ZIKA VIRUS

1. Zika virus is an infection, transmitted by mosquito bite.

2. Common symptoms include fever, skin rash, joint pains, headache and muscle pains.

3. This infection is common in Brazil, other South American countries, Mexico and Carribean islands. However, it is likely to spread to other countries soon. No cases have been identified in India yet. 

4. The mosquito that spreads Zika virus (Aedes) also spreads dengue and Chikun Gunya fever.

5. There is no vaccine to prevent Zika virus infection. So, the only method to prevent this infection is to prevent mosquito bites.

6. If Zika virus affects a pregnant woman, then, it may have adverse impact on the baby. This includes microcephaly (small brain size) and poor development of brain.

7. In rare cases, paralysis of arms and legs, due to Zika virus may occur (due to Guillain Barre syndrome).

8. An infected person can spread the zika virus infection to other, through mosquito bites. So, it is better to isolate them for a week.

9. The zika virus infection can be suspected based on the symptoms, and history of travel to affected areas within the past two weeks. The confirmation can be done by blood tests.

10. In addition to mosquito bites and mother-to-child transmission, Zika virus can also rarely spread via sexual intercourse and blood transfusion.

Dr Sudhir Kumar MD (Medicine), DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Hyderabad

Phone: 0091-40-23607777

Email: drsudhirkumar@yahoo.com

Online consultation:http://bit.ly/Dr-Sudhir-kumar

MANAGEMENT OF EPILEPSY IN PREGNANCY

MANAGING EPILEPSY IN PREGNANCY

Epilepsy is a common illness and therefore, we commonly encounter women with epilepsy (WWE), who are either pregnant or contemplating pregnancy. There are a lot of apprehensions and misconceptions regarding managing epilepsy in this group of WWE. Here, I wish to highlight some of the important aspects of managing epilepsy in women who are planning pregnancy or are currently pregnant.

1. If a woman is seizure-free for at least two years, she can consider withdrawing anti-epileptic drugs (AEDs) under the supervision of neurologist, and then plan for pregnancy.

2. If a woman has seizures, it is better to continue AEDs during pregnancy, as the risk to the baby is several times higher with seizures, as compared to that with AEDs.

3. Sodium valproate has the highest risk to the developing baby, and it should be avoided in pregnancy.

4. AEDs such as levetiracetam, lamotrigine, oxcarbazepine, topiramate, etc are safe and may be continued during pregnancy.

5. The lowest effective dose of AED should be used.

6. Try to use only a single anti-epileptic drug, if possible.

7. Folic acid vitamin supplements should be used in pregnancy.

8. The dose of anti-epileptic medication may have to be increased during the last three months of pregnancy.

9. CT scan of brain should be avoided, as far as possible, during pregnancy, as radiation exposure due to it may harm the baby.

10. MRI brain is reasonably safe for baby, especially after the first three months of pregnancy. So, if needed, it may be performed.

DR SUDHIR KUMAR MD DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Jubilee Hills, Hyderabad-500096

Email: drsudhirkumar@yahoo.com

For appointments: 0091-40-23607777/60601066