Pregnancy and multiple sclerosis –outcomes analysis 2003–2011


Authors: P. Hanulíková 1;  R. Vlk 1;  E. Meluzínová 2;  E. Hynčicová 2;  T. Binder 1;  R. Chmel 1;  L. Rob 1
Authors‘ workplace: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta prof. MUDr. L. Rob, CSc. 1;  Neurologická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. M. Bojar, CSc. 2
Published in: Čes. Gynek.2013, 78, č. 2 s. 142-148

Overview

Objective:
The analysis of perinatal results in pregnant women with multiple sclerosis (MS) and the assessment of the influence of pregnancy on this chronic disease in the population of pregnant women in our hospital in the years 2003–2011.

Design:
Retrospective analysis.

Setting:
Department of Obstetrics and Gynecology and Department of Neurology, 2nd Faculty of Medicine, Charles University and the Motol Hospital, Prague.

Methods:
Sixty-six women with the diagnosis of MS were included in our study in the years 2003–2011. All these women delivered at our clinic and were neurologically followed until the end of six months post partum.

We evaluated the influence of pregnancy on the activity of the disease during the pregnancy and 6 months after delivery, the impact on the disability progression, the influence of the mode of delivery, the analgesia used, and breastfeeding, on the relapse rate post partum. We also assessed the impact of multiple sclerosis on the course of the pregnancy, where we looked for pregnancy complications in patients with multpile sclerosis, differences in the management of labor, and the results of newborns of mothers with this disease. We performed a statistical analysis.

Results:
Relapse during pregnancy occurred in4 of the 66 women (6.1%, relapse rate – RR 0.1);17 women experienced a post partum relapse in the first six months after delivery (25.7%, RR 0.5). From our sample of 44 women breastfed (66.7%), 10 had relapse (10/44, 22.7%) in comparison with the 7 women out of a total of 22 who did not breastfed (7/22, 31.8%). No statistical significance was established, OR = 0.6 (0.2–2.0), p = 0.5518. Epidural analgesia (EDA) was used by 16 women (24.2%). Post partum relapse experienced 3 women that used EDA (3/16, 18.8%) and 14 women that did not use EDA (14/50, 28 %). OR = 0.6 (0.1–2.4), p = 0.5325. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapse. Pregnancy did not influence disability progression, EDSS (Disability status scale, Kurtzke`s scale) before pregnancy and after delivery was stable (EDSS 1.5 or EDSS 1.6). Vaginal delivery had 77% women, post partum relapse had 15 of them (15/50, 30%), 12 women (18.1%) had a caesarean sec-tion, relapse occure at 2 of them (2/16, 12.5%), three births (4.5%) were completed by vaginal extraction operations.

Five women (7.6%) delivered before 37th week of pregnancy. Birth weight under 2500 g was found in 9 women (13.6%). The incidence of serious pregnancy complications was not increased, intrauterine growth retardation (IUGR) was confirmed in 4 births (6%).

Conclusion:
There is no need to worry about pregnancy in patients with multiple sclerosis. Therapy provides long-term remission of the disease, and during pregnancy itself due to hormonal changes it is stabilized and the relapse rate decreases. In the post partum period relapse rate increases, however, the pregnancy did not influence disability progression. The mode of delivery in women with this disease is not different from the general population. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapses. The number of complications in pregnancy is not increased and the overall perinatal outcomes are comparable with the general population.

Keywords:
multiple sclerosis – relapse rate – pregnancy – perinatal outcomes


Sources

1. Achiron, A., Kishner, I., Dolev, M,, et al. Effect of intravenous imunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis. J Neurol 2004, 51(9), p. 1133–1137.

2. Amato, MP., Portaccio, E., Ghezzi, A., et al. Pregnancy and fetal outcomes after interferon-beta exposure in multiple sclerosis. Neurology, 2010, 75, p. 1794–1802.

