Pregnancy, sex and hormonal factors in multiple sclerosis.
BACKGROUND
Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors.


OBJECTIVE
A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment.


METHODS
Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes.


CONCLUSIONS
Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery. The use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued. Available knowledge about the impact of treatment on the mother, fetus and newborn is discussed. Recommendations for future research to fill knowledge gaps and clarify inconsistencies in available data are made.
Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Institute of Neurology, University College London, UK.
David H
DH
Miller
Franz
F
Fazekas
Xavier
X
Montalban
Stephen C
SC
Reingold
Maria
M
Trojano
D017668:Age of Onset; D000818:Animals; D005260:Female; D012739:Gonadal Steroid Hormones / Q000378:metabolism*; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D011256:Pregnancy Outcome; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D012739:Gonadal Steroid Hormones
Pregnancy; hormones; sex