Biringer, Kamil, Sivak, Stefan, Sivakova, Jana et al. · Neuro endocrinology letters · 2021
This study looked at 15 women with multiple sclerosis (MS) who were pregnant and gave birth between 2015-2020. The researchers found that severe fatigue combined with nerve damage was the main reason why most of these women had caesarean sections instead of vaginal deliveries. The study suggests that better diagnosis and treatment of fatigue during pregnancy might allow more women with MS to have vaginal births safely.
This study is relevant to ME/CFS research because it identifies fatigue as a major limiting factor in functional capacity during a physiologically demanding event (labour). It highlights how inadequately treated fatigue can drive clinical decision-making and disability escalation, and suggests that improved fatigue characterisation and management may be underutilised in clinical practice. The findings underscore the need for better fatigue assessment tools and treatments applicable across conditions.
This study does not prove that vaginal delivery is unsafe in MS patients with fatigue, nor does it demonstrate that caesarean section is the optimal choice. It does not establish causation between fatigue severity and delivery outcome—the fatigue may be a marker of overall disability rather than the direct cause of CS indication. The small sample size and lack of control group limits generalisation to the broader MS or ME/CFS populations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Biringer, Kamil, Sivak, Stefan, Sivakova, Jana, Ružiňák, Róbert, Martiníková, Martina, Kantorova, Ema, et al. (2021). Fatigue as the limiting factor for vaginal birth in patients with multiple sclerosis.. Neuro endocrinology letters. https://pubmed.ncbi.nlm.nih.gov/34436842/
BibTeX
@article{mecfsatlas-biringer-2021-fatigue-limiting,
author = {Biringer, Kamil and Sivak, Stefan and Sivakova, Jana and Ružiňák, Róbert and Martiníková, Martina and Kantorova, Ema and Biringerová, Zuzana and Kudela, Erik and Kurca, Egon},
title = {Fatigue as the limiting factor for vaginal birth in patients with multiple sclerosis.},
journal = {Neuro endocrinology letters},
year = {2021},
note = {PubMed: 34436842},
url = {https://www.mecfsatlas.com/evidence/biringer-2021-fatigue-limiting},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/biringer-2021-fatigue-limiting
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