Pre, During, and After Pregnancy Care in Women with Multiple Sclerosis and Spine Disorder: A Systematic Review

Introduction: Several studies have investigated the association between Multiple Sclerosis (MS) and pregnancy. However, the reported results are contradictory, which has caused confusion of obstetricians and gynecologists as well as neurologists concerning pregnancy planning of women with MS. Hence, the present study aimed to investigate. Methods: We systematically searched PubMed, Science Direct, Scopus, Web of Science, and Google Scholar databases and national databases (SID and MAGIRAN) to identify relevant studies published from 2000 to 2020, either in English or Persian, using the following keywords: autoimmune, hormonal disorders, pregnancy, menstrual cycle, multiple sclerosis, pre-pregnancy, post-pregnancy, and lactation. The keywords were combined using Boolean functions of AND and OR. Results: In total, 46 studies were identified. The results of these studies were reviewed in terms of defining disease, hormonal changes, menstrual cycle disorders, pregnancy of MS patients, evaluation of pregnancy of MS patients, hormonal changes during pregnancy, changes in immune system responses and cells, serum exosome, disease screening during pregnancy, disease management and treatment (if needed), recommendations for pregnant women, labor care, points for breastfeeding, and disease activity after delivery. Conclusion: Pre-pregnancy consulting for MS patients should be performed carefully to reduce recurrence rates during pregnancy. The symptoms of MS decrease during pregnancy, and there is no concern about medication. It should be noted that in nine months after delivery, the patient will return to normal condition, and special attention should be paid to drug therapy.