MS and pregnancy

[jimmylegs]

today my unrelated searches landed me on studies of circadian rhythym and supplement timing influences on the nutrient content in human milk. i went looking for a suitable place to post such, and although i know childbearing/childrearing has been discussed a zillion times here on the forum, there doesn't seem to be a specific area particularly devoted to relevant content. for the time being, i plan to leave any related studies of possible interest under this topic.

Multiple sclerosis in pregnancy: prevalence, sociodemographic features, and obstetrical outcomes
http://www.tandfonline.com/doi/abs/10.1 ... 17.1286314

Abstract
Objective: We sought to describe the prevalence, sociodemographic features, and antenatal/peripartum outcomes of multiple sclerosis (MS) in pregnancy.

Study design: A retrospective cohort study was performed using deliveries in California from 2001 to 2009. Cases of MS as well as other morbidities were identified via ICD-9-CM code. Logistic regression was performed to adjust for potential confounders.

Results: About 1185 out of 4,424,049 deliveries were complicated by MS. MS prevalence increased with maternal age, with Caucasians comprising a higher proportion of MS subjects. MS subjects were older and more likely to have private insurance. Women with MS were more likely to have preexisting medical conditions such as asthma, chronic hypertension, thyroid disease, or cardiac disease. However, no significant antepartum and peripartum morbidities were found to be increased in patients with MS. Urinary tract infection, cesarean delivery, and induction of labor were slightly increased in MS patients.

Conclusions: MS is a rare condition which is more likely to affect older Caucasian women of higher socioeconomic status and is associated with several preexisting medical conditions. MS, however, does not appear to pose significant increases in adverse pregnancy outcome. This suggests that pregnant patients with MS may likely experience an uneventful pregnancy.

[jimmylegs]

Treatment of multiple sclerosis during pregnancy - safety considerations
http://www.tandfonline.com/doi/abs/10.1 ... 17.1311321

Abstract
Introduction: Women with multiple sclerosis (MS) are treated early in the disease course with disease modifying therapies (DMT). Updated information is needed on pregnancy outcomes of DMT-exposed pregnancies and the effect of the drug withdrawal on MS disease activity.

Areas covered: In this review, we will cover the most important updated management strategies in planning a pregnancy when having MS.

Expert opinion: MS itself does not increase the risk of adverse pregnancy outcomes and does not negatively influence the long-term course of the disease. As MS became a treatable disease, management of DMTs before, during and after pregnancy is important. This requires updated knowledge on safety of DMTs as well as data of the effect on disease activity after drug withdrawal. A special challenge is the handling of women with highly active MS, as pregnancy might not be powerful enough to suppress the risk of rebound relapses. Exclusive breastfeeding is an option for many women who want to do so, but in cases of high disease activity and those women who do not want to breastfeed, early reintroduction of MS therapies should be considered.

[jimmylegs]

Pregnancy and multiple sclerosis: from molecular mechanisms to clinical application
https://link.springer.com/article/10.10 ... 016-0584-y
Abstract
Translational research generally refers to a “bench to bedside” approach where basic science discoveries in models move to clinical trials in humans. However, a “bedside to bench to bedside” approach may be more promising with respect to clinical relevance, since it starts with a clinical observation that can serve as a research paradigm to elucidate mechanisms and translate them back into novel therapeutic approaches. The effect of pregnancy on human autoimmune disorders in general, and multiple sclerosis (MS) in particular, serves as an intriguing example of how this can be used to understand disease pathobiology and discover new therapeutic targets. Disease activity in MS undergoes pronounced shifts in the time before, during, and after pregnancy. The most well-known and established example is a reduction in relapse rates in the last trimester by 70–80 %. However, disease activity reappears in the first few months after delivery, temporarily overshooting pre-pregnancy levels. This phenomenon has since its first description served as a model for investigating novel treatment options in animal models and has cumulated in successful phase 2a and 2b trials in female MS patients. However, recently, a number of other clinical observations have been made that might be similarly suitable to offer additional insights into pathobiological mechanisms of MS activity, progression, and possibly even incidence. Here, we outline the various changes in the clinical course of MS that have been described in relation to pregnancy, both short term and long term, and discuss how these may inform the development of novel treatments for autoimmune diseases.

