{"id":30517,"date":"2018-05-24T10:25:58","date_gmt":"2018-05-24T08:25:58","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=30517"},"modified":"2018-05-24T10:25:58","modified_gmt":"2018-05-24T08:25:58","slug":"zeny-s-roztrousenou-sklerozou-by-mely-tehotenstvi-planovat","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=30517","title":{"rendered":"\u017deny s roztrou\u0161enou skler\u00f3zou by m\u011bly t\u011bhotenstv\u00ed pl\u00e1novat"},"content":{"rendered":"

Ro\u010dn\u011b se mamink\u00e1m s roztrou\u0161enou skler\u00f3zou rod\u00ed stovky d\u011bt\u00ed. Jenom v roce 2017 porodilo 154 z nich, jak ukazuj\u00ed data z Registru pacient\u016f s roztrou\u0161enou skler\u00f3zou (ReMuS). Nemoc u\u017e pro n\u011b nen\u00ed stra\u0161\u00e1kem.<\/strong>
\n
\nZat\u00edmco je\u0161t\u011b v 90. letech je l\u00e9ka\u0159i od t\u011bhotenstv\u00ed zrazovali a \u010dasto doporu\u010dovali p\u0159eru\u0161en\u00ed, pozd\u011bj\u0161\u00ed studie uk\u00e1zaly, \u017ee t\u011bhotenstv\u00ed \u017een\u00e1m s RS ne\u0161kod\u00ed. V dob\u011b, kdy jsou t\u011bhotn\u00e9, je hormony chr\u00e1n\u00ed p\u0159ed atakou nemoci. L\u00e9ka\u0159i v\u0161ak \u017een\u00e1m s RS doporu\u010duj\u00ed t\u011bhotenstv\u00ed pe\u010dliv\u011b pl\u00e1novat. Tento vzkaz pos\u00edlaj\u00ed v\u0161em budouc\u00edm mamink\u00e1m v r\u00e1mci Sv\u011btov\u00e9ho dne roztrou\u0161en\u00e9 skler\u00f3zy, kter\u00fd letos p\u0159ipad\u00e1 na 30. kv\u011btna.<\/p>\n

\u201eP\u0159ed ot\u011bhotn\u011bn\u00edm by \u017eena m\u011bla b\u00fdt optim\u00e1ln\u011b rok bez ataky nemoci. \u010cerstv\u011b diagnostikovan\u00e9 \u017eeny by, dle doporu\u010den\u00ed neurolog\u016f, m\u011bly m\u00edt alespo\u0148 rok l\u00e9\u010dby,\u201c \u0159\u00edk\u00e1 gynekolo\u017eka MUDr. Petra Hanul\u00edkov\u00e1 z \u00dastavu pro p\u00e9\u010di o matku a d\u00edt\u011b v Praze-Podol\u00ed, kterou m\u011bs\u00ed\u010dn\u011b nav\u0161t\u00edv\u00ed des\u00edtky t\u011bhotn\u00fdch s RS. \u201eT\u011bhotenstv\u00ed s pacientkami pl\u00e1nujeme. L\u00e9\u010dbu, kterou tyto \u017eeny pravideln\u011b u\u017e\u00edvaj\u00ed, je p\u0159ed ot\u011bhotn\u011bn\u00edm nutno upravit. V\u011bt\u0161inu prepar\u00e1t\u016f ponech\u00e1v\u00e1me a\u017e do potvrzen\u00ed gravidity. V pr\u016fb\u011bhu t\u011bhotenstv\u00ed jsou, a\u017e na vz\u00e1cn\u00e9 v\u00fdjimky, pacientky bez l\u00e9\u010dby. Dost\u00e1vaj\u00ed pouze vitamin D a dal\u0161\u00ed vhodn\u00e9 vitaminov\u00e9 prepar\u00e1ty,\u201c dopl\u0148uje MUDr. Hanul\u00edkov\u00e1. V t\u011bhotenstv\u00ed mus\u00ed t\u011blo matky tolerovat \u201enap\u016fl ciz\u00ed genetick\u00fd materi\u00e1l\u201c \u2013 plod a t\u011blo tak samo harmonizuje hladinu hormon\u016f \u2013 navozuje imunotoleranci, kter\u00e1 trv\u00e1 a\u017e do porodu. L\u00e9\u010dbu l\u00e9ka\u0159i op\u011bt nasazuj\u00ed, a\u017e \u017eena skon\u010d\u00ed s kojen\u00edm, nebo pokud se u n\u00ed objev\u00ed ataka. Vlivem prudk\u00e9ho poklesu estrogen\u016f v souvislosti s porodem jsou toti\u017e maminky v \u0161estined\u011bl\u00ed a n\u00e1sledn\u00fdch m\u011bs\u00edc\u00edch nemoc\u00ed v\u00edce ohro\u017eeny. Do \u0161esti t\u00fddn\u016f od porodu proto ka\u017ed\u00e1 pacientka absolvuje vy\u0161et\u0159en\u00ed pomoc\u00ed magnetick\u00e9 rezonance. \u201eBiologick\u00e1 l\u00e9\u010dba umo\u017e\u0148uje \u017eeny na t\u011bhotenstv\u00ed dob\u0159e p\u0159ipravit, ne v\u0161echny prepar\u00e1ty jsou p\u0159i po\u010det\u00ed vhodn\u00e9. N\u011bkter\u00e9 poji\u0161\u0165ovny bohu\u017eel odm\u00edtaj\u00ed platit p\u0159eveden\u00ed pacientek s vysokou aktivitou nemoci na jin\u00fd typ biologick\u00e9 l\u00e9\u010dby, kter\u00fd pom\u00e1h\u00e1 nemoc p\u0159ed a po t\u011bhotenstv\u00ed stabilizovat,\u201c komentuje prof. MUDr. Eva Kubala Havrdov\u00e1, CSc., vedouc\u00ed Centra pro demyeliniza\u010dn\u00ed onemocn\u011bn\u00ed Neurologick\u00e9 kliniky 1. LF UK a VFN v Praze.<\/p>\n

