Esclerosis múltiple y embarazo
Multiple sclerosis and pregnancy
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Reyes, M. A., Vicuña, J., & Navas, Ángela. (2016). Esclerosis múltiple y embarazo. Revista Repertorio De Medicina Y Cirugía, 25(1), 33–39. Recuperado a partir de https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/72
Publicado:
Mar 1, 2016
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Guía de Práctica Clínica
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
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Resumen
Introducción: La esclerosis múltiple es una enfermedad neurodegenerativa común en poblaciones jóvenes en edad reproductiva; el embarazo ha sido motivo de controversia, dada la necesidad de manejo farmacológico, el riesgo de recaídas y la discapacidad resultante. Los estudios son escasos, aunque la mayoría aporta datos confiables.
Objetivos: Ofrecer al médico una adecuada orientación preconcepcional y durante el embrazo en pacientes con esta enfermedad, así como una adecuada información acerca del uso de medicamentos y sus efectos a corto y largo plazo, tanto en la madre como en el feto
Materiales y métodos: Para la revisión de la literatura se estructuró una estrategia de búsqueda utilizando los términos embarazo, esclerosis múltiple, tratamientos inmunomoduladores y efectos teratogénicos (MeSH y no MeSH), los cuales se articularon con operadores booleanos en las siguientes bases de datos: Pubmed, Ebscohost y Embase, filtrando los resultados por artículos de revisión.
Discusión: Se analizan el efecto protector del embarazo en esclerosis múltiple y la administración de vitamina D.
Conclusión: Aunque no hay evidencia suficiente sobre el efecto nocivo del tratamiento en el recién nacido, se recomienda suspenderlo.
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Referencias
1. Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the ‘treatment era’. Nat Rev Neurol. 2015;11:280–9.
2. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N Engl J Med. 1998;339:285–91.
3. De las Heras V, Alonso L. Esclerosis múltiple y embarazo. En: Arbizu T, Arroyo R, editores. Situaciones especiales en la esclerosis múltiple. Madrid: Schering; 2007.
4. Vukusic S, Hutchinson M, Hours M, Moreau T, Cortinovis-Tourniaire P, Adeleine P, et al. Pregnancy and multiple sclerosis (the PRIMS study): Clinical predictors of post-partum relapse. Brain. 2004;127:1353–60.
5. Toro J, Cardenas S, Fernando Martinez C, Urrutia J, Diaz C. Multiple sclerosis in Colombia and other Latin American countries. Mult Scler Relat Disord. 2013;2:80–9.
6. Dwosh E, Guimond C, Sadovnick AD. Reproductive counselling for MS: A rationale. Int MS J /MS Forum. 2003;10:52–9.
7. Worthington J, Jones R, Crawford M, Forti A. Pregnancy and multiple sclerosis–a 3-year prospective study. J Neurol. 1994;241:228–33.
8. Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology. 2005;65:1961–3.
9. Langer-Gould A, Beaber BE. Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin Immunol. 2013;149:244–50.
10. Fernández O, Álvarez-Cermeño JC, Arnal-García C, Arroyo R, Brieva L, Calles-Hernández MC, et al. Revisión de las novedades presentadas en el XXIX Congreso del Comité Europeo para el Tratamiento e Investigación en Esclerosis Múltiple (ECTRIMS) (III). Rev Neurol. 2014;59:371–9.
11. Luciana M, Delicias M. Embarazo y esclerosis múltiple. Servicio de Neurología. Hospital Xeral-Cíes, Vigo. Revista Española de Esclerosis Múltiple. 2011;20:5–13.
12. Devonshire V, Duquette P, Dwosh E, Guimond C, Sadovnick AD. The immune system and hormones: Review and relevance to pregnancy and contraception in women with MS. Int MS J. 2003;10:44–50.
13. Jalkanen A, Alanen A, Airas L, The Finnish Multiple Sclerosis and Pregnancy Study Group. Pregnancy outcome in women with multiple sclerosis: Results from a prospective nationwide study in Finland. Mult Scler. 2010;16:950–5.
14. Van der Kop M, Pearce M, Dahlgren L, Synnes A, Sadovnick D, Sayao A, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011;70:41–50.
