{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:29:17Z","timestamp":1766068157165,"version":"build-2065373602"},"reference-count":195,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Multiple System Atrophy (MSA) is a rare, rapidly progressive neurodegenerative disorder marked by autonomic dysfunction, parkinsonism, and cerebellar ataxia. While predominantly affecting individuals in their fifth or sixth decade, advancements in assisted reproductive technologies (ART) have created new clinical scenarios involving pregnancies in women within MSA\u2019s typical onset range. Given the scarcity of documented MSA pregnancies, this review leverages insights from related Parkinson\u2019s spectrum mechanisms to explore hypothetical scenarios for how pregnancy-induced physiological changes might influence MSA progression. Pregnancy-induced hormonal fluctuations, including elevated estrogen and progesterone levels, may modulate \u03b1-synuclein aggregation and neuroinflammatory pathways. Immune adaptations, such as fetal microchimerism and Th2-biased immune profiles, introduce additional complexities, particularly in donor embryo pregnancies involving complex microchimerism. Metabolic demands and oxidative stress further intersect with these mechanisms, potentially accelerating disease progression. We analyze existing literature and theoretical models, emphasizing the need for interdisciplinary research. Clinical implications are discussed to propose evidence-based strategies for optimizing maternal-fetal outcomes. This paper identifies critical knowledge gaps and proposes avenues for future investigation to optimize maternal-fetal outcomes in this unique and underexplored clinical intersection.<\/jats:p>","DOI":"10.3390\/ijms26073348","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T06:52:56Z","timestamp":1743749576000},"page":"3348","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Parkinson\u2019s Spectrum Mechanisms in Pregnancy: Exploring Hypothetical Scenarios for MSA in the Era of ART"],"prefix":"10.3390","volume":"26","author":[{"given":"Dalibor","family":"Kovacevic","sequence":"first","affiliation":[{"name":"\u201cGenesis\u201d Hospital, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6870-0079","authenticated-orcid":false,"given":"Gordana","family":"Velikic","sequence":"additional","affiliation":[{"name":"Department for Research and Development, Clinic Orto MD-Parks Dr Dragi Hospital, 21000 Novi Sad, Serbia"},{"name":"Hajim School of Engineering, University of Rochester, Rochester, NY 14627, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dusan M.","family":"Maric","sequence":"additional","affiliation":[{"name":"Hajim School of Engineering, University of Rochester, Rochester, NY 14627, USA"},{"name":"Faculty of Stomatology Pancevo, University Business Academy, 26000 Pancevo, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7613-6631","authenticated-orcid":false,"given":"Dusica L.","family":"Maric","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-1581","authenticated-orcid":false,"given":"Miljan","family":"Puletic","sequence":"additional","affiliation":[{"name":"Faculty of Stomatology Pancevo, University Business Academy, 26000 Pancevo, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljiljana","family":"Gvozdenovic","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, and Intensive Care, Clinical Center Vojvodina, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9308-3076","authenticated-orcid":false,"given":"Danilo","family":"Vojvodic","sequence":"additional","affiliation":[{"name":"Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia"},{"name":"Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0350-4733","authenticated-orcid":false,"given":"Gordana","family":"Supic","sequence":"additional","affiliation":[{"name":"Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia"},{"name":"Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1056\/NEJM199807303390501","article-title":"Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group","volume":"339","author":"Confavreux","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"1","article-title":"Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy","volume":"12","year":"2022","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13024-022-00579-z","article-title":"Multiple system atrophy: \u03b1-Synuclein strains at the neuron-oligodendrocyte crossroad","volume":"17","author":"Reddy","year":"2022","journal-title":"Mol. Neuro-Degener."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jenkins, E.C., Chattopadhyay, M., and Germain, D. (2021). Folding Mitochondrial-Mediated Cytosolic Proteostasis Into the Mi-tochondrial Unfolded Protein Response. Front. Cell Dev. Biol., 9.","DOI":"10.3389\/fcell.2021.715923"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s40478-019-0730-6","article-title":"Understanding the pathogenesis of multiple system atrophy: State of the art and future perspectives","volume":"7","year":"2019","journal-title":"Acta Neuropathol. Commun."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Malfertheiner, K., Stefanova, N., and Heras-Garvin, A. (2021). The Concept of \u03b1-Synuclein Strains and How Different Conformations May Explain Distinct Neurodegenerative Disorders. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.737195"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s00702-016-1545-2","article-title":"Multiple system atrophy: Pathogenic mechanisms and biomarkers","volume":"123","author":"Jellinger","year":"2016","journal-title":"J. Neural. Transm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5607\/en.2014.23.4.277","article-title":"Multiple System Atrophy: Genetic or Epigenetic?","volume":"23","author":"Sturm","year":"2014","journal-title":"Exp. Neurobiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12967-023-03905-1","article-title":"The genetic basis of multiple system atrophy","volume":"21","author":"Tseng","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ndayisaba, A., Kaindlstorfer, C., and Wenning, G.K. (2019). Iron in Neurodegeneration\u2014Cause or Consequence?. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00180"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5382","DOI":"10.1038\/s41467-021-25767-1","article-title":"Selective targeting of the TLR2\/MyD88\/NF-\u03baB pathway reduces \u03b1-synuclein spreading in vitro and in vivo","volume":"12","author":"Dutta","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40035-024-00401-4","article-title":"\u03b1-Synuclein oligomers potentiate neuroinflammatory NF-\u03baB activity and induce Cav3.2 calcium signaling in astrocytes","volume":"13","author":"Leandrou","year":"2024","journal-title":"Transl. Neurodegener."