Odborn\u00e9 studie dok\u00e1zaly, \u017ee t\u011bhotenstv\u00ed zdravotn\u00ed stav v\u011bt\u0161iny \u017een nezhor\u0161uje, nemoc se obvykle vr\u00e1t\u00ed do stavu p\u0159ed porodem. S nepl\u00e1novan\u00fdm t\u011bhotenstv\u00edm se l\u00e9ka\u0159i potk\u00e1vaj\u00ed ve zhruba polovin\u011b p\u0159\u00edpad\u016f, stejn\u011b jako u zdrav\u00e9 populace. V takov\u00fdch p\u0159\u00edpadech t\u011bhotnou pacientku intenzivn\u011b sleduje neurolog. Pacientky s RS mohou p\u0159i volb\u011b ur\u010dit\u00fdch prepar\u00e1t\u016f podstoupit i proces um\u011bl\u00e9ho oplodn\u011bn\u00ed. Mohou tak\u00e9 krom\u011b obvykl\u00fdch kontraindikac\u00ed u\u017e\u00edvat v\u0161echny formy antikoncepce. Eventu\u00e1ln\u00ed pozornost zasluhuje pouze zv\u00fd\u0161en\u00e9 riziko \u017eiln\u00ed tromb\u00f3zy u dlouhodob\u011b imobiln\u00edch pacientek.<\/p>\n