15. Korn-Lubetzki I, Kahana E, Cooper G, Abramsky O. Activity of multiple sclerosis during pregnancy and puerperium. Ann Neurol. 1984;16:229–31.
16. Frith JA, McLeod JG. Pregnancy and multiple sclerosis. J Neurol Neurosurg Psychiatry. 1988;51:495–8.
17. Finkelsztejn A, Fragoso YD, Ferreira ML, Lana Peixoto MA, Alves Leon SV, Gomes S, et al. The Brazilian database on pregnancy in multiple sclerosis. Clin Neurol Neurosurg. 2011;113:277–80.
18. Damek DM, Shuster E,A. Pregnancy and multiple sclerosis. Mayo Clin Proc. 1997;72:977–89.
19. Gulick E, Halper J. Influence of infant feeding method on pospartum relapse of mothers with MS. Int J MS Care. 2002;4:4–12.
20. Portaccio E, Ghezzi A, Hakiki B, Martinelli V, Moiola L. Breastfeeding is not related to pospartum relapses in multiple sclerosis. MS Study Group of the Italian Neurological Society. Neurology. 2011;77:145–50.
21. Langer-Gould A, Huang S, van den Eeden S, Gupta R, Leimpeter A, Albers K, et al. Vitamin D, pregnancy, breastfeeding, and pospartum multiple sclerosis relapses. Arch Neurol. 2011;68:310–3.
22. Dessa Sadovnick A. The genetics of multiple sclerosis. Clin Neurol Neurosurg. 2002;104:199–202.
23. Ben-Zacharia A, Morgante L. Conocimientos básicos de genética en esclerosis múltiple. [Documento en Internet] New Jersey: Consortium of MS Centers; 2005 [consultado 10 Oct 2015]. Disponible en: https://c.ymcdn.com/sites/www.mscare.org/resource/resmgr/Articles/Article0023 BasicGenetics SP.pdf.
24. Ebers GC, Sadovnick AD, Dyment DA, Yee IM, Willer CJ, Risch N. Parent-of-origin effect in multiple sclerosis: observations in half-siblings. Lancet. 2004;363:1773–4.
25. Ebers GC. Genetic epidemiology of multiple sclerosis. Curr Opin Neurol. 1996;9:155–8.
26. Ebers GC, Bulman DE, Sadovnick AD, Paty DW, Warren S, Hader W, et al. A population-based study of multiple sclerosis in twins. N Engl J Med. 1986;315:1638–42.
27. Hupperts R, Broadley S, Mander A, Clayton D, Compston DA, Robertson NP. Patterns of disease in concordant parent-child pairs with multiple sclerosis. Neurology. 2001;57:290–5.
28. Ascherio A. Environmental factors in multiple sclerosis. Expert Rev Neurother. 2013;13:3–9.
29. Fernandez Liguori N, Klajn D, Acion L, Caceres F, Calle A, Carra A, et al. Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study). Mult Scler. 2009;15:555–62.
30. Kieseier BC, Wiendl H. Postpartum disease activity and breast feeding in multiple sclerosis revisited. Neurology. 2010;75:392–3.
31. Willer CJ, Sadovnick AD, Ebers GC. Microchimerism in autoimmunity and transplantation: Potential relevance to multiple sclerosis. J Neuroimmunol. 2002;126:126–33.
32. Sandeberg-Wollheim M, Alteri E, Stam Moraga M, Kornmann G. Pregnancy outcomes in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult Scler. 2011;17:423–30.
33. Boskovic R, Wide R, Wolpin J, Bauer DJ, Koren G. The reproductive effects of beta interferon therapy in pregnancy: A longitudinal cohort. Neurology. 2005;65:807–11.
34. Patti F, Cavallaro T, Lo Fermo S, Nicoletti A, Cimino V, Vecchio R, et al. Is in utero early-exposure to interferon beta a risk factor for pregnancy outcomes in multiple sclerosis? J Neurol. 2008;255:1250–3.
