Neuteboom RF, Verbraak E, Voerman JS et al.
Erasmus Medical Center, Rotterdam, The Netherlands.
Mult Scler 2009;15:907–12.
Editor’s note: Multiple sclerosis (MS) more commonly affects females than males, and disease presentation often occurs during the reproductive years (
Lancet 2002;359:1221–31). It is recognized that relapse rates in MS are lower in pregnant patients, especially in late pregnancy (
N Engl J Med 1998;339:285–91); this is believed to be due to changes in adaptive immunity from proinflammatory to anti-inflammatory immune mechanisms throughout the course of pregnancy (
Immunol Today 1993;14:353–6). The sex hormones estrogen and progesterone have also been implicated in this phenomenon (
J Neurol Sci 2005;233:49–54).