Disparities in Pregnancy Experiences Found Among Black, Hispanic/Latinx and White Women with MS

 Researchers examined medical records of women with MS in the U.S. and their pregnancy outcomes, comparing those of Black, Hispanic/Latinx, and white people. They reported that those identifying as Black or Hispanic/Latinx tended to enter pregnancy with higher levels of MS disability and often with fewer health care resources. There were also differences in types of delivery, birthweights, and socioeconomic factors.
 
Why Does This Matter? This study adds to the growing awareness of health disparities and can inform ongoing efforts to improve care for everyone living with MS.
 
Background: MS is highly individualized, and disease characteristics and a treatment plan are significant considerations in family planning and pregnancies. These investigators wanted to understand how healthcare inequities may impact the pregnancy outcomes of Black and Hispanic/Latinex women. Previous studies suggest that prenatal care is especially important for Black and Hispanic/Latinx women because they tend to have higher risks of high blood pressure, diabetes and other disorders that may complicate their pregnancies.
 
Study Details: To better understand differences among women with MS and their pregnancy experiences, Dr. Riley Bove (University of California, San Francisco - UCSF), a National MS Society Harry Weaver Scholar, and collaborators examined medical records from 9 MS centers in the U.S. They looked for pregnancy and delivery information of women with MS or CIS (a single neurological event that indicates early MS) between 2010 and 2021. They analyzed 294 pregnancies that resulted in live births.
 
Results: Some differences they found included:

• Black and Hispanic/Latinx women tended to be younger than white women when they became pregnant, and they had higher levels of MS disability when they became pregnant.
• More white women had private insurance, and more received an ultrasound exam at 14 weeks of pregnancy.
• Black women had the highest rates of emergency cesarean deliveries, and Hispanic/Latinx women had the fewest delivery complications. Babies’ birth weights of both tended to be lower than those of white women.

 
Comment: The authors suggest that some reasons for the differences may include availability of transportation, types of insurance, social support, and access to prenatal care. Studies like these can inform ongoing efforts to improve care for everyone living with MS.

More on COVID-19 and MS

Coronavirus Risk for People Living with Multiple Sclerosis (MS)

MS itself does not increase the risk of getting COVID-19. However, certain factors associated with your MS may increase your risk for complications:

• Chronic medical conditions, such as lung disease, heart disease, diabetes, cancer, smoking and asthma
• Significantly restricted mobility, such as needing to spend most of your day seated or in bed
• Age 65 or older
• Possibly taking certain disease modifying therapies that deplete immune system cells
• Severe obesity or BMI higher than 40
• Living in a long-term care facility

Sometimes, the body’s response to infections, including COVID-19, may cause a temporary worsening of MS symptoms. Typically, these symptoms settle down once the infection clears up. If you are experiencing new MS symptoms or have any concerns about any of your MS symptoms, please contact your MS healthcare provider.
 

Protecting Yourself from Coronavirus

The Centers for Disease Control and Prevention (CDC) provides recommendations on how to prevent the spread of COVID-19 and what to do if you show symptoms.   

Working and Coronavirus (COVID-19)

MS Healthcare Providers

Healthcare providers who treat people living with MS can find additional information in our Professional Resource Center.

Healthcare Workers Who Have MS

• There is no increased risk of you getting COVID-19 because you have MS.
• If you are concerned about your risk of getting COVID-19 because of the DMT you take, please contact your MS provider for advice.
• There are no special PPE instructions for people with MS. You should follow the same precautions as other healthcare workers. If you are concerned about your risk due to your DMT, please contact your MS provider for advice.

Employee Rights

There are many protections that could be available to you if your employer is not being flexible with work from home options or workplace accommodations. Visit our employment resources page to learn more or contact an MS Navigator to discuss your individual rights and options.

Children with MS

There is no specific advice for children with MS; they should follow the advice above for all people with MS. The CDC has specific recommendations for children and COVID-19.

Pregnancy

At this time there is no specific advice for women with MS who are pregnant. There is general information on COVID-19 and pregnancy on the CDC website.

Additional Resources

• COVID-19 Studies Recruiting People with MS
• Centers for Disease Control and Prevention
• World Health Organization

Study: Woman’s Risk of Having a First Neurologic Event, Which Often Leads to MS, Decreased with Increased Number of Pregnancies

Women’s risk for developing clinically isolated syndrome, which often leads to multiple sclerosis, was shown to decrease with increased number of pregnancies in a comprehensive study undertaken in Australia. Clinically isolated syndrome (CIS) is a first neurologic episode caused by inflammation or damage to nerve fiber-insulating myelin in the brain or spinal cord. Although the results of this Ausimmune Study need to be confirmed, the findings encourage further exploration of potential treatments such as sex hormones, which may mimic pregnancy’s benefits in women with MS. The sex hormone estriol is currently in clinical trials, supported by the National MS Society and the National Institutes of Health, to treat women MS.


Anne-Louise Ponsonby, PhD (Murdoch Childrens Research Institute, Melbourne) and colleagues across Australia report their findings in Neurology (2011;76:540-548). This study was supported by a research grant from the National MS Society to Anthony McMichael, PhD, the National Health and Medical Research Council of Australia, and MS Research Australia.

Background: Before 1950, most women with MS were counseled to avoid pregnancy because of the belief that it might make their MS worse. Over the past 40 years, studies in hundreds of women with MS have almost all reached the opposite conclusion: that pregnancy reduces the number of MS exacerbations, especially in the second and third trimesters.

The Ausimmune Study was undertaken to investigate whether increased exposure to sunlight and vitamin D may be protective against MS in people who had not yet been diagnosed with MS, but who had experienced a CIS. Read more about previously released findings. In the current study, the team used this unique population to study whether the number of pregnancies or offspring affects the risk for developing a CIS.

The Study: Investigators looked at the records of 282 men and women who had developed a CIS, and compared the number of children – and in women, the number of pregnancies – with controls who did not develop CIS.

Women who had one pregnancy were nearly half as likely to develop CIS, and those with three or more pregnancies had more than one fourth the risk of developing CIS compared with controls. Other factors considered – such as sun exposure and immune-system-related genes associated with MS – did not otherwise explain these associations. There was no association between risk of CIS and the number of children in men.

Comment: In an accompanying editorial, Martin Daumer, PhD, Brian G. Weinshenker, MD, and Rhonda Voskuhl, MD, comment that these findings need to be replicated in other countries to be validated, and caution that the study does not address whether pregnancy affects the long-term course of MS or development of disability.

Even with these caveats, the editorial authors say that because of studies such as this one, there is a compelling need for research to develop therapeutic approaches that mimic pregnancy’s benefits in women with MS. Dr. Voskuhl is now leading a team of investigators at seven medical centers to conduct a two-year, controlled clinical trial of estriol – a sex hormone that is increased during pregnancy – added to standard therapy to treat MS in 150 women with relapsing-remitting MS. This study recently completed enrollment.

This study provides additional evidence of a link between gender and autoimmunity. Read more about the Society’s efforts to study this link for clues to stopping MS in its tracks and ending it forever.