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Anilkumar, S., and Wright-Jin, E. (2024). NF-\u03baB as an Inducible Regulator of Inflammation in the Central Nervous System. Cells, 13.","DOI":"10.20944\/preprints202402.0003.v1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12967-024-04893-6","article-title":"Exosomes: Potential targets for the diagnosis and treatment of neuropsychiatric disorders","volume":"22","author":"Li","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Al-Chalabi, A., D\u00fcrr, A., Wood, N.W., Parkinson, M.H., Camuzat, A., Hulot, J.-S., Morrison, K.E., Renton, A., Sussmuth, S.D., and Landwehrmeyer, B.G. (2009). Genetic variants of the alpha-synuclein gene SNCA are associated with multiple system atrophy. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0007114"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zingale, V.D., Gugliandolo, A., and Mazzon, E. (2021). MiR-155: An Important Regulator of Neuroinflammation. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23010090"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Guo, Y., Hong, W., Wang, X., Zhang, P., K\u00f6rner, H., Tu, J., and Wei, W. (2019). MicroRNAs in Microglia: How do MicroRNAs Affect Activation, Inflammation, Polarization of Microglia and Mediate the Interaction Between Microglia and Glioma?. Front. Mol. Neurosci., 12.","DOI":"10.3389\/fnmol.2019.00125"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Slota, J.A., and Booth, S.A. (2019). MicroRNAs in Neuroinflammation: Implications in Disease Pathogenesis, Biomarker Discovery and Therapeutic Applications. Non-Coding RNA, 5.","DOI":"10.3390\/ncrna5020035"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kakran, N., Gupta, S., Singh, N., Verma, Y., Tewari, P., and Lal, A. (2024). A Review of Hormonal Changes During Pregnancy In Trimesters. IJFMR, 6.","DOI":"10.36948\/ijfmr.2024.v06i03.22456"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Seth, S., Lewis, A.J., and Galbally, M. (2016). Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: A systematic literature review. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-0915-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.12998\/wjcc.v9.i1.91","article-title":"Role of relaxin in diastasis of the pubic symphysis peripartum","volume":"9","author":"Wang","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Del R\u00edo, J.P., Alliende, M.I., Molina, N., Serrano, F.G., Molina, S., and Vigil, P. (2018). Steroid Hormones and Their Action in Women\u2019s Brains: The Importance of Hormonal Balance. Front. Public. Health, 6.","DOI":"10.3389\/fpubh.2018.00141"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Barbati, C., Pierdominici, M., Gambardella, L., Malchiodi Albedi, F., Karas, R.H., Rosano, G., Malorni, W., and Ortona, E. (2012). Cell surface estrogen receptor alpha is upregulated during subchronic metabolic stress and inhibits neuronal cell degeneration. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0042339"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Arjmand, S., Bender, D., Jakobsen, S., Wegener, G., and Landau, A.M. (2023). Peering into the Brain\u2019s Estrogen Receptors: PET Tracers for Visualization of Nuclear and Extranuclear Estrogen Receptors in Brain Disorders. Biomolecules, 13.","DOI":"10.3390\/biom13091405"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1016\/j.psyneuen.2009.06.003","article-title":"Estradiol and the relationship between dendritic spines, NR2B containing NMDA receptors, and the magnitude of long-term potentiation at hippocampal CA3-CA1 synapses","volume":"34","author":"Smith","year":"2009","journal-title":"Psychoneuroendocrinology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2792","DOI":"10.1523\/JNEUROSCI.1970-18.2019","article-title":"Neuron-Derived Estrogen Regulates Synaptic Plasticity and Memory","volume":"39","author":"Lu","year":"2019","journal-title":"J. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13041-019-0442-7","article-title":"Structural plasticity of the hippocampus in response to estrogens in female rodents","volume":"12","author":"Sheppard","year":"2019","journal-title":"Mol. Brain"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Finney, C.A., Shvetcov, A., Westbrook, R.F., Jones, N.M., and Morris, M.J. (2020). The role of hippocampal estradiol in synaptic plasticity and memory: A systematic review. Front. Neuroendocrinol., 56.","DOI":"10.1016\/j.yfrne.2019.100818"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Khan, D., and Ansar Ahmed, S. (2016). The Immune System Is a Natural Target for Estrogen Action: Opposing Effects of Estrogen in Two Prototypical Autoimmune Diseases. Front. Immunol., 6.","DOI":"10.3389\/fimmu.2015.00635"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.clim.2004.05.011","article-title":"Estrogen as an immunomodulator","volume":"113","author":"Lang","year":"2004","journal-title":"Clin. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1159\/000537794","article-title":"The Effects of Neuroactive Steroids on Myelin in Health and Disease","volume":"33","author":"Samah","year":"2024","journal-title":"Med. Princ. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0165-0173(01)00139-4","article-title":"Progesterone synthesis and myelin formation in peripheral nerves","volume":"37","author":"Schumacher","year":"2001","journal-title":"Brain Res. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3845","DOI":"10.1007\/s00429-016-1197-x","article-title":"Estrogen- and progesterone-mediated structural neuroplasticity in women: Evidence from neuroimaging","volume":"221","author":"Catenaccio","year":"2016","journal-title":"Brain Struct. Funct."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Prevost, M., Zelkowitz, P., Tulandi, T., Hayton, B., Feeley, N., Carter, C.S., Joseph, L., Pournajafi-Nazarloo, H., Yong Ping, E., and Abenhaim, H. (2014). Oxytocin in pregnancy and the postpartum: Relations to labor and its management. Front. Public Health, 2.","DOI":"10.3389\/fpubh.2014.00001"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Uvn\u00e4s-Moberg, K., Ekstr\u00f6m-Bergstr\u00f6m, A., Berg, M., Buckley, S., Pajalic, Z., Hadjigeorgiou, E., Kot\u0142owska, A., Lengler, L., Kielbratowska, B., and Leon-Larios, F. (2019). Maternal plasma levels of oxytocin during physiological childbirth\u2014A systematic review with implications for uterine contractions and central actions of oxytocin. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2365-9"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1111\/jdi.12634","article-title":"Higher maternal serum prolactin levels are associated with reduced glucose tolerance during pregnancy","volume":"8","author":"Ekinci","year":"2017","journal-title":"J. Diabetes Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s12195-020-00647-8","article-title":"Dynamic Regulation of JAK-STAT Signaling Through the Prolactin Receptor Predicted by Computational Modeling","volume":"14","author":"Mortlock","year":"2020","journal-title":"Cell Mol. Bioeng."