title: Pregnancy outcomes in multiple sclerosis patients previously treated with cyclophosphamide.
abstract: BACKGROUND
  Cyclophosphamide (Cyc) can induce ovarian failure and can have teratogenic effect. Few case reports of successful pregnancies after Cyc treatment in women with autoimmune diseases and malignancies have been described. To date, there are no data about Cyc effect on pregnancy outcomes in MS patients.
  
  
  OBJECTIVE
  To describe pregnancy outcomes in multiple sclerosis (MS) patients treated with Cyc before conception.
  
  
  METHODS
  We reviewed retrospectively the medical records of all MS patients who received Cyc from 1st of January 1997 to 31st of March 2012, referring to the MS centre of the University of Catania. All pregnancies, occurred during the follow-up period after Cyc treatment, were recorded according to a computerized and standardized protocol (iMED).
  
  
  RESULTS
  We found a total of 105 MS women of childbearing age; eleven patients experienced a pregnancy (10.4%); 10 of them had a successful delivery; and one experienced a voluntary abortion. Five women had a preterm delivery. One child was small for gestational age.
  
  
  CONCLUSIONS
  Although the favourable pregnancy outcomes, Cyc should be avoided in young women planning a pregnancy. However, Cyc might be considered as a possible alternative to licensed therapies in few selected cases of very aggressive MS, including women of childbearing age.
authors.affiliation: Department G.F. Ingrassia-section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Patti
authors.forename: S
authors.initials: S
authors.lastname: Messina
authors.forename: E
authors.initials: E
authors.lastname: D'Amico
authors.forename: S
authors.initials: S
authors.lastname: Lo Fermo
authors.forename: M
authors.initials: M
authors.lastname: Zappia
mesh_terms: D000328:Adult; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007231:Infant, Newborn; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: fertility; immunosuppression; multiple sclerosis; pregnancy outcome; teratogenicity; women