| Impact of pregnancy on MS risk and prognosis |
| Altintas et al., 2015> |
Retrospective cohort |
199 |
Women with MS can get pregnant safely, and the condition does not impair the functional capacity of women with MS during or after pregnancy, although fertility is reduced even before diagnosis. Pregnancy has a favorable effect on the transition from progressive to remittent forms of the disease. |
17/27 |
| Fares et al., 2016 |
Prospective cohort |
29 |
MS does not increase gestational risk and usually triggers remission of the disease for up to 2 years after delivery, although in the long run symptoms seen prior to pregnancy tend to reemerge. |
18/27 |
| Ferraro et al., 2017 |
Case-control |
803 |
MS does not affect the rates of deliveries from C-sections or breastfeeding. 16% of women with MS and no children report fear of physical incapacity to care, fear of interrupting treatment during pregnancy and the disease getting worse, and especially fear of transmitting the disease to their offspring. |
15/27 |
| Spadaro et al., 2019 |
Case-control |
134 |
Deciduous immune cells at the maternal-fetal interface modulate systemic immune function by decreasing cellular action, except for M2 monocytes, which control the disease during pregnancy. |
20/27 |
| Zuluaga et al., 2019 |
Prospective cohort |
501 |
Although hormonal changes in the various hypothalamic-pituitary axes affect some autoimmune diseases, pregnancy does not change the prognosis of patients with MS. |
19/27 |
| Impact of MS on pregnancy outcomes |
| Houtchens et al., 2018 |
Retrospective cohort |
2115 |
Pregnant women with MS have more preterm labor, peripartum infection, and hereditary congenital malformations, although they present other associated comorbidities and are older on average compared to individuals without MS, which makes it difficult to analyze isolated data. |
16/27 |
| Moberg et al., 2020 |
Retrospective cohort |
4692 |
Women with MS have reportedly fewer children, primarily because a diagnosis of MS negatively affects the decision to have children. MS alone does not affect the percentage of miscarriages or number of ectopic pregnancies. |
19/27 |
| Winkelmann et al., 2019 |
Randomized clinical trial |
70 |
Treatment with glatiramer acetate or interferon does not increase the risk of spontaneous miscarriage or birth defects during the first trimester of pregnancy. |
20/27 |
| Impact of MS on fertility and infertility treatments |
| Correale et al., 2012 |
Prospective cohort |
16 |
ART was associated with a 7-fold increase in the risk of MS exacerbation and with a 9-fold increase in the risk of enhanced disease activity as seen in MRI scans of lesions. Worsening was associated with higher number of cells producing IL-8, IL-12, IFNc, and TGF-b, as well as increased VEGF production by CD4. T cells and CXCL-12 plasma levels, all GnRH-mediated. |
19/27 |
| Ghafoori et al., 2020 |
Cross-sectional |
25 |
Iranian women with MS avoided pregnancy for fear of motor impairment affecting their ability to care for their children, fear of sclerosis medications affecting the menstrual cycle or limitation of techniques and reproduction treatment due to the presence of the disease. |
17/27 |
| Hellwig et al., 2009 |
Retrospective cohort |
23 |
The results confirm an increased relapse rate after as many as 78 ART cycles in women with MS. They indicate that women with MS should be informed that there is a possible risk of increased RR. |
19/27 |
| Michel et al., 2012 |
Retrospective cohort |
32 |
A significant increase in the annualized relapse rate (ARR) was observed during the 3 months following IVF compared with the same period just before IVF. The significant increase in relapses was associated with the use of GnRH agonists as well as IVF failure. |
19/27 |
| Roux et al., 2015 |
Retrospective cohort |
115 |
There is no direct impact of MS on fertility and treatment does not interfere with the mean age of spontaneous pregnancy. |
17/27 |
| Sepúlveda et al., 2016 |
Cross-sectional |
25 |
There was no difference between levels of FSH, LH, inhibits, estrogen, progesterone, free testosterone, anti-Müllerian hormone (AMH), or ovarian reserve in women with controlled MS or without the disease. However, patients with uncontrolled disease and subjects with active MS had smaller ovaries with fewer follicles and decreased AMH levels. |
18/27 |
| Smith et al., 2019 |
Prospective cohort |
63 |
Family planning has to be considered since there is no direct relationship between decreased fertility and MS. Women who discontinue treatment after finding out they were pregnancy had more frequent and intense postpartum episodes. |
17/27 |
| Thöne et al., 2015 |
Cross-sectional |
148 |
MS and other localized autoimmune diseases are related to lower levels of AMH during activation, and increased endoglin (endothelial transmembrane receptor) unrelated to IL-B (autoimmune lymphocytic signaling). There is no relationship between the production of anti-ovarian antibodies and MS. |
19/27 |