i still think this is about the addition and then cessation of supplementation with prenatal vits.
scholar search results on related terms:
"prenatal vitamin": 4850
"postnatal vitamin": 525
"postpartum vitamin": 421
"postnatal vitamin" "prenatal vitamin": 146
ooh, one rare title actually suggesting content looks at pre and post supplementation effects - A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV‐infected women
"postpartum vitamin" "prenatal vitamin": 40
no titles comparing rates of either leaping out here, either.

results are negligible using the terms 'breastfeeding vitamin' and 'lactation vitamin' as well.

c'mon now, science - time to pick up this thread.

[jimmylegs]

Management of Multiple Sclerosis During Pregnancy and the Reproductive Years: A Systematic Review
http://journals.lww.com/greenjournal/Ab ... cy.13.aspx
OBJECTIVE: To examine the evidence guiding management of multiple sclerosis (MS) in reproductive-aged women.
DATA SOURCES: We conducted an electronic literature search using PubMed, ClinicalTrials.gov, and other available resources. The following keywords were used: “multiple sclerosis” and “pregnancy.” We manually searched the reference lists of identified studies.
METHODS OF STUDY SELECTION: Two reviewers categorized all studies identified in the search by management topic, including effect of pregnancy on MS course, fetal risks associated with disease-modifying treatments during pregnancy, and management of patients off disease-modifying treatment. We categorized studies by strength of evidence and included prior meta-analyses and systematic studies. These studies were then summarized and discussed by an expert multidisciplinary team.
TABULATION, INTEGRATION, AND RESULTS: The risk of MS relapses is decreased during pregnancy and increased postpartum. Data are lacking regarding the risks of disease-modifying treatments during pregnancy. There may be an increased risk of MS relapses after use of assisted reproductive techniques. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS.
CONCLUSION: Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.

^ increased relapse risk associated with assisted reproductive techniques jives with what i understand about nutrition, ms and fertility..
lower zinc status is associated with both ms and impaired fertility.
low zinc is associated with low uric acid, and low uric acid is also a known issue for pwms.
low zinc is associated with low fertility in men.
oh hells yes a 2016 systematic review and meta analysis; had not seen this one before:

Zinc levels in seminal plasma and their correlation with male infertility: A systematic review and meta-analysis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773819/ "Zinc supplementation was found to significantly increase the semen volume, sperm motility and the percentage of normal sperm morphology"

as posted elsewhere, i told a past employer who was having trouble to take zinc, and she was pregnant in six weeks (after previously having tried unsuccessfully for a year and a half).

Correlation between serum zinc levels and successful immunotherapy in recurrent spontaneous abortion patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778605/
Immunotherapy with paternal lymphocytes plays an important role in preventing recurrent spontaneous abortion (RSA) and is an effective treatment for it. This kind of treatment is performed as an immunotherapy method in several centers in the world. It attributes to the production of anti-paternal cytotoxic antibodies (APCAs) in women with RSA. ... RESULTS: Serum zinc levels in group (a) patients were 74.98 ± 11.88 μg/dl, which was significantly higher than those in group (b) with the zinc concentration of 64.22 ± 9.22 μg/dl. CONCLUSIONS: Zinc deficiency may be one of the substantial causes of negative results for LIT in RSA patients. Therefore, compensation of zinc defect before LIT can be a promising approach to improve the immune response in patients.

ouch meanwhile here's me hunting down serum zinc levels in healthy controls and finding means at 119 ug/dl (or *.153 = 18.2 umol/l) repeatedly. ok science, now let's do the study where we get the ladies' serum zinc levels up over 100 at a minimum, then see if anyone even needs to bother with APCAs at all..

