REVIEW Multiple sclerosis and pregnancy

Multiple sclerosis causes disability in young adults and, like most autoimmune diseases, affects women more commonly than men. The disease can therefore present at a time when many have, or are considering, starting a family. The effect of pregnancy on the outcome of multiple sclerosis is reviewed and the management of pregnant women who have multiple sclerosis is discussed. Multiple sclerosis, an inflammatory demy-elinating disease of the central nervoussystem, is the commonest cause of neuro-logical disability in young adults in the UK. Fifty per cent of multiple sclerosis patients will require the aid of a stick to walk 15 years after the diagnosis.1 Prevalence rates in the England vary between 80 and 287 per 100 000 with higher rates in northern Scotland and Orkney.2 Typically, females are affected nearly twice as commonly as males. In women multiple sclerosis very frequently manifests at a time when many will be consider-ing pregnancy, and bringing up children can be expected to occur at a time of increasing disability. Despite this, little is known about the effect of pregnancy on disease progression or of the disease process on the outcome of pregnancy. There have been few good trials of adequate duration and as such we are poorly equipped to discuss these issues with patients considering pregnancy. Many studies are retrospective and therefore are limited by recall bias. We review the available information about relapse rates during pregnancy and the puerper-ium, anaesthetic and radiological considerations, treatment options, and finally discuss the immunological changes occurring during preg-nancy and what we can learn from these observa-tions about the pathogenesis of multiple sclerosis