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Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria.
Mult Scler. 2020 01; 26(1):69-78.MS

Abstract

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+Show Affiliations

Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30507345

Citation

Bsteh, Gabriel, et al. "Pregnancy and Multiple Sclerosis in the DMT Era: a Cohort Study in Western Austria." Multiple Sclerosis (Houndmills, Basingstoke, England), vol. 26, no. 1, 2020, pp. 69-78.
Bsteh G, Algrang L, Hegen H, et al. Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria. Mult Scler. 2020;26(1):69-78.
Bsteh, G., Algrang, L., Hegen, H., Auer, M., Wurth, S., Di Pauli, F., Deisenhammer, F., & Berger, T. (2020). Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria. Multiple Sclerosis (Houndmills, Basingstoke, England), 26(1), 69-78. https://doi.org/10.1177/1352458518816614
Bsteh G, et al. Pregnancy and Multiple Sclerosis in the DMT Era: a Cohort Study in Western Austria. Mult Scler. 2020;26(1):69-78. PubMed PMID: 30507345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria. AU - Bsteh,Gabriel, AU - Algrang,Laura, AU - Hegen,Harald, AU - Auer,Michael, AU - Wurth,Sebastian, AU - Di Pauli,Franziska, AU - Deisenhammer,Florian, AU - Berger,Thomas, Y1 - 2018/12/03/ PY - 2018/12/7/pubmed PY - 2018/12/7/medline PY - 2018/12/4/entrez KW - Multiple sclerosis KW - delivery KW - disability progression KW - disease-modifying treatment KW - pregnancy KW - relapse KW - risk SP - 69 EP - 78 JF - Multiple sclerosis (Houndmills, Basingstoke, England) JO - Mult. Scler. VL - 26 IS - 1 N2 - 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. SN - 1477-0970 UR - https://www.unboundmedicine.com/medline/citation/30507345/Pregnancy_and_multiple_sclerosis_in_the_DMT_era:_A_cohort_study_in_Western_Austria_ L2 - https://journals.sagepub.com/doi/10.1177/1352458518816614?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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