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Torner, L. (2016). Actions of Prolactin in the Brain: From Physiological Adaptations to Stress and Neurogenesis to Psycho-pathology. Front. Endocrinol., 7.","DOI":"10.3389\/fendo.2016.00025"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.bbi.2011.07.233","article-title":"Prolactin, neurogenesis, and maternal behaviors","volume":"26","author":"Larsen","year":"2012","journal-title":"Brain Behav. Immun."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"13042","DOI":"10.1073\/pnas.1621196114","article-title":"Maternal prolactin during late pregnancy is important in generating nurturing behavior in the offspring","volume":"114","author":"Sairenji","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.psyneuen.2016.10.005","article-title":"Prenatal maternal cortisol concentrations predict neurodevelopment in middle childhood","volume":"75","author":"Davis","year":"2017","journal-title":"Psychoneuroendocrinology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Mathiesen, L., Bay-Richter, C., Wegener, G., Liebenberg, N., and Knudsen, L.E. (2020). Maternal stress and placental function; ex vivo placental perfusion studying cortisol, cortisone, tryptophan and serotonin. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233979"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"416739","DOI":"10.1155\/2012\/416739","article-title":"Changes in the Th1:Th2 cytokine bias in pregnancy and the effects of the anti-inflammatory cyclopentenone prostaglandin 15-deoxy-\u0394(12,14)-prostaglandin J2","volume":"2012","author":"Sykes","year":"2012","journal-title":"Mediat. Inflamm."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Krop, J., Heidt, S., Claas, F.H.J., and Eikmans, M. (2020). Regulatory T Cells in Pregnancy: It Is Not All About FoxP3. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01182"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Huang, N., Chi, H., and Qiao, J. (2020). Role of Regulatory T Cells in Regulating Fetal-Maternal Immune Tolerance in Healthy Pregnancies and Reproductive Diseases. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01023"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Wen, B., Liao, H., Lin, W., Li, Z., Ma, X., Xu, Q., and Yu, F. (2023). The Role of TGF-\u03b2 during Pregnancy and Pregnancy Complications. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242316882"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/imm.12218","article-title":"The up side of decidual natural killer cells: New developments in immunology of pregnancy","volume":"141","author":"Siewiera","year":"2014","journal-title":"Immunology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4049\/jimmunol.175.1.61","article-title":"Human First-Trimester Trophoblast Cells Recruit CD56brightCD16\u2212NK Cells into Decidua by Way of Expressing and Secreting of CXCL12\/Stromal Cell-Derived Factor 1","volume":"175","author":"Wu","year":"2005","journal-title":"J. Immunol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Xu, X., Zhou, Y., and Wei, H. (2020). Roles of HLA-G in the Maternal-Fetal Immune Microenvironment. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.592010"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Chighizola, C.B., Lonati, P.A., Trespidi, L., Meroni, P.L., and Tedesco, F. (2020). The Complement System in the Pathophysiology of Pregnancy and in Systemic Autoimmune Rheumatic Diseases During Pregnancy. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.02084"},{"key":"ref_51","first-page":"103664","article-title":"Feto-maternal microchimerism: Memories from pregnancy","volume":"25","author":"Desco","year":"2021","journal-title":"iScience"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1258\/om.2008.080008","article-title":"Fetal microchimerism and maternal health during and after pregnancy","volume":"1","year":"2008","journal-title":"Obstet. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/clinchem\/hvaa304","article-title":"Forever Connected: The Lifelong Biological Consequences of Fetomaternal and Maternofetal Microchimerism","volume":"67","author":"Bianchi","year":"2021","journal-title":"Clin. Chem."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1161\/CIRCRESAHA.111.249037","article-title":"Fetal cells traffic to injured maternal myocardium and undergo cardiac differentiation","volume":"110","author":"Kara","year":"2012","journal-title":"Circ. Res."},{"key":"ref_55","first-page":"002","article-title":"Emerging Questions in Materno-Fetal Microchimerism","volume":"S1","author":"Irie","year":"2011","journal-title":"Reprod. Sys Sex. Disord."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1093\/clinchem\/hvac056","article-title":"Fetomaternal Microchimerism and Amniotic Fluid Stem Cells: The Current State of Knowledge","volume":"68","author":"Rosner","year":"2022","journal-title":"Clin. Chem."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1038\/nrendo.2010.216","article-title":"Fetal microchimerism as an explanation of disease","volume":"7","author":"Fugazzola","year":"2011","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1212\/WNL.0000000000005065","article-title":"Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era","volume":"90","author":"Alroughani","year":"2018","journal-title":"Neurology"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Zangh\u00ec, A., D\u2019Amico, E., Callari, G., Chisari, C.G., Borriello, G., Grimaldi, L.M.E., and Patti, F. (2020). Pregnancy and the Postpartum Period in Women With Relapsing-Remitting Multiple Sclerosis Treated With Old and New Disease-Modifying Treatments: A Real-World Multi-center Experience. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00105"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.parkreldis.2017.05.007","article-title":"Parkinson\u2019s disease and pregnancy: An updated review","volume":"40","author":"Seier","year":"2017","journal-title":"Park. Relat. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Varyt\u0117, G., Zakarevi\u010dien\u0117, J., Rama\u0161auskait\u0117, D., Lau\u017eikien\u0117, D., and Arlauskien\u0117, A. (2020). Pregnancy and Multiple Sclerosis: An Update on the Disease Modifying Treatment Strategy and a Review of Pregnancy\u2019s Impact on Disease Activity. Medicina, 56.","DOI":"10.3390\/medicina56020049"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"103449","DOI":"10.1016\/j.autrev.2023.103449","article-title":"Multiple sclerosis and pregnancy: Pathogenesis, influencing factors, and treatment options","volume":"22","author":"Wang","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/mdc3.12925","article-title":"Management of Parkinson\u2019s Disease During Pregnancy: Literature Review and Multidisciplinary Input","volume":"7","author":"Young","year":"2020","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s10072-023-07029-8","article-title":"Pregnancy, fertile life factors, and associated clinical course in PRKN early-onset Par-kinson\u2019s disease","volume":"45","author":"Bovenzi","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1186\/1752-1947-5-599","article-title":"Pregnancy in multiple system atrophy: A case report","volume":"5","author":"Zhu","year":"2011","journal-title":"J. Med. Case Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1038\/nrneurol.2015.53","article-title":"Multiple sclerosis and pregnancy in the \u2018treatment era\u2019","volume":"11","author":"Vukusic","year":"2015","journal-title":"Nat. Rev. Neurol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s00415-012-6653-9","article-title":"Multiple sclerosis and pregnancy: Therapeutic considerations","volume":"260","author":"Houtchens","year":"2013","journal-title":"J. Neurol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Olivola, S., Xodo, S., Olivola, E., Cecchini, F., Londero, A.P., and Driul, L. (2020). Parkinson\u2019s Disease in Pregnancy: A Case Report and Review of the Literature. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.01349"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s004150050479","article-title":"Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy","volume":"246","author":"Mathias","year":"1999","journal-title":"J. Neurol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1159\/000507292","article-title":"Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy","volume":"19","author":"Jung","year":"2019","journal-title":"Neurodegener. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2754","DOI":"10.1007\/s00415-020-09881-6","article-title":"An update on MSA: Premotor and non-motor features open a window of op-portunities for early diagnosis and intervention","volume":"267","author":"Chelban","year":"2020","journal-title":"J. Neurol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10286-017-0500-0","article-title":"First symptoms in multiple system atrophy","volume":"28","author":"McKay","year":"2018","journal-title":"Clin. Auton. Res."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Foxcroft, K.F., Callaway, L.K., Byrne, N.M., and Webster, J. (2013). Development and validation of a pregnancy symptoms inventory. BMC Pregnancy Childbirth, 13.","DOI":"10.1186\/1471-2393-13-3"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/j.1479-828X.1999.tb03122.x","article-title":"Symptoms During Normal Pregnancy: A Prospective Controlled Study","volume":"39","author":"Zib","year":"1999","journal-title":"Aust. NZ J. Obst Gynaeco."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Loerup, L., Pullon, R.M., Birks, J., Fleming, S., Mackillop, L.H., Gerry, S., and Watkinson, P.J. (2019). Trends of blood pressure and heart rate in normal pregnancies: A systematic review and meta-analysis. BMC Med., 17.","DOI":"10.1186\/s12916-019-1399-1"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s12311-011-0299-5","article-title":"Orthostatic hypotension is differentially associated with the cerebellar versus the parkinsonian variant of multiple system atrophy: A comparative study","volume":"11","author":"Wenning","year":"2012","journal-title":"Cerebellum."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s10286-019-00648-2","article-title":"Early bladder dysfunction in multiple system atrophy: Who seek shall find","volume":"29","author":"Richard","year":"2019","journal-title":"Clin. Auton. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s11884-019-00533-8","article-title":"Treatment of Refractory Urinary Urgency, Frequency, and Incontinence in Pregnancy","volume":"14","author":"Pennycuff","year":"2019","journal-title":"Curr. Bladder Dysfunct. Rep."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1212\/WNL.0000000000012968","article-title":"Fatigue in Patients With Multiple System Atrophy: A Prospective Cohort Study","volume":"98","author":"Zhang","year":"2022","journal-title":"Neurology"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s11940-018-0503-8","article-title":"Sleep Abnormalities in MultipleSystem Atrophy","volume":"20","year":"2018","journal-title":"Curr. Treat. Options Neurol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s11920-022-01343-2","article-title":"Sleep During Pregnancy","volume":"24","author":"Meers","year":"2022","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.3233\/JPD-223392","article-title":"A Guide for the Differential Diagnosis of Multiple System Atrophy in Clinical Practice","volume":"12","author":"Kauppila","year":"2022","journal-title":"J. Parkinsons Dis."},{"key":"ref_83","unstructured":"Andreas, F.R.U. (2022). Geriatric Pregnancy. [Master\u2019s Thesis, Vilniaus Universitetas]."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.ajog.2017.03.012","article-title":"Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: With an emphasis on US population-based studies","volume":"217","author":"Luke","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_85","first-page":"71","article-title":"In vitro fertilization and age. When old is too old?","volume":"14","author":"Pokulniewicz","year":"2015","journal-title":"Prz. Menopauzalny"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1177\/01622439211021914","article-title":"Age-discriminated IVF Access and Evidence-based Ageism: Is There a Better Way?","volume":"47","author":"Cavaliere","year":"2022","journal-title":"Sci. Technol. Hum. Values"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4049\/immunohorizons.2400032","article-title":"From Womb to World: Exploring the Immunological Connections between Mother and Child","volume":"8","author":"Bobby","year":"2024","journal-title":"Immunohorizons"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.4110\/in.2024.24.e30","article-title":"Multi-Layered Mechanisms of Immunological Tolerance at the Maternal-Fetal Interface","volume":"24","author":"Joo","year":"2024","journal-title":"Immune Netw."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s44368-024-00002-3","article-title":"Immunological harmony: The dynamic influence of cellular and humoral immunity on pregnancy success","volume":"1","author":"Pandey","year":"2024","journal-title":"Discov. Immun."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.ejogrb.2011.05.008","article-title":"Fetal microchimerism: Benevolence or malevolence for the mother?","volume":"158","author":"Boyon","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1016\/j.devcel.2022.05.018","article-title":"Fetomaternal microchimerism in tissue repair and tumor development","volume":"57","author":"Sedov","year":"2022","journal-title":"Dev. Cell"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1002\/bies.201500059","article-title":"Fetal microchimerism and maternal health: A review and evolutionary analysis of cooperation and conflict beyond the womb","volume":"37","author":"Boddy","year":"2015","journal-title":"BioEssays"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Mpakosi, A., Sokou, R., Theodoraki, M., Iacovidou, N., Cholevas, V., and Kaliouli-Antonopoulou, C. (2024). Deciphering the Role of Ma-ternal Microchimerism in Offspring Autoimmunity: A Narrative Review. Medicina, 60.","DOI":"10.3390\/medicina60091457"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Ducza, E., Cs\u00e1nyi, A., and G\u00e1sp\u00e1r, R. (2017). Aquaporins during Pregnancy: Their Function and Significance. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18122593"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"4224","DOI":"10.1172\/JCI122182","article-title":"Regulatory T cells in embryo implantation and the immune response to pregnancy","volume":"128","author":"Robertson","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s12272-013-0161-z","article-title":"Role of chemokine CCL2 and its receptor CCR2 in neurodegenerative diseases","volume":"36","author":"Bose","year":"2013","journal-title":"Arch. Pharm. Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12974-018-1237-y","article-title":"An IFN\u03b3\/CXCL2 regulatory pathway determines lesion localization during EAE","volume":"15","author":"Stoolman","year":"2018","journal-title":"J. Neuroinflammation"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Mor, G. (2006). Th1\/Th2 Balance of the Implantation Site in Humans. Immunology of Pregnancy. Medical Intelligence Unit, Springer.","DOI":"10.1007\/0-387-34944-8"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"3285","DOI":"10.4049\/jimmunol.0711996","article-title":"Th1\/Th2 Patterns and Balance in Cytokine Production in the Parents and Infants of a Large Birth Cohort1","volume":"182","author":"Halonen","year":"2009","journal-title":"J. Immunol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"S422","DOI":"10.1513\/AnnalsATS.201602-095AW","article-title":"Aging of the Immune System. Mechanisms and Therapeutic Targets","volume":"13","author":"Weyand","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Lewis, E.D., Wu, D., and Meydani, S.N. (2022). Age-associated alterations in immune function and inflammation. Prog. Neuro-Psychopharmacol. Biol. Psychiatry, 118.","DOI":"10.1016\/j.pnpbp.2022.110576"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Haynes, L. (2020). Aging of the Immune System: Research Challenges to Enhance the Health Span of Older Adults. Front. Aging, 1.","DOI":"10.3389\/fragi.2020.602108"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/cei.13437","article-title":"The effects of advanced maternal age on T-cell subsets at the maternal-fetal interface prior to term labor and in the offspring: A mouse study","volume":"201","author":"Levenson","year":"2020","journal-title":"Clin. Exp. Immunol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"9919024","DOI":"10.1155\/2021\/9919024","article-title":"Inflamm-Aging-Related Cytokines of IL-17 and IFN-\u03b3 Accelerate Osteoclastogenesis and Periodontal Destruction","volume":"2021","author":"Tan","year":"2021","journal-title":"J. Immunol. Res."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1038\/s41392-023-01588-0","article-title":"Microglia in neurodegenerative diseases: Mechanism and potential therapeutic targets","volume":"8","author":"Gao","year":"2023","journal-title":"Sig Transduct. Target. Ther."},{"key":"ref_106","unstructured":"Gellman, M.D. (2020). In Vitro Fertilization, Assisted Reproductive Technology. Encyclopedia of Behavioral Medicine, Springer."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Kim, C.A., Aguilar, J.M.H., Hidalgo, L., and Katz, E. (2024). Review of minimally disruptive in vitro fertilization (IVF) approaches as a strategy for assisted human conception. Georget. Med. Rev., 8.","DOI":"10.52504\/001c.117697"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s43032-021-00829-3","article-title":"The Future of IVF: The New Normal in Human Reproduction","volume":"29","author":"Kushnir","year":"2022","journal-title":"Reprod. Sci."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1515\/revneuro-2020-0082","article-title":"The role of prolactin in central nervous system inflammation","volume":"32","author":"Cerbon","year":"2021","journal-title":"Rev. Neurosci."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.neuroscience.2023.05.013","article-title":"Disruption of \u03b1-Synuclein Proteostasis in the Striatum and Midbrain of Long-term Ovariectomized Female Mice","volume":"523","author":"Zhou","year":"2023","journal-title":"Neuroscience"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Saeed, K., Jo, M.H., Park, J.S., Alam, S.I., Khan, I., Ahmad, R., Khan, A., Ullah, R., and Kim, M.O. (2021). 17\u03b2-Estradiol Abrogates Oxidative Stress and Neuroinflammation after Cortical Stab Wound Injury. Antioxidants, 10.","DOI":"10.3390\/antiox10111682"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"3646","DOI":"10.1210\/endo.141.10.7693","article-title":"Antiinflammatory Effects of Estrogen on Microglial Activation","volume":"141","author":"Annadora","year":"2000","journal-title":"Endocrinology"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"517","DOI":"10.2119\/2008-00026.Stice","article-title":"Estrogen, NF\u03baB, and the Heat Shock Response","volume":"14","author":"Stice","year":"2008","journal-title":"Mol. Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1210\/er.2007-0001","article-title":"The Complex Role of Estrogens in Inflammation","volume":"28","author":"Straub","year":"2007","journal-title":"Endocr. Rev."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.ejogrb.2020.01.033","article-title":"Acute cardiovascular changes in women undergoing in vitro fertilisation (IVF), a systematic review and meta-analysis","volume":"248","author":"Fujitake","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/joim.13136","article-title":"(Danderyd University Hospital, Stockholm, Sweden). Cardiovascular problems associated with IVF therapy (Review)","volume":"289","author":"Henriksson","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00484-022-02301-6","article-title":"Physiological mechanisms of the impact of heat during pregnancy and the clinical impli-cations: Review of the evidence from an expert group meeting","volume":"66","author":"Samuels","year":"2022","journal-title":"Int. J. Biometeorol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"102651","DOI":"10.1016\/j.jaut.2021.102651","article-title":"T helper cell immunity in pregnancy and influence on autoimmune disease progression","volume":"121","author":"Graham","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"106072","DOI":"10.1016\/j.earlhumdev.2024.106072","article-title":"Egg donation and gestational surrogacy: Pregnancy is riskier with an unrelated embryo","volume":"196","author":"McCoy","year":"2024","journal-title":"Early Hum. Dev."