Predictors and dynamics of postpartum relapses in women with multiple sclerosis. (May 2014)

• Record Type: Journal Article
• Authors: Hughes, Stella E; Spelman, Tim; Gray, Orla M; Boz, Cavit; Trojano, Maria; Lugaresi, Alessandra; Izquierdo, Guillermo; Duquette, Pierre; Girard, Marc; Grand'Maison, Francois; Grammond, Pierre; Oreja-Guevara, Celia; Hupperts, Raymond; Bergamaschi, Roberto; Giuliani, Giorgio; Lechner-Scott, Jeannette; Barnett, Michael; Edite Rio, Maria; van Pesch, Vincent; Amato, Maria Pia; Iuliano, Gerardo; Slee, Mark; Verheul, Freek; Cristiano, Edgardo; Fernández-Bolaños, Ricardo; Poehlau, Dieter; Saladino, Maria Laura; Deri, Norma; Cabrera-Gomez, Jose; Vella, Norbert; Herbert, Joseph; Skromne, Eli; Savino, Aldo; Shaw, Cameron; Moore, Fraser; Vucic, Steve; Petkovska-Boskova, Tatjana; McDonnell, Gavin; Hawkins, Stanley; Kee, Frank; Butzkueven, Helmut;
• Other Names: Paolicelli Damiano non-byline-author.; Lucchese Guglielmo non-byline-author.; Iaffaldano Pietro non-byline-author.; Zwanikken Cees non-byline-author.; De Luca Giovanna non-byline-author.; Di Tommaso Valeria non-byline-author.; Travaglini Daniela non-byline-author.; Pietrolongo Erika non-byline-author.; di Ioia Maria non-byline-author.; Farina Deborah non-byline-author.; Mancinelli Luca non-byline-author.; Marriott Mark non-byline-author.; Kilpatrick Trevor non-byline-author.; King John non-byline-author.; van der Walt Anneke non-byline-author.; Skibina Olga non-byline-author.; Haartsen Jodi non-byline-author.; Chamorro Beatriz non-byline-author.; Petersen Thor non-byline-author.; Cartechini Elisabetta non-byline-author.; Pucci Eugenio non-byline-author.; William David non-byline-author.; Dark Lisa non-byline-author.; Fiol Marcela non-byline-author.; Correale Jorge non-byline-author.; Ysrraelit Celica non-byline-author.; Den Braber-Moerland Leontien non-byline-author.; Jaacks Gonzalo non-byline-author.; Laffue Alfredo non-byline-author.; Fernanda Páez María non-byline-author.; Muñoz Daniel non-byline-author.; Oleschko Arruda Walter non-byline-author.; Paine Mark non-byline-author.; Vella Malcolm non-byline-author.; Vetere Santiago non-byline-author.;
• Is Part Of: Multiple sclerosis. Volume 20:Number 6(2014)
• Page Start: 739
• Page End: 746
• Publication Date: 2014-05
• Subjects: Multiple sclerosis -- relapsing–remitting -- pregnancy -- disease-modifying treatments -- disability progression; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458513507816
• Languages: English
• ISSNs: 1352-4585

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.