V \u010cesku je odhadem 20 000 lid\u00ed s RS. Podle nejnov\u011bj\u0161\u00edch dat z registru jsou \u017eeny zastoupeny mezi nemocn\u00fdmi t\u00e9m\u011b\u0159 ze 72 %. Chronick\u00e9 z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed nervov\u00e9ho syst\u00e9mu se nej\u010dast\u011bji objevuje kolem 30. roku, tedy v dob\u011b, kdy zakl\u00e1daj\u00ed rodiny. \u201eS odsouv\u00e1n\u00edm mate\u0159stv\u00ed na pozd\u011bj\u0161\u00ed dobu p\u0159ib\u00fdv\u00e1 \u017een, kter\u00e9 se do\u010dkaj\u00ed diagn\u00f3zy d\u0159\u00edve ne\u017e prvn\u00edho d\u00edt\u011bte. Z biologick\u00e9ho hlediska je ur\u010dit\u011b lep\u0161\u00ed, kdy\u017e m\u00e1 \u017eena prvn\u00ed d\u00edt\u011b p\u0159ed t\u0159ic\u00edtkou,\u201c uv\u00e1d\u00ed doc. MUDr. Dana Hor\u00e1kov\u00e1, Ph.D. z Centra pro demyeliniza\u010dn\u00ed onemocn\u011bn\u00ed 1. L\u00e9ka\u0159sk\u00e9 fakulty UK a VFN Praha. \u017deny s RS by m\u011bly mate\u0159stv\u00ed pl\u00e1novat i proto, \u017ee narozen\u00ed miminka je sice radost, ale tak\u00e9 fyzick\u00e1 a psychick\u00e1 z\u00e1t\u011b\u017e. \u201ePacientka by u\u017e p\u0159edem m\u011bla myslet na to, koho m\u016f\u017ee po\u017e\u00e1dat o pomoc, pokud se bude c\u00edtit vy\u010derpan\u00e1 a nevyspal\u00e1. Pro nemoc je typick\u00e1 chronick\u00e1 \u00fanava a v\u011bt\u0161\u00ed sklony k depres\u00edm. Je proto d\u016fle\u017eit\u00e9, aby rodina nebo p\u0159\u00e1tel\u00e9 fungovali a v p\u0159\u00edpad\u011b pot\u0159eby mamince ulevili,\u201c dopl\u0148uje doc. Hor\u00e1kov\u00e1. T\u011bhotenstv\u00ed by tedy m\u011bla pl\u00e1novat nejenom maminka, ale cel\u00e1 rodina. L\u00e9ka\u0159i u maminek s RS doporu\u010duj\u00ed spont\u00e1nn\u00ed porod, pokud je to mo\u017en\u00e9. \u201ePro budouc\u00ed imunitu d\u00edt\u011bte je velmi d\u016fle\u017eit\u00e9, aby pro\u0161lo porodn\u00edmi cestami a dostalo se do kontaktu s p\u0159irozenou mikrofl\u00f3rou, kter\u00e1 se zde nach\u00e1z\u00ed,\u201c \u0159\u00edk\u00e1 doc. Hor\u00e1kov\u00e1. D\u011bti maminek s RS se rod\u00ed bez v\u00fdvojov\u00fdch vad a se stejnou porodn\u00ed v\u00e1hou jako d\u011bti zdrav\u00fdch \u017een. Riziko p\u0159enosu RS z matky na d\u00edt\u011b je relativn\u011b mal\u00e9 a ve srovn\u00e1n\u00ed se zdravou populac\u00ed pouze m\u00edrn\u011b zv\u00fd\u0161en\u00e9. Rozhodn\u011b v\u0161ak podle l\u00e9ka\u0159\u016f nen\u00ed d\u016fvodem, aby lid\u00e9 s RS nem\u011bli d\u011bti. \u201ePacienti a jejich d\u011bti by nem\u011bli kou\u0159it, u\u017e od d\u011btstv\u00ed je u nich t\u0159eba db\u00e1t zv\u00fd\u0161en\u00e9ho p\u0159\u00edsunu vitaminu D,\u201c dodala doc. Hor\u00e1kov\u00e1.<\/p>\n

\u010cesk\u00e1 republika pat\u0159\u00ed k zem\u00edm s vysok\u00fdm v\u00fdskytem roztrou\u0161en\u00e9 skler\u00f3zy, ro\u010dn\u011b odhadem p\u0159ibude 700 nov\u00fdch pacient\u016f. ReMuS nyn\u00ed sleduje v\u00edce ne\u017e 13 000 pacient\u016f. P\u0159es 80 % nemocn\u00fdch veden\u00fdch v registru u\u017e\u00edv\u00e1 biologickou l\u00e9\u010dbu (10 666), \u010d\u00e1st jich modern\u00ed l\u00e9\u010dbu nem\u00e1 (2 337). Registr pom\u016f\u017ee l\u00e9ka\u0159\u016fm do budoucna l\u00e9pe ur\u010dit, pro koho je jak\u00e1 l\u00e9\u010dba vhodn\u00e1. Komu d\u00e1t hned zpo\u010d\u00e1tku agresivn\u00ed l\u00e9\u010dbu a komu pom\u016f\u017ee pozd\u011bji, nebo ji t\u0159eba v\u016fbec nebude pot\u0159ebovat. K personalizovan\u00e9 l\u00e9\u010db\u011b je t\u0159eba i nad\u00e1le zlep\u0161ovat monitoraci pacient\u016f, zejm\u00e9na pomoc\u00ed nov\u00fdch kvantitativn\u00edch klinick\u00fdch a magnetickorezonan\u010dn\u00edch test\u016f. Novinkou, kter\u00e1 zat\u00edm nen\u00ed zcela ov\u011b\u0159ena a v \u010desk\u00e9m prost\u0159ed\u00ed nen\u00ed dostupn\u00e1, je m\u011b\u0159en\u00ed hladiny neurofilament. Jde o struktur\u00e1ln\u00ed b\u00edlkoviny, kter\u00e9 se uvol\u0148uj\u00ed do krve p\u0159i po\u0161kozen\u00ed nervov\u00fdch bun\u011bk. \u201e\u010c\u00edm vy\u0161\u0161\u00ed je tato b\u00edlkovina, t\u00edm agresivn\u011bj\u0161\u00ed pr\u016fb\u011bh nemoc m\u00e1 \u2013 toto doprovodn\u00e9 vy\u0161et\u0159en\u00ed by n\u00e1m pomohlo sledovat pr\u016fb\u011bh a \u00fa\u010dinek l\u00e9\u010dby,\u201c popisuje doc. Hor\u00e1kov\u00e1.<\/p>\n