[jimmylegs]

not related to ms, but still interesting

Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation
http://jn.nutrition.org/content/147/4/603.short
Abstract
Background: Human milk is the subject of many studies, but procedures for representative sample collection have not been established. Our improved methods for milk micronutrient analysis now enable systematic study of factors that affect its concentrations.
Objective: We evaluated the effects of sample collection protocols, variations in circadian rhythms, subject variability, and acute maternal micronutrient supplementation on milk vitamin concentrations.
Methods: In the BMQ (Breast-Milk-Quality) study, we recruited 18 healthy women (aged 18–26 y) in Dhaka, Bangladesh, at 2–4 mo of lactation for a 3-d supplementation study. On day 1, no supplements were given; on days 2 and 3, participants consumed ∼1 time and 2 times, respectively, the US-Canadian Recommended Dietary Allowances for vitamins at breakfast (0800–0859). Milk was collected during every feeding from the same breast over 24 h. Milk expressed in the first 2 min (aliquot I) was collected separately from the remainder (aliquot II); a third aliquot (aliquot III) was saved by combining aliquots I and II. Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E and fat were measured in each sample.
Results: Significant but small differences (14–18%) between aliquots were found for all vitamins except for vitamins B-6 and B-12. Circadian variance was significant except for fat-adjusted vitamins A and E, with a higher contribution to total variance with supplementation. Between-subject variability accounted for most of the total variance. Afternoon and evening samples best reflected daily vitamin concentrations for all study days. Acute supplementation effects were found for thiamin, riboflavin, and vitamins B-6 and A at 2–4 h postdosing, with 0.1–6.17% passing into milk. Supplementation was reflected in fasting, 24-h postdose samples for riboflavin and vitamin B-6. Maximum amounts of dose-responding vitamins in 1 feeding ranged from 4.7% to 21.8% (day 2) and 8.2% to 35.0% (day 3) of Adequate Intake.
Conclusions: In the milk of Bangladeshi mothers, differences in vitamin concentrations between aliquots within feedings and by circadian variance were significant but small. Afternoon and evening collection provided the most-representative samples. Supplementation acutely affects some breast-milk micronutrient concentrations. This trial was registered at clinicaltrials.gov as NCT02756026

[Scott1]

Hi,

It would be nice if they told us in the first post what they meant by cardiac disease.

Did you find any long range follow ups post birth that look at both mother and child in , say, 5, 10,15 years to look for general health status? I don't mean MS, just health in general.

The studies almost imply that pregnancy is as bad as it gets. It's really when the baby becomes a teenager that you wonder what happened!

Regards,

[Leonard]

Metabolic factors are an influence, be it a weak influence (see also ACTRIM Feb 2017 Forum)
MS often comes to a halt when women get pregnant but after the pregnancy it comes back with some force.

Pregnant women have higher cortisol production, amongst others.
Many metabolis processes will change.

Cellular feeding mechanisms will improve; intra-cellular anti-viral mechanisms be stimulated.
Herpes virinae will be pressed down and the disease will calm down at least for a while

[jimmylegs]

@scott not sure but i can see a common nutritional thread across the asthma, hypertension, thyroid and cardiac array presented.
@leonard 3rd study above touches on the disease activity shifts before during and after pregnancy

[jimmylegs]

Maternal and Perinatal Exposures Are Associated With Risk for Pediatric-Onset Multiple Sclerosis
http://pediatrics.aappublications.org/c ... /e20162838
OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children.

METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status.

RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20–4.21, P = .01) and cesarean delivery with 60% reduction (95% CI 0.20–0.82, P = .01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardening-related occupation (odds ratio [OR] 2.18, 95% CI 1.14–4.16, P = .02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06–2.81, P = .03) were both associated with increased odds to have pediatric MS.

CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.

[Punchy]

My son was born via C-section, as was I. I'm big into the influence of gut bacteria, and believe it's the first step to a healthy immune system.

I have heard that some hospitals are now swabbing c-section infants with their mother's vaginal and rectal swabs, to simulate the transfer that occurs during natural childbirth.

My son did not receive this benefit, but then I was put on a course of strong antibiotics during my delivery, so perhaps it wouldn't have been effective.

The medical profession is so terrified of bacteria, I can't see this practice becoming the norm anytime soon.