35. Weber-Schoendorfer C, Schaefer C. Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler. 2009;15:1037–42.
36. Salminen HJ, Leggett H, Boggild M. Glatiramer acetate exposure in pregnancy: Preliminary safety and birth outcomes. J Neurol. 2010;257:2020–3.
37. Hoevenaren IA, de Vries LC, Rijnders RJ, Lotgering FK. Delivery of healthy babies alters natalizumab use for multiple sclerosis: A report of 2 cases. Acta Neurol Scand. 2011;123:430–3.
38. Lu E, Wang B, Guimond C. Disease-modifying drugs for multiple sclerosis in pregnancy: A systematic review. Neurology. 2012;79:1130–5.
39. Amato MP, Portaccio E. Fertility, pregnancy and childbirth in patients with multiple sclerosis: Impact of disease-modifying drugs. CNS Drugs. 2015;29:207–20.
40. Coyle P. Multiple sclerosis in pregnancy. Continuum. 2014;20:42–59.
2. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N Engl J Med. 1998;339:285–91.
3. De las Heras V, Alonso L. Esclerosis múltiple y embarazo. En: Arbizu T, Arroyo R, editores. Situaciones especiales en la esclerosis múltiple. Madrid: Schering; 2007.
4. Vukusic S, Hutchinson M, Hours M, Moreau T, Cortinovis-Tourniaire P, Adeleine P, et al. Pregnancy and multiple sclerosis (the PRIMS study): Clinical predictors of post-partum relapse. Brain. 2004;127:1353–60.
5. Toro J, Cardenas S, Fernando Martinez C, Urrutia J, Diaz C. Multiple sclerosis in Colombia and other Latin American countries. Mult Scler Relat Disord. 2013;2:80–9.
6. Dwosh E, Guimond C, Sadovnick AD. Reproductive counselling for MS: A rationale. Int MS J /MS Forum. 2003;10:52–9.
7. Worthington J, Jones R, Crawford M, Forti A. Pregnancy and multiple sclerosis–a 3-year prospective study. J Neurol. 1994;241:228–33.
8. Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology. 2005;65:1961–3.
9. Langer-Gould A, Beaber BE. Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin Immunol. 2013;149:244–50.
10. Fernández O, Álvarez-Cermeño JC, Arnal-García C, Arroyo R, Brieva L, Calles-Hernández MC, et al. Revisión de las novedades presentadas en el XXIX Congreso del Comité Europeo para el Tratamiento e Investigación en Esclerosis Múltiple (ECTRIMS) (III). Rev Neurol. 2014;59:371–9.
11. Luciana M, Delicias M. Embarazo y esclerosis múltiple. Servicio de Neurología. Hospital Xeral-Cíes, Vigo. Revista Española de Esclerosis Múltiple. 2011;20:5–13.
12. Devonshire V, Duquette P, Dwosh E, Guimond C, Sadovnick AD. The immune system and hormones: Review and relevance to pregnancy and contraception in women with MS. Int MS J. 2003;10:44–50.
13. Jalkanen A, Alanen A, Airas L, The Finnish Multiple Sclerosis and Pregnancy Study Group. Pregnancy outcome in women with multiple sclerosis: Results from a prospective nationwide study in Finland. Mult Scler. 2010;16:950–5.
14. Van der Kop M, Pearce M, Dahlgren L, Synnes A, Sadovnick D, Sayao A, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011;70:41–50.
15. Korn-Lubetzki I, Kahana E, Cooper G, Abramsky O. Activity of multiple sclerosis during pregnancy and puerperium. Ann Neurol. 1984;16:229–31.
16. Frith JA, McLeod JG. Pregnancy and multiple sclerosis. J Neurol Neurosurg Psychiatry. 1988;51:495–8.
17. Finkelsztejn A, Fragoso YD, Ferreira ML, Lana Peixoto MA, Alves Leon SV, Gomes S, et al. The Brazilian database on pregnancy in multiple sclerosis. Clin Neurol Neurosurg. 2011;113:277–80.
18. Damek DM, Shuster E,A. Pregnancy and multiple sclerosis. Mayo Clin Proc. 1997;72:977–89.
19. Gulick E, Halper J. Influence of infant feeding method on pospartum relapse of mothers with MS. Int J MS Care. 2002;4:4–12.
