Multiple sclerosis and vitamin D during pregnancy and lactation.

BACKGROUND: Both pregnancy and high vitamin D concentration seem to generate a protective environment against multiple sclerosis (MS) relapses. Longitudinal case-control analysis of vitamin D concentrations during pregnancy and lactation of MS mothers is lacking. AIMS OF THE STUDY: To examine serum 25-hydroxyvitamin-D3 levels of MS patients during and after pregnancy and compare these to the levels measured in healthy controls. METHODS: Fifteen relapsing-remitting MS mothers underwent repeated testing for 25-hydroxyvitamin-D3 at 10-12, 26-28 and 35-37 gestational weeks and 1, 3 and 6 months post-partum. An identical series of samples was collected from six control mothers. RESULTS: The prevalence of vitamin D deficiency (<50 nmol/l) during pregnancy was high (73%) among MS patients. Vitamin D levels were significantly higher during pregnancy when compared to early post-partum values among MS patients. At the end of the follow-up period, the vitamin D levels returned to levels observed in early pregnancy. In healthy controls, the alterations during and after pregnancy were similar in nature, but the vitamin D concentrations were higher at all time points when compared to MS patients (P = 0.037). CONCLUSIONS: Vitamin D deficiency during the pregnancy and lactation seems to be common in mothers with MS and needs to be treated adequately.

Increased thyroid autoimmunity among women with multiple sclerosis in the postpartum setting.

BACKGROUND: Multiple sclerosis (MS) patients are predisposed to thyroid abnormalities, but the risk for pregnancy-related thyroid pathology among MS patients has not been evaluated. OBJECTIVES: The objectives of this research are to prospectively evaluate the prevalence of thyroid autoimmunity among MS patients in relation to pregnancy, and to investigate its impact on pregnancy outcome, postpartum depression and fatigue. METHODS: Forty-six pregnant MS patients underwent repeat testing for serum thyroid antibodies (Abs), clinical evaluation and thyroid hormone measurement. Results were compared to 35 age-matched healthy mothers. RESULTS: At six months postpartum 35.3% of MS patients presented elevated levels of thyroid Abs compared to 5.7% of controls, p = 0.01. Mean thyroid Ab concentrations among MS patients were significantly reduced during pregnancy and returned to maximal levels at six months postpartum. The proportion of individuals with postpartum thyroid dysfunction did not differ significantly between MS patients and healthy controls (3.4% vs 2.9%, p = 1.00). Elevated thyroid Ab levels did not increase the risk for adverse pregnancy outcome, fatigue or postpartum depression. CONCLUSIONS: Considering the tendency of MS mothers to develop thyroid autoimmunity postpartum and in association to treatments, we recommend screening MS patients for thyroid dysfunction (TSH) during early pregnancy and after delivery.

Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland.

The majority of individuals obtaining the diagnosis of multiple sclerosis are women of childbearing age. They are naturally concerned as to how multiple sclerosis affects the course of pregnancy and the developing foetus. The objective of this study was to prospectively evaluate the incidence of pregnancy complications and delivery risks, and to follow the natural course of multiple sclerosis during and after pregnancy in a cohort of Finnish patients with multiple sclerosis. Sixty-one patients with multiple sclerosis who became pregnant during the years 2003-2005 were prospectively followed-up from early pregnancy until 6 months postpartum. Multiple sclerosis relapses, Expanded Disability Status Scale rates and obstetric details were recorded. The results were compared with the statistics obtained from Finnish Medical Birth Register from the year 2004. We found that patients with multiple sclerosis were no more likely to experience pregnancy complications than Finnish pregnant women generally, but they had a greater likelihood for a need of artificial insemination (4.9% vs. 0.9%; p = 0.0009). Subjects with multiple sclerosis were more likely to undergo assisted vaginal delivery than the at-large cohort (16.4% vs. 6.5%; p = 0.0017). We conclude that pregnancy does not seem to pose a woman with multiple sclerosis to a greater risk for pregnancy complications when compared with women in general. The potential need for instrumental delivery should, however, be taken into account when planning the delivery of a mother with multiple sclerosis.

Humoral response to John Cunningham virus during pregnancy in multiple sclerosis.

BACKGROUND: Pregnancy induces an immunosuppressive state in the mother to ensure immunological acceptance of the foetus. Impairment of cell-mediated immune responses may render the mother susceptible to intracellular pathogens. It is not presently known whether pregnancy alters the immunosurveillance for John Cunningham virus (JCV), an opportunistic pathogen associated with natalizumab treatment for multiple sclerosis (MS). OBJECTIVE: To evaluate whether the humoral immune response to JCV is altered during pregnancy among MS patients and healthy controls to get insight to potential pregnancy-induced alterations related to immune response to JCV during pregnancy. METHODS: Serum anti-JCV-antibody-indices (JCV-Ab-index) were determined by a two-step second-generation enzyme-linked immunosorbent assay in 49 MS patients during and after pregnancy and in 49 healthy controls during pregnancy. For comparison, total IgG levels and antibodies against Epstein-Barr, cytomegalo and measles viruses were similarly measured. RESULTS: The JCV-Ab-indices of MS patients were not altered during the pregnancy (1st vs. 3rd trimester, 0.62 vs. 0.77, p = 0.99). Contrary to this, in the healthy controls JCV-Ab-indices (p = 0.005), antibody levels to the other viruses, and total IgG levels (p < 0.0001) decreased significantly during pregnancy. CONCLUSIONS: JCV-Ab levels remain unaltered during MS pregnancy, while the total IgG concentration is reduced/diluted due to increasing plasma volumes during the course of pregnancy. This may imply a biologically significant alteration in the immune response to JCV during MS pregnancy.