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Mult Scler Relat Disord. 2019 Jan 3;28:235-243. doi: 10.1016/j.msard.2019.01.003. [Epub ahead of print]

Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study.

Author information

1
Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
2
Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
3
Hospital Universitario Virgen Macarena, Sevilla, Spain.
4
CORe, Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
5
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia.
6
Medical Faculty, 19 Mayis University, Samsun, Turkey.
7
Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait.
8
Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
9
KTU Medical Faculty Farabi Hospital, Trabzon, Turkey.
10
Ospedale Civile, Azienda Ospedaliero-Universitaria, Modena, Italy.
11
Dipartimento di Scienze Biomediche e Neuromotorie, Università "Alma Mater Studiorum, Bologna, Italy; IRCCS "Istituto delle Scienze Neurologiche di Bologna", Bologna, Italy.
12
University Newcastle, Newcastle, Australia; John Hunter Hospital, Newcastle, Australia.
13
Brain and Mind Centre, Sydney, Australia.
14
Neuro Rive-Sud, Quebec, Canada.
15
CISSS Chaudière-Appalache, Levis, Canada.
16
Hospital Germans Trias i Pujol, Spain.
17
Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
18
University of Queensland, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia.
19
UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, Italy.
20
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
21
Department of Medicine and Surgery, University of Parma, Parma, Italy.
22
Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy.
23
Cliniques Universitaires Saint-Luc, Brussels, Belgium; Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
24
Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
25
Hospital Universitario La Paz, Madrid, Spain; Hospital Clínico San Carlos (IdISCC), Madrid, Spain.
26
Groene Hart ziekenhuis, Gouda, the Netherlands.
27
Westmead Hospital, Sydney, Australia.
28
Liverpool Hospital, Sydney, Australia.
29
Flinders University and Medical Centre, Adelaide, Australia.
30
Nemocnice Jihlava, Jihlava, Czech Republic.
31
CSSS Saint-Jérôme, Saint-Jerome, Canada.
32
Hospital de Galdakao-Usansolo, Galdakao, Spain.
33
Box Hill Hospital, Melbourne, Australia.
34
Department of Neurology ASL3 Genovese, Genova, Italy; Department of Rehabilitation M.L. Novarese Hospital Moncrivello, Italy.
35
Hospital Donostia, Spain.
36
Geelong Hospital, Geelong, Australia.
37
Biogen, Copenhagen, Denmark.
38
Biogen, Sydney, Australia.
39
Biogen, Zug, Switzerland.
40
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia. Electronic address: vilija.jokubaitis@monash.edu.

Abstract

BACKGROUND:

Exposure to disease-modifying therapy (DMT) during early pregnancy in women with relapsing-remitting MS (RRMS) may be increasing.

OBJECTIVE:

To retrospectively determine incidence of pregnancy, DMT exposure and pregnancy outcomes in women with RRMS.

METHODS:

We identified all women with RRMS aged 15-45 years in the MSBase Registry between 2005-2016. Annualised pregnancy incidence rates were calculated using Poisson regression models. DMT exposures and pregnancy outcomes were assessed.

RESULTS:

Of 9,098 women meeting inclusion criteria, 1,178 (13%) women recorded 1,521 pregnancies. The annualised incidence rate of pregnancy was 0.042 (95% CI 0.040, 0.045). A total of 635 (42%) reported pregnancies were conceived on DMT, increasing from 27% in 2006 to 62% in 2016. The median duration of DMT exposure during pregnancy was 30 days (IQR: 9, 50). There were a higher number of induced abortions on FDA pregnancy class C/D drugs compared with pregnancy class B and no DMT (p = 0.010); but no differences in spontaneous abortions, term or preterm births.

CONCLUSIONS:

We report low pregnancy incidence rates, with increasing number of pregnancies conceived on DMT over the past 12-years. The median duration of DMT exposure in pregnancy was relatively short at one month.

KEYWORDS:

Incidence; Multiple sclerosis; Outcomes; Pregnancy; Therapy

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