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Pregnancy in Multiple Sclerosis: A Portuguese cohort study
Joana Jesus-Ribeiro1, Inês Correia1, Ana Inês Martins1
1Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Multiple Sclerosis and Related Disorders
|October 23, 2017
Summary
Pregnancy reduces multiple sclerosis (MS) relapses, but relapses during pregnancy predict postpartum relapses and impact disability. Disease-modifying therapies and breastfeeding did not affect MS activity or pregnancy outcomes.
Area of Science:
- Neurology
- Obstetrics
- Immunology
Background:
- Pregnancy in multiple sclerosis (MS) lacks standardized treatment guidelines.
- This study evaluates MS clinical course, therapeutic options, and outcomes during pregnancy.
Purpose of the Study:
- To assess the clinical course of MS during pregnancy.
- To evaluate therapeutic options, obstetrical outcomes, and breastfeeding in MS patients.
- To identify factors influencing postpartum MS activity.
Main Methods:
- Retrospective study of 97 women with relapsing-remitting MS.
- Evaluated disease activity one year before, during, and one year after pregnancy.
- Collected data on demographics, disease activity, treatments, obstetrics, and breastfeeding.
Main Results:
- Annualized relapse rate (ARR) decreased during pregnancy (0.3 ± 0.6) vs. pre-pregnancy (0.6 ± 0.8).
- Postpartum relapses were linked to shorter disease duration and less breastfeeding.
- Relapses during pregnancy predicted postpartum relapses (OR = 4.9).
- Disease-modifying therapy, breastfeeding, C-section, or epidural analgesia did not impact postpartum relapses.
- Expanded Disability Status Scale (EDSS) increased during and after pregnancy.
- Cesarean delivery (43.3%) and epidural analgesia (63.9%) were common.
- Newborn complications included low birth weight (6.1%) and birth asphyxia (6.4%).
Conclusions:
- Pregnancy reduces MS relapses, but postpartum relapses are predicted by pregnancy relapses, impacting disability.
- Disease-modifying therapy, breastfeeding, C-section, and epidural analgesia showed no significant impact on postpartum MS activity.
- MS did not adversely affect pregnancy outcomes; C-sections and epidural analgesia were safe.
- Breastfeeding did not influence MS activity.
