Peripartum disease activity in moderately and severely disabled women with multiple sclerosis. Issue 2 (April 2022)

• Record Type: Journal Article
• Authors: Ostrem, Bridget LaMonica; Anderson, Annika; Conway, Sarah; Healy, Brian C; Oh, Jiwon; Jacobs, Dina; Dobson, Ruth; Graham, Edith Larmon; Sadovnick, A Dessa; Zimmerman, Vanessa; Liu, Yanqing; Bove, Riley; Houtchens, Maria
• Is Part Of: Multiple sclerosis journal, experimental, translational and clinical. Volume 8:Issue 2(2022)
• Publication Date: 2022-04
• Subjects: Multiple sclerosis -- relapsing-remitting multiple sclerosis -- pregnancy -- postpartum period -- disease progression -- breastfeeding; Multiple sclerosis -- Periodicals; 616.834
• DOI: 10.1177/20552173221104918
• Languages: English
• ISSNs: 2055-2173

Abstract

Background: The effects of pregnancy on multiple sclerosis (MS) inflammatory activity are not well described in women with moderate to severe disabilities. Objective: To quantify the peripartum annualized relapse rate (ARR) in women with MS with an Expanded Disability Status Scale (EDSS) ≥ 3. Methods: We performed a retrospective cohort study of 85 pregnancies in 74 subjects with preconception EDSS ≥ 3. We quantified peripartum ARR and tested for risk factors predictive of peripartum relapses, postpartum brain magnetic resonance imaging activity (new T2 or gadolinium-enhancing lesions), and disability worsening. Results: There were 74 live births, with a 56% operative delivery rate. In subjects with relapsing-remitting MS, ARR decreased to 0.11 during the third trimester of pregnancy compared to 0.59 in the year preconception and increased to 1.22 in the 3 months postpartum. Women with a higher preconception EDSS had higher odds of postpartum relapses and clinically significant worsening of disability as compared to subjects with a lower EDSS. Conclusions: Moderately to severely disabled women with MS have a lower risk of relapse during pregnancy as compared to preconception, followed by a marked increase postpartum. Further studies are needed to identify ways to reduce peripartum inflammatory activity and disability progression in women with MS with moderate to severe disability.