Pregnancy, oral contraceptives and multiple sclerosis*

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Abstract
All female patients with Multiple Sclerosis (MS) from an epidemiological area of Southern Lower Saxony completed a questionnaire in connection with a standardized neurological examination. The family status of these 179 patients differed significantly from the expected distribution. MS patients were more often single (observed 24, expected 16.5) and divorced (observed 13, expected 5.3). The degree of disability was higher and the duration of the disease longer for the group of divorced patients. Married, widowed and divorced patients had a lower mean number of children (1.63) than would be expected from the general population (1.91). This difference results from a higher percentage of married women without any children and from the small number of families with more than three children. 204 out of 250 children were born before disease onset, 46 during the disease. The percentage of spontaneous abortions and congenital malformations was similar for the pregnancies before and during the disease. 46 % of the patients in the reproductive age used contraceptive methods, most often oral contraceptives (21 %). The influence of pregnancy and oral contraceptives on the course of the disease was investigated in 446 female patients. In addition to the 179 patients mentioned above, the data of 267 female patients could be gained from a central data pool. In the whole material neither pregnancy nor oral contraceptives had an effect on prognosis – defined as the degree of disability reached after a known period of illness. The patients with pregnancy before disease onset and intake of oral contraceptives during the disease exhibited a higher degree of disability compared to the corresponding groups of “no pregnancy” and “pregnancy during the disease”. Young patients seemed less disabled when taking the pill, a finding which needs further prospective investigation.