Predictors and dynamics of postpartum relapses in women with multiple sclerosis
SE Hughes, T Spelman, OM Gray… - Multiple Sclerosis …, 2014 - journals.sagepub.com
Multiple Sclerosis Journal, 2014•journals.sagepub.com
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 …
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 …
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.
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