20. Portaccio E, Ghezzi A, Hakiki B, Martinelli V, Moiola L. Breastfeeding is not related to pospartum relapses in multiple sclerosis. MS Study Group of the Italian Neurological Society. Neurology. 2011;77:145–50.
21. Langer-Gould A, Huang S, van den Eeden S, Gupta R, Leimpeter A, Albers K, et al. Vitamin D, pregnancy, breastfeeding, and pospartum multiple sclerosis relapses. Arch Neurol. 2011;68:310–3.
22. Dessa Sadovnick A. The genetics of multiple sclerosis. Clin Neurol Neurosurg. 2002;104:199–202.
23. Ben-Zacharia A, Morgante L. Conocimientos básicos de genética en esclerosis múltiple. [Documento en Internet] New Jersey: Consortium of MS Centers; 2005 [consultado 10 Oct 2015]. Disponible en: https://c.ymcdn.com/sites/www.mscare.org/resource/resmgr/Articles/Article0023 BasicGenetics SP.pdf.
24. Ebers GC, Sadovnick AD, Dyment DA, Yee IM, Willer CJ, Risch N. Parent-of-origin effect in multiple sclerosis: observations in half-siblings. Lancet. 2004;363:1773–4.
25. Ebers GC. Genetic epidemiology of multiple sclerosis. Curr Opin Neurol. 1996;9:155–8.
26. Ebers GC, Bulman DE, Sadovnick AD, Paty DW, Warren S, Hader W, et al. A population-based study of multiple sclerosis in twins. N Engl J Med. 1986;315:1638–42.
27. Hupperts R, Broadley S, Mander A, Clayton D, Compston DA, Robertson NP. Patterns of disease in concordant parent-child pairs with multiple sclerosis. Neurology. 2001;57:290–5.
28. Ascherio A. Environmental factors in multiple sclerosis. Expert Rev Neurother. 2013;13:3–9.
29. Fernandez Liguori N, Klajn D, Acion L, Caceres F, Calle A, Carra A, et al. Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study). Mult Scler. 2009;15:555–62.
30. Kieseier BC, Wiendl H. Postpartum disease activity and breast feeding in multiple sclerosis revisited. Neurology. 2010;75:392–3.
31. Willer CJ, Sadovnick AD, Ebers GC. Microchimerism in autoimmunity and transplantation: Potential relevance to multiple sclerosis. J Neuroimmunol. 2002;126:126–33.
32. Sandeberg-Wollheim M, Alteri E, Stam Moraga M, Kornmann G. Pregnancy outcomes in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult Scler. 2011;17:423–30.
33. Boskovic R, Wide R, Wolpin J, Bauer DJ, Koren G. The reproductive effects of beta interferon therapy in pregnancy: A longitudinal cohort. Neurology. 2005;65:807–11.
34. Patti F, Cavallaro T, Lo Fermo S, Nicoletti A, Cimino V, Vecchio R, et al. Is in utero early-exposure to interferon beta a risk factor for pregnancy outcomes in multiple sclerosis? J Neurol. 2008;255:1250–3.
35. Weber-Schoendorfer C, Schaefer C. Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler. 2009;15:1037–42.
36. Salminen HJ, Leggett H, Boggild M. Glatiramer acetate exposure in pregnancy: Preliminary safety and birth outcomes. J Neurol. 2010;257:2020–3.
37. Hoevenaren IA, de Vries LC, Rijnders RJ, Lotgering FK. Delivery of healthy babies alters natalizumab use for multiple sclerosis: A report of 2 cases. Acta Neurol Scand. 2011;123:430–3.
38. Lu E, Wang B, Guimond C. Disease-modifying drugs for multiple sclerosis in pregnancy: A systematic review. Neurology. 2012;79:1130–5.
39. Amato MP, Portaccio E. Fertility, pregnancy and childbirth in patients with multiple sclerosis: Impact of disease-modifying drugs. CNS Drugs. 2015;29:207–20.
40. Coyle P. Multiple sclerosis in pregnancy. Continuum. 2014;20:42–59.