Life Chapters: Navigating Multiple Sclerosis Across Pregnancy, Breastfeeding, Epidemiology, and Beyond
摘要
Multiple sclerosis (MS) entails a complex interplay of various factors that significantly impact the progression of the disease. This chapter covers the multifaceted dynamics of MS during pregnancy, examining fertility, the impact of pregnancy on MS, and the long-term progression. Despite no evidence of reduced fertility in individuals with MS, concerns about disease transmission and lower childbearing rates persist, leading to a lower average number of children per woman. Pregnancy, a natural modifier for MS, is associated with a significant decrease in relapse rates during the third trimester. However, the postpartum phase poses an elevated risk of relapses, attributed to the sudden removal of protective factors during pregnancy. Multiple pregnancies diminish the likelihood of developing MS, while the impact of consecutive pregnancies on disease progression remains complex. The review also discusses obstetric outcomes, disease-modifying therapies (DMTs), and the influence of various components such as body mass index (BMI), Epstein–Barr virus (EBV), vitamin D deficiency, and smoking on MS susceptibility. The complex interplay of genetic predisposition and environmental elements in shaping the risk and progression of MS is emphasized, providing valuable insights for clinicians and researchers navigating family planning and MS management.