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Mult Scler. 2014 May;20(6):739-46. doi: 10.1177/1352458513507816. Epub 2013 Oct 9.

Predictors and dynamics of postpartum relapses in women with multiple sclerosis.

Author information

1
Department of Neurology, Royal Victoria Hospital, Belfast, UK.

Abstract

BACKGROUND:

Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.

OBJECTIVE:

To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.

METHODS:

An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.

RESULTS:

The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.

CONCLUSION:

Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.

KEYWORDS:

Multiple sclerosis; disability progression; disease-modifying treatments; pregnancy; relapsing–remitting

PMID:
24107309
DOI:
10.1177/1352458513507816
[Indexed for MEDLINE]

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