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Andrawus, M., Sharvit, L., and Atzmon, G. (2022). Epigenetics and Pregnancy: Conditional Snapshot or Rolling Event. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232012698"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Indrio, F., Martini, S., Francavilla, R., Corvaglia, L., Cristofori, F., Mastrolia, S.A., Neu, J., Rautava, S., Russo Spena, G., and Raimondi, F. (2017). Epigenetic Matters: The Link between Early Nutrition, Microbiome, and Long-term Health Development. Front. Pediatr., 5.","DOI":"10.3389\/fped.2017.00178"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"103388","DOI":"10.1016\/j.autrev.2023.103388","article-title":"Conceiving complexity: Biological mechanisms underpinning the lasting effect of pregnancy on multiple sclerosis outcomes","volume":"22","author":"Campagna","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s10815-022-02451-x","article-title":"Epigenetics of pregnancy: Looking beyond the DNA code","volume":"39","author":"Zuccarello","year":"2022","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/nrcardio.2011.197","article-title":"Do fetal cells repair maternal hearts?","volume":"9","author":"Lim","year":"2012","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1093\/molehr\/gaq067","article-title":"Fetal stem cell microchimerism: Natural-born healers or killers?","volume":"16","author":"Lee","year":"2010","journal-title":"Mol. Hum. Reprod."},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Sbeih, M., Oul\u00e8s, B., Alkobtawi, M., Schwendimann, L., Ng\u00f4, Q.T., Fontaine, R., Teissier, N., Gressens, P., and Aractingi, S. (2022). CCL2 recruits fetal microchimeric cells and dampens maternal brain damage in post-partum mice. Neurobiol. Dis., 174.","DOI":"10.1016\/j.nbd.2022.105892"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1210\/er.2017-00211","article-title":"Metabolic Flexibility as an Adaptation to Energy Resources and Requirements in Health and Disease","volume":"39","author":"Smith","year":"2018","journal-title":"Endocr. Rev."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Grzeszczak, K., \u0141anocha-Arendarczyk, N., Malinowski, W., Zi\u0119tek, P., and Kosik-Bogacka, D. (2023). Oxidative Stress in Pregnancy. Biomolecules, 13.","DOI":"10.20944\/preprints202310.1578.v1"},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Jovandaric, M.Z., Babic, S., Raus, M., and Medjo, B. (2023). The Importance of Metabolic and Environmental Factors in the Occurrence of Oxidative Stress during Pregnancy. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241511964"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"1","DOI":"10.29328\/journal.cjog.1001155","article-title":"Antioxidants and Pregnancy Complications: Exploring Therapeutic Strategies for Better Outcomes","volume":"7","author":"Obeagu","year":"2024","journal-title":"Clin. J. Obstet. Gynecol."},{"key":"ref_131","doi-asserted-by":"crossref","unstructured":"Diniz, M.S., Magalh\u00e3es, C.C., Tocantins, C., Grilo, L.F., Teixeira, J., and Pereira, S.P. (2023). Nurturing through Nutrition: Exploring the Role of Antioxidants in Maternal Diet during Pregnancy to Mitigate Developmental Programming of Chronic Diseases. Nutrients, 15.","DOI":"10.3390\/nu15214623"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1213\/XAA.0000000000000939","article-title":"Anesthesia in Patients With Multiple-System Atrophy: A Narrative Review and Practice Guidance","volume":"12","author":"Kumar","year":"2019","journal-title":"A&A Pract."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"17562864211051012","DOI":"10.1177\/17562864211051012","article-title":"A systematic review of relapse rates during pregnancy and postpartum in patients with relapsing multiple sclerosis","volume":"14","author":"Hellwig","year":"2021","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_134","first-page":"1277","article-title":"Unmet Need in Early-Onset Parkinson\u2019s Disease: Deep Brain Stimulation and Pregnancy","volume":"14","author":"Smilowska","year":"2024","journal-title":"J. Park. Dis."},{"key":"ref_135","first-page":"144","article-title":"Midodrine in Pregnancy: A Case Report and Literature Review","volume":"4","year":"2015","journal-title":"Cardiol. Pharmacol."},{"key":"ref_136","first-page":"17","article-title":"Treatment of Addison\u2019s disease during pregnancy","volume":"2018","author":"Oliveira","year":"2018","journal-title":"Endocrinol. Diabetes Metab. Case Rep."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/bs.seda.2016.08.014","article-title":"Chapter 12\u2014Drugs That Affect Autonomic Functions or the Extrapyramidal System","volume":"Volume 38","author":"Sidhartha","year":"2016","journal-title":"Side Effects of Drugs Annual"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/B978-0-12-804766-8.00008-X","article-title":"Chapter 8\u2014Autonomic dysfunction: Diagnosis and management","volume":"Volume 167","author":"Dekosky","year":"2019","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_139","unstructured":"(2024, December 20). DROXIDOPA\u2014Droxidopa Capsule Zydus Pharmaceuticals USA Inc., Highlights of Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/getFile.cfm?setid=aa3ce55a-1ea9-4b50-b682-6f25398bcc29&type=pdf."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"477","DOI":"10.3233\/JPD-212976","article-title":"Monoamine Oxidase-B Inhibitors for the Treatment of Parkinson\u2019s Disease: Past, Present, and Future","volume":"12","author":"Tan","year":"2022","journal-title":"J. Parkinsons Dis."},{"key":"ref_141","doi-asserted-by":"crossref","unstructured":"Finberg, J.P., and Rabey, J.M. (2016). Inhibitors of MAO-A and MAO-B in Psychiatry and Neurology. Front. Pharmacol., 7.","DOI":"10.3389\/fphar.2016.00340"},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/0300-483X(86)90044-2","article-title":"Reproductive toxicity studies with oxybutynin hydrochloride","volume":"40","author":"Edwards","year":"1986","journal-title":"Toxicology"},{"key":"ref_143","first-page":"e1","article-title":"Sertraline use during pregnancy and the risk of major malformations","volume":"212","author":"Zhao","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_144","first-page":"112","article-title":"Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances","volume":"64","author":"Hung","year":"2017","journal-title":"Hu Li Za Zhi"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00737-018-0936-9","article-title":"Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women\u2019s views on the acceptability of and satisfaction with interventions","volume":"23","author":"Evans","year":"2020","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"102799","DOI":"10.1016\/j.ctim.2022.102799","article-title":"The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review","volume":"64","author":"Yu","year":"2022","journal-title":"Complement. Ther. Med."