3. Arias, L., Jalkanen, A., Alanen, A., et al. Breastfeeding, postpartum and pregnancy disease activity in multiple sclerosis. Neurology, 2010, 75, p. 474–476.

4. Beitins, IZ., Bayard, F., Ances, IG., et al. The transplacental passage of prednisone and prednisolone in pregnancy near term. J Pediatr, 1972, 81, p. 936–945.

5. Carmichael, SL., Shaw, GM., Ma, C., Werler, MM., et al. National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol, 2007, 197(6), p. 585.e1-7; discussion p. 683–684, e1-7.

6. Confavreux, C., Hutchinson, M., Hours, M., et al. Rate of pregnancy-related relapses in multiple sclerosis. N Engl J Med, 1998, 339, p. 285–291.

7. Dahl, J., Myhr, KM., Daltveit, AK., Gilhus, NE. Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis. J Neurol, 2008, 255, p. 623–627.

8. D´Hooghe, MB., Nagls, G., Uitdehaag, BMJ. Long term effects od childbirth in MS. J Neurol Neurosurg Psychiatry, 2010, 81, p. 38–41.

9. Dufek, M. Roztroušená skeróza – EDSS (expanded diseability status scale), tzv. Kurtzkeho škála. Neurol pro praxi, 2011, 12(Suppl. G), p. 6–9.

10. Dwosh, E,, Guimond, C., Sadovnick, AD. Reproductive counselling for MS: a rationale. Int MS J, 2003, 10, p. 52–59.

11. Finkelsztejn, A., Brooks, J., Paschoal, J., Fragoso, Y. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG, 2011, 118, p. 790–797.

12. Haas, J., et al. High dose IVIG in the postpartum period for prevention of exacerbations in MS. Mult Scler, 2000, 6, Suppl 2, p. 18–20, discussion p. 533.

13. Hellwig, K., Haghikia, A., Gold, R. Pregnancy and natalizumab: results of an observational study in 35 accidental pregnancies during natalizumab treatment. Mult Scler, 2011, 17, p. 958–963.

14. Kelly, VM., Lorene, NM., Chakravarty, EF. Obstetric outcomes in women with multiple sclerosis: new insights. Curr Opin Neurol, 2009, 19, p. 248–254.

15. Langer-Gould, A., Huang, SM., Gupta, R., et al. Exclusivebreastfeeding and the risk of postpartum relapses in women with multiple sclerosis. Arch Neurol, 2009, 66, p. 958–963.

16. Lee, M., O´Brien, P. Multiple sclerosis and pregnancy. J Neurol Neurosurg Psychiatry, 2008, 79, p. 1308–1311.

17. Meluzínová, E. Těhotenství a roztroušená skleróza. Neurol pro praxi, 2010, 11(5), p. 221–223.

18. Mueller BA, Zhang J, Critchlow CW. Birth outcomes andneed for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol 2002, 186, p. 446–452.

19. Runmarker, B., Andersen, O. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain, 1995, 118, p. 253–261.

20. Tsang, B., Macdonell, R. Multiple sclerosis. Diagnosis, management and prognosis. Austr Family Physic, 2011, 40, 12, p. 948–955.

21. Tsui, A., Lee, M. Multiple sclerosis and pregnancy. Curr Opin in Obstet and Gynecol, 2011, 23, p. 435–439.

22. Vukusic, S., Confarveux, C., et al. Pregnancy in multiple sclerosis: The children of PRIMS. Clin Neurol Neurosurg, 2006, 108, p. 226–270.

23. Vukusic, S., Ionescu, I., El-Etr, M., et al. The prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPART´MUS) trial: rationale, objectives and state of advancement. J Neurol, 2009, 286, p. 114–118.

24. Zuvich, RL., McCauley, JL., Pericak-Vance, MA., Haines, JL. Genetics and pathogenesis of multiple sclerosis. Sem Immunol, 2009, 21, p. 328–333.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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