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Does CCSVI explain why Pregnant Women Have Fewer Relapses

Just a thought - does anyone think this might be relevant to CCSVI?

It seems to me that the MS relapse rate in pregnant women correlates with the changes in their volume of blood and cardiac output over the course of their pregnancy. But I don't think there is a study directly linking the two. Is this another oddity of MS which seems to confirm/support the importance of oxygenated blood (and CCSVI) in MS generally?

Any scientists out there got any thoughts?

Pregnant women have fewer relapses as their pregnancy advances. The relapse rate increases in the three months following delivery and then returns to pre pregnancy rate.
In pregnant women the volume of blood and cardiac output both increase as their pregnancy advances but returns to pre pregnancy rate about six weeks after delivery.

Rate of Pregnancy-Related Relapse in Multiple Sclerosis
http://www.nejm.org/doi/full/10.1056/NE ... 7303390501
Conclusions
In women with multiple sclerosis, the rate of relapse declines during pregnancy, especially in the third trimester, and increases during the first three months post partum before returning to the prepregnancy rate.
(See the graph within the link)

Physical Changes During Pregnancy
http://www.merck.com/mmhe/sec22/ch257/ch257d.html

Heart and Blood Flow: During pregnancy, the woman's heart must work harder because as the fetus grows, the heart must pump more blood to the uterus. By the end of pregnancy, the uterus is receiving one fifth of the woman's prepregnancy blood supply. During pregnancy, the amount of blood pumped by the heart (cardiac output) increases by 30 to 50%.
As cardiac output increases, the heart rate at rest speeds up from a normal prepregnancy rate of about 70 beats per minute to 80 or 90 beats per minute. During exercise, cardiac output and heart rate increase more when a woman is pregnant than when she is not. During labor, cardiac output increases by an additional 10%. After delivery, cardiac output decreases rapidly at first, then more slowly. It returns to the prepregnancy level about 6 weeks after delivery.

The volume of blood increases by 50% during pregnancy. The amount of fluid in the blood increases more than the number of red blood cells (which carry oxygen). Thus, even though there are more red blood cells, blood tests indicate mild anemia, which is normal. For reasons not clearly understood, the number of white blood cells (which fight infection) increases slightly during pregnancy and markedly during labor and the first few days after delivery.

The following is an extract from the UK MS Society notes on pregnancy and MS:
"Does pregnancy affect MS relapses?
There have been many research studies examining the impact of pregnancy on MS. They all show that pregnancy appears to have a positive protective influence, with relapse rates going down, especially during the third trimester (that is between six and nine months). The reasons for this are not fully understood, but it is thought that hormone levels play a role. Improvements during pregnancy may also relate to the fact that immune system activity is lowered in pregnant women to stop them from rejecting the baby. Similar effects are seen in women with other autoimmune conditions.

However, in the first three months after the baby is born, the risk of relapse rises. This is thought to occur as hormones return to pre-pregnancy levels. Research suggests that these post-pregnancy relapses do not increase long-term levels of disability. In other words, pregnancy has no effect on the progression of MS in the long-term, rather the overall effect is neutral."

I have a hunch that it is the existence of CCSVI in pregnant women with MS which explains why the improved oxygen levels, and increased cardiac output, associated with pregnancy reduces their relapse rate - rather than just hormones and autoimmune reactions! Or is the corresponding increase in relapses, when oxygen levels and cardiac output return to normal after the birth, a complete coincidence? Maybe the brains of pregnant MS ladies get a boost at the same time as their uterus..
Is it possible pregnant ladies with MS are another exception which help to 'prove' the importance of CCSVI in MS generally?

Typically, venous malformations present early in life. However, it is not uncommon for venous malformations to present for the first time in the adult patient. There are many case reports that have documented the sudden appearance of a previously unrecognized venous malformation. This behaviour has been attributed to mechanical or hormonal factors. Malan and Puglionisi proposed that pressure or flow changes related to mechanical forces, such as trauma, could reactivate dormant angiopoietic cells and stimulate endothe- lial cell growth. The concept that female hormones can modulate endothelial growth in venous mal- formations is supported by the higher incidence of venous malformations in female patients and their rapid growth at the onset of puberty and during pregnancy.

this article is pre-CCSVI, found by our Cheer

source: http://phleb.rsmjournals.com/cgi/reprint/22/6/264.pdf

That's a cool article. I wonder if that could explain why it matters how far you live from the equator around the time of puberty. Could it be that pubescent hormones exacerbate the development of congenital venous malformations unless you happen to be getting plenty of vitamin D?

But I am thinking about the fact that pregnant women with MS get BETTER while they are pregnant.

Pregnancy causes fewer relapses.

And if most pregnant women with MS also have CCSVI (congenital or later onset..) then maybe the increased blood flow (experienced in all pregnancies) improves the impact of the pre-existing CCSVI on their MS.

And if it is giving them a short term boost, over the course of the pregnancy, maybe the lack of oxygen element of CCSVI is having more short term impact than the longer term iron deposit impact over the nine months.

Maybe also why people with MS experience symptom improvement if they use HBO etc And ties in with the Vascular comorbidity study showing people with MS become disabled sooner if they have coronary issues. We should all be hitting the gym - might not all need angio after all.

LOL. I've hit the gym. I still need angio.

Yep, you still need angio. Had mine 10 days ago - it is brilliant, but going to leave gym till next week.

But I am pretty sure all of my improvements so far boil down to just getting more oxygen. Now can't wait to see what happens when iron starts shifting.

I had 70% on left and 60% on right jugs. But MS not evident until I was 44 - just been pondering whether running 5 miles every day in my 20s and having babies in my 30s kept it at bay.. Then last year had a last go at trying to get fit (MS two sticks at that stage) - got heart rate down to 64 from 84 doing wobbly cycling and then started walking. End of village the best I could do - then Ben Nevis and 12 miles in three months. Sadly gluten mistake and iron deposits nailed me big time - until the angio might just have got me in the nick of time!
Get your angio soon as you can xx