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.yhbeh.2012.02.023","article-title":"Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis","volume":"62","author":"Robinson","year":"2012","journal-title":"Horm. Behav."},{"key":"ref_148","unstructured":"van der Klaauw, I. (2024). The Influence of Pregnancy-Associated Hormones on Immune Responses and the Contribution of Immuno-Endocrine Crosstalk to Successful Pregnancy. [Bachelor\u2019s Thesis, University of Groningen]."},{"key":"ref_149","unstructured":"Stern, C.M.M. (1989). Pregnancy Proteins and Hormones in the Immune Response of Pregnancy. Immunology of Pregnancy and Its Disorders, Springer."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jri.2012.05.004","article-title":"Interleukin-6 in pregnancy and gestational disorders","volume":"95","author":"Prins","year":"2012","journal-title":"J. Reprod. Immunol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"7628","DOI":"10.1523\/JNEUROSCI.0313-19.2019","article-title":"Female Sex and Brain-Selective Estrogen Benefit \u03b1-Synuclein Tetramerization and the PD-like Motor Syndrome in 3K Transgenic Mice","volume":"39","author":"Rajsombath","year":"2019","journal-title":"J. Neurosci."},{"key":"ref_152","doi-asserted-by":"crossref","unstructured":"Shukla, S., Kumar, L., Sarkar, A., Srividya, K., and Nazir, A. (2020). Targeted downregulation of estradiol binding Na+\/H+ exchanger nhx-2, mimics calorie restriction, extends reproductive longevity and ameliorates effects associated with alpha synuclein aggregation in C. elegans. bioRxiv.","DOI":"10.1101\/2020.07.30.229344"},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Briz, V., and Baudry, M. (2014). Estrogen regulates protein synthesis and actin polymerization in hippocampal neurons through different molecular mechanisms. Front. Endocrinol., 5.","DOI":"10.3389\/fendo.2014.00022"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.abb.2007.07.029","article-title":"Translational machinery and protein folding: Evidence of conformational variants of the estrogen receptor alpha","volume":"467","author":"Horjales","year":"2007","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1095\/biolreprod.110.089532","article-title":"Bidirectional Interaction Between Unfolded-Protein-Response Key Protein HSPA5 and Estrogen Signaling in Human Endometrium","volume":"85","author":"Guzel","year":"2011","journal-title":"Biol. Reprod."},{"key":"ref_156","first-page":"e47500","article-title":"A Comprehensive Review of Gestational Diabetes Mellitus: Impacts on Maternal Health, Fetal Development, Childhood Outcomes, and Long-Term Treatment Strategies","volume":"15","author":"Nakshine","year":"2023","journal-title":"Cureus"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s13760-023-02424-6","article-title":"The risk of Parkinson\u2019s disease in diabetic people: An updated systematic review and meta-analysis","volume":"124","author":"Azami","year":"2024","journal-title":"Acta Neurol. Belg."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.2337\/dc11-1584","article-title":"Diabetes and Risk of Parkinson\u2019s Disease: A systematic review and meta-analysis","volume":"34","author":"Cereda","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_159","doi-asserted-by":"crossref","unstructured":"Kciuk, M., Kruczkowska, W., Ga\u0142\u0119ziewska, J., Wanke, K., Ka\u0142uzi\u0144ska-Ko\u0142at, \u017b., Aleksandrowicz, M., and Kontek, R. (2024). Alzheimer\u2019s Disease as Type 3 Diabetes: Understanding the Link and Implications. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252211955"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41531-023-00462-8","article-title":"A nationwide cohort study on diabetes severity and risk of Parkinson disease","volume":"9","author":"Han","year":"2023","journal-title":"npj Parkinsons Dis."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s10654-023-00970-0","article-title":"Diabetes mellitus, prediabetes and the risk of Parkinson\u2019s disease: A systematic review and meta-analysis of 15 cohort studies with 29.9 million participants and 86,345 cases","volume":"38","author":"Aune","year":"2023","journal-title":"Eur. J. Epidemiol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.14336\/AD.2022.0325","article-title":"Association between Parkinson\u2019s Disease and Diabetes Mellitus: From Epidemiology, Pathophysiology and Prevention to Treatment","volume":"13","author":"Yu","year":"2022","journal-title":"Aging Dis."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/s41593-023-01513-2","article-title":"Women\u2019s neuroplasticity during gestation, childbirth and postpartum","volume":"27","author":"Noguero","year":"2024","journal-title":"Nat. Neurosci."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1152\/physiol.00048.2014","article-title":"The cerebral circulation during pregnancy: Adapting to preserve normalcy","volume":"30","author":"Johnson","year":"2015","journal-title":"Physiology"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s11682-022-00750-6","article-title":"Altered cerebral blood flow in older adults with Alzheimer\u2019s disease: A systematic review","volume":"17","author":"Swinford","year":"2023","journal-title":"Brain Imaging Behav."},{"key":"ref_166","doi-asserted-by":"crossref","unstructured":"Tovo, P.A., Marozio, L., Abbona, G., Calvi, C., Frezet, F., Gambarino, S., Dini, M., Benedetto, C., Galliano, I., and Bergallo, M. (2023). Pregnancy Is Associated with Impaired Transcription of Human Endogenous Retroviruses and of TRIM28 and SETDB1, Particularly in Mothers Affected by Multiple Sclerosis. Viruses, 15.","DOI":"10.3390\/v15030710"},{"key":"ref_167","doi-asserted-by":"crossref","unstructured":"Medegan Fagla, B., and Buhimschi, I.A. (2024). Protein Misfolding in Pregnancy: Current Insights, Potential Mechanisms, and Implications for the Pathogenesis of Preeclampsia. Molecules, 29.","DOI":"10.3390\/molecules29030610"},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Rai, S.N., Singh, P., Steinbusch, H.W.M., Vamanu, E., Ashraf, G., and Singh, M.P. (2021). The Role of Vitamins in Neurodegenerative Disease: An Update. Biomedicines, 9.","DOI":"10.3390\/biomedicines9101284"},{"key":"ref_169","first-page":"315","article-title":"Maternal-Fetal Microchimerism: Impacts on Offspring\u2019s Immune Development and Transgenerational Immune Memory Transfer","volume":"73","year":"2024","journal-title":"Physiol. Res."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00737-018-0889-z","article-title":"Brain plasticity in pregnancy and the postpartum period: Links to maternal caregiving and mental health","volume":"22","author":"Craddock","year":"2019","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_171","doi-asserted-by":"crossref","unstructured":"Businaro, R., Vauzour, D., Sarris, J., M\u00fcnch, G., Gyengesi, E., Brogelli, L., and Zuzarte, P. (2021). Therapeutic Opportunities for Food Supplements in Neurodegenerative Disease and Depression. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.669846"},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Ondaro, J., Hernandez-Eguiazu, H., Garciandia-Arcelus, M., Loera-Valencia, R., Rodriguez-G\u00f3mez, L., Jim\u00e9nez-Z\u00fa\u00f1iga, A., Goikolea, J., Rodriguez-Rodriguez, P., Ruiz-Martinez, J., and Moreno, F. (2022). Defects of Nutrient Signaling and Autophagy in Neurodegeneration. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.836196"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"6101","DOI":"10.1073\/pnas.1817298116","article-title":"Human pregnancy zone protein stabilizes misfolded proteins including preeclampsia- and Alzheimer\u2019s-associated amyloid beta peptide","volume":"116","author":"Cater","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_174","doi-asserted-by":"crossref","unstructured":"Nakashima, A., Shima, T., Tsuda, S., Aoki, A., Kawaguchi, M., Furuta, A., Yasuda, I., Yoneda, S., Yamaki-Ushijima, A., and Cheng, S.B. (2021). Aggrephagy Deficiency in the Placenta: A New Pathogenesis of Preeclampsia. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22052432"},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.bpobgyn.2022.09.003","article-title":"Environmental toxicants and placental function","volume":"85","author":"Bloom","year":"2022","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"3138","DOI":"10.1161\/STROKEAHA.120.028978","article-title":"Impact of Age and Sex on \u03b1-Syn (\u03b1-Synuclein) Knock-down-Mediated Poststroke Recovery","volume":"51","author":"Chelluboina","year":"2020","journal-title":"Stroke"},{"key":"ref_177","doi-asserted-by":"crossref","unstructured":"Sajdel-Sulkowska, E.M. (2023). The Impact of Maternal Gut Microbiota during Pregnancy on Fetal Gut-Brain Axis Development and Life-Long Health Outcomes. Microorganisms, 11.","DOI":"10.20944\/preprints202307.0759.v1"},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/mds.27203","article-title":"Altered gut microbiome and metabolome in patients with multiple system atrophy","volume":"33","author":"Tan","year":"2018","journal-title":"Mov. Disord."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.brainresbull.2013.07.003","article-title":"Epigenetics of stress adaptations in the brain","volume":"98","author":"Stankiewicz","year":"2013","journal-title":"Brain Res. Bull."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13148-024-01635-9","article-title":"Epigenetics of prenatal stress in humans: The current research landscape","volume":"16","author":"Dieckmann","year":"2024","journal-title":"Clin. Epigenet."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1039\/C6LC00259E","article-title":"A microphysiological model of the human placental barrier","volume":"16","author":"Blundell","year":"2016","journal-title":"Lab. Chip."},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1159\/000497416","article-title":"The Elusive Role of Placental Macrophages: The Hofbauer Cell","volume":"11","author":"Zulu","year":"2019","journal-title":"J. Innate Immun."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/0895-7061(96)00016-7","article-title":"Effects of placental proteases on maternal and fetal blood pressure in normal pregnancy and preeclampsia","volume":"9","author":"Mizutani","year":"1996","journal-title":"Am. J. Hypertens."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1038\/s41390-022-01940-0","article-title":"Development of the immune system in the human embryo","volume":"92","author":"Hossain","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"7567708","DOI":"10.1155\/2022\/7567708","article-title":"Understanding the Immune System in Fetal Protection and Maternal Infections during Pregnancy","volume":"2022","author":"Hussain","year":"2022","journal-title":"J. Immunol. Res."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"eaat3910","DOI":"10.1126\/scitranslmed.aat3910","article-title":"Human fetal immune cells fight back","volume":"10","author":"Chougnet","year":"2018","journal-title":"Sci. Transl. Med."},{"key":"ref_187","doi-asserted-by":"crossref","unstructured":"Wulf, M.A., Senatore, A., and Aguzzi, A. (2017). The biological function of the cellular prion protein: An update. BMC Biol., 15.","DOI":"10.1186\/s12915-017-0375-5"},{"key":"ref_188","doi-asserted-by":"crossref","unstructured":"Linden, R. (2017). The Biological Function of the Prion Protein: A Cell Surface Scaffold of Signaling Modules. Front. Mol. Neurosci., 10.","DOI":"10.3389\/fnmol.2017.00077"},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/jnr.10118","article-title":"Lack of prion protein expression results in a neuronal phenotype sensitive to stress","volume":"67","author":"Brown","year":"2002","journal-title":"J. Neurosci. Res."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/bjaceaccp\/mku013","article-title":"Placental structure, function and drug transfer","volume":"15","author":"Griffiths","year":"2015","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain."},{"key":"ref_191","doi-asserted-by":"crossref","unstructured":"Pierzynowska, K., Woli\u0144ski, J., Westr\u00f6m, B., and Pierzynowski, S.G. (2020). Maternal Immunoglobulins in Infants-Are They More Than Just a Form of Passive Immunity?. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00855"},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5653\/cerm.2014.41.3.97","article-title":"The role of autophagy in the placenta as a regulator of cell death","volume":"41","author":"Gong","year":"2014","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1387\/ijdb.082770cg","article-title":"Gene expression in the placenta: Maternal stress and epigenetic responses","volume":"54","author":"Gheorghe","year":"2010","journal-title":"Int. J. Dev. Biol."},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1042\/BST20230173","article-title":"An emerging role for tissue plasticity in developmental precision","volume":"52","author":"Naganathan","year":"2024","journal-title":"Biochem. Soc. Trans."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1038\/s41567-022-01787-6","article-title":"Morphogen gradient orchestrates pattern-preserving tissue morphogenesis via motility-driven unjamming","volume":"18","author":"Pinheiro","year":"2022","journal-title":"Nat. Phys."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/7\/3348\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:09:32Z","timestamp":1760029772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/7\/3348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":195,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijms26073348"],"URL":"https:\/\/doi.org\/10.3390\/ijms26073348","relation":{},"ISSN":["1422-0067"],"issn-type":[{"type":"electronic","value":"1422-0067"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}