O roztrou\u0161en\u00e9 skler\u00f3ze<\/p>\n

Roztrou\u0161en\u00e1 skler\u00f3za je chronick\u00e9 z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu, jeho\u017e p\u0159\u00ed\u010dina nen\u00ed doposud zn\u00e1ma. Toto onemocn\u011bn\u00ed propuk\u00e1 v\u011bt\u0161inou v mlad\u0161\u00edm v\u011bku, \u010dast\u011bji postihuje \u017eeny. Pro RS je typick\u00e9 st\u0159\u00edd\u00e1n\u00ed obdob\u00ed z\u00e1chvat\u016f (atak) a obdob\u00ed zd\u00e1nliv\u00e9ho klidu. Tento proces je nep\u0159edv\u00eddateln\u00fd, a proto i l\u00e9\u010dba (\u010di prevence) je t\u011b\u017ek\u00e1. Na cel\u00e9m sv\u011bt\u011b trp\u00ed RS 2,5 milionu nemocn\u00fdch, v \u010cesku se odhaduje po\u010det pacient\u016f na 20 tis\u00edc. Nemoc se vyskytuje hlavn\u011b ve st\u0159edn\u00edch a chladn\u011bj\u0161\u00edch zem\u011bpisn\u00fdch \u0161\u00ed\u0159k\u00e1ch. Rizikov\u00fdmi faktory nemoci jsou krom\u011b genetick\u00e9 dispozice EB virus (Epstein-Barrov\u00e9 virus), kou\u0159en\u00ed a nedostatek vitaminu D. Informace o roztrou\u0161en\u00e9 skler\u00f3ze lze nal\u00e9zt i na port\u00e1le www.rskompas.cz.<\/p>\n

O Nada\u010dn\u00edm fondu IMPULS<\/p>\n

Nada\u010dn\u00ed fond IMPULS vznikl v roce 2000. Jeho c\u00edlem je podporovat projekty v oblasti v\u011bdy, v\u00fdzkumu a terapie pacient\u016f s roztrou\u0161enou skler\u00f3zou mozkom\u00ed\u0161n\u00ed v \u010cR. P\u0159isp\u00edv\u00e1 zejm\u00e9na na fyzioterapii a psychoterapii, kter\u00e9 nejsou hrazeny z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, v\u011bnuje se podpo\u0159e vzd\u011bl\u00e1v\u00e1n\u00ed a osv\u011btov\u00e9 \u010dinnosti. Jako jedin\u00e1 nest\u00e1tn\u00ed neziskov\u00e1 organizace v EU je z\u0159izovatelem celost\u00e1tn\u00edho Registru pacient\u016f s roztrou\u0161enou skler\u00f3zou (ReMuS) a jeho financov\u00e1n\u00ed zaji\u0161\u0165uje z vlastn\u00edch zdroj\u016f. V\u00edce informac\u00ed na www.nfimpuls.cz.<\/p>\n

Tiskov\u00e1 zpr\u00e1va<\/p>\n","protected":false},"excerpt":{"rendered":"

Ro\u010dn\u011b se mamink\u00e1m s roztrou\u0161enou skler\u00f3zou rod\u00ed stovky d\u011bt\u00ed. Jenom v roce 2017 porodilo 154 z nich, jak ukazuj\u00ed data z Registru pacient\u016f s roztrou\u0161enou […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":16282,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-30517","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30517"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30517\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/16282"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30517"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}