The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do?

ABSTRACT

Introduction

Multiple sclerosis (MS) is more prevalent in women than in men. The sex of the patient, and pregnancy, are reported to be associated with the clinical features of MS. The mechanism of this is unclear.

Areas covered

This review summarizes data about sex differences in MS and the role of pregnancy. Possible mechanisms for the effects of sex and pregnancy are summarized, and practical suggestions for addressing these issues are provided.

Expert opinion

There is considerable interdependence of the variables that are associated with MS. Men have a worse outcome of MS, and this could be due to the same factors that lead to greater incidence of neurodegenerative disease in men. The possible role of parity on the long-term outcome of MS is of interest. Future studies that look at the mechanisms of the effects of the sex of the patient on the outcome of MS are required. However, there are some actions that can be taken without further research. We can concentrate on public health measures that address the modifiable risk factors for MS and ensure that disease is controlled in women who intend to become pregnant and use appropriate disease modifying agents during pregnancy.

KEYWORDS:

• Multiple sclerosis
• sex
• gender
• pregnancy
• disease course
• parity
• epigenetics

Article highlights

• MS is more frequent in women, and has worse outcome in men

• Sex influences the relapse rate, the type of disease and the site of onset of MS.

• Pregnancy affects relapse rate and there is some evidence of an association of parity with outcome

• There is some evidence of sex differences in response to immune therapies for MS

• A worse outcome for men could be related to sex effects on neurodegeneration

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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