BACKGROUND: Multiple sclerosis (MS) predominantly affects women of child-bearing potential. Pregnancy in MS is still a controversial issue lacking standardized treatment recommendations. OBJECTIVE: To examine the reciprocal effects of pregnancy, MS, and disease-modifying treatment (DMT). METHODS: We analyzed 387 pregnancies in 239 women with relapsing remitting multiple sclerosis (RRMS) and ⩾1 pregnancy, establishment of diagnosis >1 year before conception, and ⩾2 years of follow-up after delivery. Relapse rates and Expanded Disability Status Scale (EDSS) scores were compared in the year before conception, during pregnancy, and 2 years postpartum. Binary logistic regression was used to investigate predictors of risk for relapses and disability progression during pregnancy and postpartum. RESULTS: Risk of relapse and disability progression during pregnancy was predicted by pre-conception relapse activity, higher EDSS score at conception, use of highly effective disease-modifying treatment (H-DMT) pre-conception, and prolonged washout period. Postpartum relapse and disability progression was associated with relapse activity pre-conception and during pregnancy and use of H-DMT pre-conception. Early restart of DMT reduced the risk of postpartum relapse. CONCLUSION: A personalized approach in planning pregnancy in women with MS while on H-DMT needs to be adopted. It seems reasonable maintaining natalizumab closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during early pregnancy and after delivery.
BACKGROUND:Multiple sclerosis (MS) predominantly affects women of child-bearing potential. Pregnancy in MS is still a controversial issue lacking standardized treatment recommendations. OBJECTIVE: To examine the reciprocal effects of pregnancy, MS, and disease-modifying treatment (DMT). METHODS: We analyzed 387 pregnancies in 239 women with relapsing remitting multiple sclerosis (RRMS) and ⩾1 pregnancy, establishment of diagnosis >1 year before conception, and ⩾2 years of follow-up after delivery. Relapse rates and Expanded Disability Status Scale (EDSS) scores were compared in the year before conception, during pregnancy, and 2 years postpartum. Binary logistic regression was used to investigate predictors of risk for relapses and disability progression during pregnancy and postpartum. RESULTS: Risk of relapse and disability progression during pregnancy was predicted by pre-conception relapse activity, higher EDSS score at conception, use of highly effective disease-modifying treatment (H-DMT) pre-conception, and prolonged washout period. Postpartum relapse and disability progression was associated with relapse activity pre-conception and during pregnancy and use of H-DMT pre-conception. Early restart of DMT reduced the risk of postpartum relapse. CONCLUSION: A personalized approach in planning pregnancy in women with MS while on H-DMT needs to be adopted. It seems reasonable maintaining natalizumab closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during early pregnancy and after delivery.
Authors: Wei Zhen Yeh; Putu Ayu Widyastuti; Anneke Van der Walt; Jim Stankovich; Eva Havrdova; Dana Horakova; Karolina Vodehnalova; Serkan Ozakbas; Sara Eichau; Pierre Duquette; Tomas Kalincik; Francesco Patti; Cavit Boz; Murat Terzi; Bassem I Yamout; Jeannette Lechner-Scott; Patrizia Sola; Olga G Skibina; Michael Barnett; Marco Onofrj; Maria José Sá; Pamela Ann McCombe; Pierre Grammond; Radek Ampapa; Francois Grand'Maison; Roberto Bergamaschi; Daniele L A Spitaleri; Vincent Van Pesch; Elisabetta Cartechini; Suzanne Hodgkinson; Aysun Soysal; Albert Saiz; Melissa Gresle; Tomas Uher; Davide Maimone; Recai Turkoglu; Raymond Mm Hupperts; Maria Pia Amato; Franco Granella; Celia Oreja-Guevara; Ayse Altintas; Richard A Macdonell; Tamara Castillo-Trivino; Helmut Butzkueven; Raed Alroughani; Vilija G Jokubaitis Journal: Neurology Date: 2021-04-20 Impact factor: 9.910
Authors: Vilija G Jokubaitis; Olga Skibina; Raed Alroughani; Ayse Altintas; Helmut Butzkueven; Sara Eichau; Yara Fragoso; Kerstin Hellwig; Stella E Hughes; Louise Rath; Anneke van der Walt; Orla Gray Journal: Ther Adv Neurol Disord Date: 2021-04-12 Impact factor: 6.570
Authors: Gabriel Bsteh; Harald Hegen; Katharina Riedl; Patrick Altmann; Franziska Di Pauli; Rainer Ehling; Gudrun Zulehner; Paulus Rommer; Fritz Leutmezer; Florian Deisenhammer; Thomas Berger Journal: Front Neurol Date: 2022-01-17 Impact factor: 4.003
Authors: Gabriel Bsteh; Christina Bitschnau; Harald Hegen; Michael Auer; Franziska Di Pauli; Paulus Rommer; Florian Deisenhammer; Thomas Berger Journal: Eur J Neurol Date: 2020-10-22 Impact factor: 6.288